Why I won’t be sticking my finger up your bum… well maybe not?

Lets make a couple of things clear first.

If you visit and ask for a check up, I’ll always start with a series of questions. You may be thinking, “Just give me the blood form” but be patient, the questions are an essential part of the consultation. If you answer No, No, No, No, No, etc…… then I’ll move onto examination like listening to your chest, pressing your belly and checking your blood pressure etc. And then maybe some tests as a way of screening for disease.

Screening by definition is looking for absence of bad stuff in someone who has no signs or symptoms of bad stuff. A good example is a screening mammogram for breast cancer. If you tick yes, I have a breast lump, then no screening mammogram for you. That requires a consultation with your GP and potentially a more comprehensive testing regimen which may require extra imaging, a biopsy and a visit to a surgeon. So, the idea of screening is to find the possible bad stuff before it becomes really bad stuff and makes you sick.

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So moving on, who now who gets a finger up the bum?

Once upon a time all men of a certain age were encouraged to attend their GP for annual digital rectal examination (DRE) and prostate specific antigen test (PSA) as a way of screening for prostate cancer. Understandably this may have made some blokes disinclined to come in for any check-up.

For asymptomatic men the Cancer Council, amongst other authorities, do not recommend a digital rectal examination.

Symptoms of prostate cancer include frequent urination, particularly at night, pain when you urinate, blood in the urine and an weakened urine stream. Once prostate cancer spreads it may cause pain in the bones, unexplained weight loss and fatigue. Unfortunately, lots of other things can cause similar symptoms to prostate cancer, such as, sexually transmitted and urinary tract infection and a gradual enlargement of the prostate with with aging that is not cancer, known as benign prostate hypertrophy. There are obviously lots of other things that may cause bone pain, weight loss and fatigue and for those you really should see your doctor.

So what can you do to screen for prostate cancer. Maybe you had a prostate specific antigen (PSA) test? Routine PSA testing for detection of prostate cancer is a controversial issue. New evidence suggests that PSA screening for most men will not provide a survival advantage even if it finds prostate cancer. The Cluster Randomized Trial of PSA Testing for Prostate Cancer trial was run in the UK over 10 years.  This trial of over 400,000 men, aged 50 to 69 years, compared those who had a PSA test to those who didn’t. Not unsurprisingly, more men were diagnosed with prostate cancer PSA group (4.3% versus 3.6%). However there was no significant difference in prostate cancer mortality (0.30 per 1000 person-years for the PSA group vs 0.31 for the control group) after 10 years.

But PSA testing is not really the focus of this blog. If you would like read more look at these links

Cancer Council Australia

“For men at average risk of prostate cancer who have been informed of the benefits and harms of testing and who decide to undergo regular testing for prostate cancer, offer PSA testing every 2 years from age 50 to age 69, and offer further investigation if total PSA is greater than 3.0 ng/mL.”

RACGP

“Whilst the RACGP recommends against prostate cancer screening  we recognise many men will be asking their GPs about screening.”

Now moving back to why I may have to ask to do a rectal examination!

A rectal examination is still part of the examination should you have rectal bleeding, pain or other anal complaints and this includes the 50% of the population who don’t have a prostate.

A rectal exam can find anal warts, haemorrhoids, anal fissures, constipation and prostatitis.

And a recent recommendation from ASHM is that men who have sex with men who are over 50 and are HIV positive should undergo a rectal examination to look for anal cancer. Some suggest this examination even if you are not HIV positive.

Putting some perspective to the incidence of various common cancers.

  • Anal cancer in general population 2/100,000 person
  • Men who have sex with men without HIV 40/100,000
  • Men who have sex with men with HIV  77.8/100,000
  • Bowel cancer 73/100,000
  • Prostate cancer 170/100,000 men
  • Cervical cancer 7.1 cases /100,000 women
  • Ovarian cancer 10.8 cases per 100,000 women
  • Breast cancer 123/100,000 women and 1/ 100,000 men

More cancer statistics can be gleaned from the Australian Institute of Health and Welfare.

So I hope this has made things clearer. If you are overdue for a health check-up go and see your GP, you may not need a rectal exam!

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