Senior Urologist & Uro-Oncologist, Apollo Hospital Gurugram
Part 2 of 10 in Diagnosis and Management of Prostate Cancer
Why Physical Examination Still Matters in Prostate Cancer
July 7, 2024
Most prostate cancers confined to the gland itself are entirely asymptomatic. By the time symptoms appear, bone pain, anaemia, swelling in the legs, the disease is usually already advanced. This is exactly why physical examination, not just imaging, remains central to catching it early.
Why the digital rectal exam still matters
Dr. Shrivastava was direct about a real trend: doctors increasingly skip physical examination now that good-quality MRI and PET scans are available, but no scan replaces a proper exam. For any patient above 40 to 45 years of age presenting with a urinary complaint, he examines head to toe, abdomen, scrotum, lower limbs, and never lets such a patient leave the clinic without a digital rectal examination. Without it, the tumour cannot even be clinically staged.
What the exam can reveal
A cancer palpable on digital exam, or swelling in the feet, both point toward more advanced disease. This is why examining the lower limbs is part of the same clinical picture, not a separate step.
This article is based on a Jivo Masterclass session conducted by Dr. Nitin Shrivastava, Consultant, Urology and Uro-Oncology, Artemis Hospital, Gurgaon (his affiliation at the time of this session). The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
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This guide is based on a live Jivo Masterclass: Dr.Nitin Shrivastava taught doctors across Africa on July 7, 2024.
FROM THE LIVE Q&A
Moderator
What is the role of physical medicine and rehabilitation in the treatment of prostate cancer?
Dr.Nitin Shrivastava
Rehabilitation does not treat the prostate cancer itself, but it is an integral part of the treatment process. After prostate surgery, patients need to do Kegel exercises to regain continence.
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Frequently Asked Questions
What factors should we consider when interpreting age-adjusted PSA levels, other than UTI?▼
The rise in subsequent PSA levels, PSA velocity, and PSA density all give more clues when a reading is borderline, and these additional tests should be done before deciding on a biopsy.
What is the time range that should be considered between two PSA measurements during screening?▼
Routine mass PSA screening is not recommended. But for high-risk patients, yearly PSA is a good idea. If the PSA comes out abnormal, it should be repeated after four to six weeks.
What is the best method of managing BPH?▼
First make sure BPH is not causing damage to the kidneys. For mild symptoms, only lifestyle management is needed. For bothersome symptoms, a single alpha blocker is used. There is no one universal method; if it's damaging the kidneys, surgery is needed.
Apart from PSA, what other hormones should be monitored in case of prostate cancer?▼
None. PSA is the only one.
What are the factors contributing to prostate cancer, and what are the staging parameters?▼
The most important contributing factor is genetics and family history. Researchers point to some role of obesity and possibly a non-vegetarian diet, but these risk factors are not firmly established.
Why is a digital rectal exam still necessary with modern imaging available?▼
No scan replaces physical examination. Without a rectal exam, the tumour cannot be clinically staged, and most prostate cancers confined to the gland cause no symptoms at all.
What does a palpable finding on exam suggest?▼
A palpable tumour on digital rectal exam, or swelling in the feet, both indicate a higher chance the disease is already advanced.
In This Series: Diagnosis and Management of Prostate Cancer
- 1.Diagnosis and Management of Prostate Cancer
- 2.Why Physical Examination Still Matters in Prostate Cancer
- 3.PSA Testing: Age-Adjusted Thresholds, Density and Velocity
- 4.Who Needs Earlier Prostate Cancer Screening
- 5.When to Biopsy: Balancing Missed Cancer Against Overtreatment
- 6.Biopsy Technique and Imaging: Transrectal vs Transperineal, CT vs MRI
- 7.Managing BPH: From Lifestyle to Alpha-Blockers to Surgery
- 8.TURP: How Often It Can Be Repeated, and the Real Tradeoff
- 9.After Prostate Surgery: Incontinence, Neobladder and Quality of Life
- 10.Nutrition and Multidisciplinary Care in Prostate Cancer