‘Has anyone in your family had prostate cancer?’ Cancer screening at the urologist begins with questions about your health and your family’s history of relevant illnesses. — dpa
Many a man may feel anxious before seeing a urologist for the first time, perhaps even to the point of getting sweaty palms and going weak at the knees.
A digital rectal exam can be a particular object of dread.
So when should you make an appointment? And what can you expect during your visit?
Two urologists have answers.
According to German Society for Urology (DGU) spokesman Dr Axel Merseburger, a man should see a urologist in cases of:
- Frequent or painful urination
- Blood in the urine
- Recurrent urinary tract infections (UTIs)
- Kidney stones
- Erectile dysfunction
- Testicular pain, or
- Unexplained lower abdominal pain.
External signs of inflammation in the genital region, or lumps in or around the testicles, are also cause for an examination by a urologist, says Association of Urologists in Private Practice in Hamburg executive board chairman Dr Robert Frese.
In addition, urologists can provide consultation on matters relating to fertility, sexual problems or sexually-transmitted diseases (STDs).
“But you should always see your GP (general practitioner) first, who can refer you to the proper specialists,” Dr Merseburger says.
If for nothing else, every man should see a urologist for cancer screening.
“Prostate cancer is the most common cancer in men, as breast cancer is in women,” points out Dr Frese.
Worldwide, there were an estimated 1,414,259 cases in 2020, according to the Global Cancer Observatory, a specialised agency platform of the World Health Organization (WHO).
Annual screening is recommended for men aged 45 and over.
However, a large percentage of men typically don’t get screened regularly, and many don’t at all.
Whether it’s a cancer screening or you want to have acute symptoms checked, a proper visit with a urologist should begin with a thorough conversation about your medical history.
This should touch on such things as any cancer cases in your family, pre-existing conditions you may have, and your use of medicines.
“Your sexual function should not be left out for fear of embarrassment either,” Dr Frese says.
Depending on any symptoms you may have, a physical examination then follows.
This may also perhaps be complemented by a urine and/or blood test.
Along with examining and palpating – or feeling – the penis and scrotum for any abnormal areas, the urologist palpates the prostate gland and checks the lymph nodes, Dr Frese says.
Prostate palpation, also known as a digital rectal exam (DRE), is somewhat controversial because “not every small, early tumour can be adequately felt”.
For this reason, professional medical associations such as the DGU recommend prostate-specific antigen (PSA) screening too.
PSA is protein produced by cells of the prostate gland, and men with prostate cancer often have an elevated level in their blood.
Some non-cancerous conditions can also raise the level, however.
Dr Merseburger advises men to consult their urologist about the suitability of having both a DRE and PSA test.
Dr Frese, for his part, discourages leaving out a DRE, as “it can provide essential information on the size and shape of the prostate gland, as well as palpable abnormalities that could indicate colon cancer”.
How uncomfortable it’s felt to be depends on the individual.
In any case, it’s not painful and generally takes only a few seconds.
You typically lie on your side, knees bent, and the doctor inserts a gloved, lubricated finger into your rectum and palpates the prostate – located just below the urinary bladder – for any hard, lumpy or abnormal areas.
“It’s a bit unpleasant, but a blood test is worse,” remarks Dr Frese.
“When you explain its purpose to the patient, they all agree to have it.”
Along with background information, a little humour can help to ease any embarrassment, he says.
Dr Merseburger advises his patients to simply relax and breathe calmly.
He also thoroughly explains the importance of a DRE to allay any anxiety or embarrassment.
As Dr Frese sees it, the reason that men often neglect to get screened for prostate cancer lies in their psyche.
“Men don’t like going to a doctor. They tend to regard their body as a machine, and a doctor as a mechanic that you call on only when something isn’t working properly.”
No.
“Roughly 40% of my patients are women,” Dr Frese says, noting that recurrent UTIs, kidney stones or incontinence are the main causes of their visits.
“Women can also develop tumours that are treated by a urologist, such as bladder cancer or a kidney tumour.”
Children, too, get urological treatment.
Common causes, according to Dr Merseburger, are congenital anomalies or an undescended testicle. – By Anke Dankers/dpa
