Episode Transcript
Interviewer: Your annual prostate exam. Is it still something that you should have done every year, or can you skip it? We'll find out next on The Scope.
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Interviewer: Dr. Tom Miller, so, at one point, I know that every year that they said you should get a prostate exam if you're after over 50 years old. Do you have to still do that anymore, or is there a better way?
Should I Get a Prostate Exam Every Year?
Dr. Miller: Well, aside from the prostate exam being the brunt of many, many jokes over the year, the answer now is generally no. The guidelines no longer suggest doing a prostate exam to screen for colon cancer. It was done in the past because the number of prostate cancers were picked up on digital screening, but we've no evidence that finding those cancers on exam actually leads to better outcomes, that is cures for prostate cancer. We do recommend the standard screening with PSA. That's still something that should be done at the age of 50 in average-risk men, and perhaps screening should start earlier for men who have a history of prostate cancer in their family. The digital exam is pretty much gone by the way, so.
Interviewer: All right. So, just to clarify, because I mean this is a bit of a paradigm change for me. It feels a little weird like . . .
Dr. Miller: Well, most men would tell you that.
Interviewer: Yes, I don't mean in that way, but it feels a little strange that we're saying now you don't need to do the rubber glove and the whole thing, that there's actually an alternative test you're talking about. Tell me more about that test.
PSA Test: An Alternative to the Rectal Exam
Dr. Miller: Well, basically, the PSA test has been around for some time now since the mid-80s, and it was used in conjunction with the digital exam. More recently, the guidelines have de-emphasized the need to do a digital exam to check for prostate cancer. And, again, the reason for that is that we may not . . . if we find prostate cancer, it will be advanced and it may not change the outcome of the disease. Whereas testing with PSA, which is a blood test, can find cancer early enough to cure the cancer.
Interviewer: Got you. So it's just a blood draw that would start after the age of 50, earlier, if you have a family history?
At What Age Should I Get Tested?
Dr. Miller: Average comers starting at the age of 50.
Interviewer: Yes. So, as somebody who's approaching 50, is that something I can request from my doctor? Or what does the evidence say about getting it much before 50 if I don't have a family history?
Dr. Miller: Basically, there's not a lot of good evidence that getting tested before the age of 50 with PSA is useful unless you have certain risk factors, family history, strong family history.
Interviewer: Got you. But after 50, if the doctor, if your physician's not suggesting it, then that's something you should be sure that you're suggesting to them.
Dr. Miller: Correct. So if you do have a complaint, so if you have a complaint where you have dysuria, pain with urination, a digital exam would be something that a physician would do. I don't want to point out that we don't do the digital exam. We do the digital exam when there's a reason to do it.
Interviewer: Got you, and there's some symptoms or something going.
Dr. Miller: Exactly. Interviewer: Got you. So, otherwise, ask for that PSA. It's completely . . . it's even more effective.
Dr. Miller: Correct.
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