AMIDST fears and stigma associated with the digital rectal examination used to screen for prostate cancer in men, consultant urologists are insisting that it is still important and not the only barrier associated with getting men to screen.

The digital rectal examination (DRE) is one of two main tests used to screen for prostate cancer. While it is the most effective at early detection of the cancer, it is the most feared by men, often resulting in reluctance to get screened and unfortunately missing chances of early detection of prostate cancer — the deadliest disease amongst local men.

Consultant urologist at the University Hospital of the West Indies, Dr Belinda Morrison-Blidgen told reporters and editors at the Jamaica Observer Monday Exchange that whilst it is feared and considered a barrier to screening, it is still important in diagnosing and cannot be done away with.

Dr Morrison-Blidgen further mentioned that there are other social determinants that act as barriers in the screening process.

“The rectal exam is one of the barriers, but it is not the only barrier. There are many men who are just even afraid of going to the doctor — period…Reports from the Jamaica Healthy Lifestyle Survey will tell you that the average Jamaican male, many of them do not see a doctor at all. It’s a very, very low percentage of males who have a regular physician that they see or even go to a regular health centre, other than if they have some sudden acute illness,” she said.

“I will say that the rectal exam is an issue, but I don’t think it’s the only issue, and I don’t want to play it up as the only issue….let us not make it out just to be the [prostate-specific antigen] PSA alone.. It’s just the whole concept of the medical consultation and going to the doctor to be told that they are ill, rather than just the DRE alone,” she added.

Further, with regard to the importance of the DRE, consultant urologist Dr William Aiken said it helps to determine the stage and aggressiveness of the cancer.

“We, the Jamaica Urological Society, believe that this test [DRE] is still important because it not only assists in helping to diagnose prostate cancer if it is present, but if it is present, it helps us to determine how locally extensive the cancer is. By that I mean, whether the cancer is in one lobe of the prostate, two lobes; whether it is outside of the prostate, if it’s outside of the prostate; if it’s outside, is it extended to the pelvic side wall? It is very important in terms of part of the evaluation,” he stressed.

“So at some point the man must have a DRE if he’s diagnosed with prostate cancer,” Dr Aiken insisted.

The examination involves a doctor inserting his or her gloved, lubricated finger into the rectum of a patient to evaluate the prostate.

“The normal prostate feels like the tip of your nose — it has a firm rubbery consistency. Essentially, what we are looking for is whether there are any abnormalities of the prostate,” he said.

The other method is the PSA test which measures the level of PSA in the blood. PSA is a substance made by the prostate, and the levels of PSA in the blood can be higher in men who have prostate cancer.

According to the Centres for Disease Control and Prevention (CDC), the higher the PSA level in the blood, the more likely a prostate problem is present. But many factors, such as age and race, can affect PSA levels. Also, some prostate glands make more PSA than others, and the PSA level may also be elevated in other conditions that affect the prostate.

PSA levels, the CDC said, can also be affected by certain medical procedures, certain medications, an enlarged prostate, and a prostate infection. Given these factors, it may therefore be more difficult to diagnose prostate cancer through the PSA test only.

Dr Aiken noted, however, that any man who insists that they want just the prostate-specific antigen test will not be turned away, “but we will explain that the evaluation will be sub-optimal because there are some patients who may have a normal PSA but rectal exam is abnormal”.

“Should you have a cancer, the information we get from the DRE is very important in determining the local stage of the patient or to know the extent of spread of the cancer. So, it’s a very important part of the evaluation,” he said.

It is important that men, especially those at higher risk of developing prostate cancer, get screened. Screening, as the CDC has stated, can find prostate cancers that may be at high risk of spreading, so that they can be treated before they spread. This may lower the chance of death from prostate cancer in some men.

Further, according to the CDC, for every 1,000 men between the ages of 55 and 69 years old who are screened, about one death will be prevented, and three men will be prevented from getting prostate cancer that spreads to other places in the body.

Importantly, many men with prostate cancer never experience symptoms and, without screening, will never know they have the disease.

Meanwhile, the Jamaica Cancer Society (JCS) believes that prostate cancer can be effectively treated if diagnosed in its early stage. At an advanced stage the disease will cost millions of dollars to treat and could result in possible death.

To know their status, men are advised to get both the rectal and blood tests done by a urologist, family doctor, or at Ministry of Health and Wellness health centres.

Jamaican men, who are among the population at highest risk, are advised to begin testing for prostate cancer at age 40, and to do so once per year.

The JCS is also encouraging Jamaican men to make healthy lifestyle choices by consuming a diet low in fat; increasing their intake of fruits and vegetables; eating more fish rich in omega-3; and exercising at least 30 minutes daily.