When Should a Man Get A Prostate Exam?

When Should Men Get Their First Prostate Exam?

As we finish out November, also known as “No-shave November” or “Movember” to increase awareness about men’s health issues, I want to touch on a part of men’s health that is at the forefront of most men’s minds: Prostate Health, Prostate Enlargement, and Prostate Cancer.

So, when should men get their first prostate exam – and do you need to have them at all? Let’s clarify those questions.

Early Screening

At Redefined Health Clinic, we screen and monitor for prostate health before we even see you as a patient. Part of our initial intake questionnaire asks you about your personal and family history of prostate diseases. Is there a family history of prostate cancer? Did a first-degree male relative have prostate cancer? Answering yes to these questions might put you at risk.

Current recommendations call for Prostate cancer screening at age 50. But if you have an early family history of Prostate Cancer, we will screen even earlier at age 40-45.

What Does Screening Look Like?

The old-school way of thought was that starting at age 50, men would get their prostate checked annually, otherwise known as a digital rectal exam (DRE). A DRE is a rectal exam using a gloved and lubricated finger to examine the prostate internally.

However, we have learned that placing just the slightest amount of pressure on the prostate during the DRE can cause a false positive elevation of the Prostate Specific Antigen (PSA) in a blood test. The PSA is a protein produced by both cancerous and noncancerous tissue in the prostate.

What if Your PSA is High?

High levels of PSA may indicate the presence of prostate cancer. But many other conditions, such as an enlarged or inflamed prostate, constipation, vigorous bicycle riding, motorcycle/motocross riding, long horseback rides, and even intercourse can increase PSA levels. When sending a man to the lab to have his PSA level checked, we ask they refrain from those activities for 3-5 days before their blood test.

If your PSA test comes back high, we may need to do further testing which would include more blood tests, a DRE, and a referral to a urologist.

How Does TRT Affect My Prostate?

Despite internet rumors, Testosterone Replacement Therapy does not cause prostate cancer. However, there are some things that we need to screen for before starting testosterone therapy.

First, our initial blood word includes a baseline PSA level. We want to know what your level is even before starting TRT. We check that level again at least annually, if not twice yearly. If your PSA level begins to increase, we decide together how to handle the testosterone dose.

However, if you already have prostate cancer then TRT can cause already-established prostate cancers to grow more quickly. That’s why we screen for it before starting any TRT.

What is BPH vs Prostate Cancer?

BPH stands for Benign Prostatic Hypertrophy. It just means an enlarged prostate. It is not prostate cancer.

Common symptoms of BPH include frequent urination (especially at night), feeling that you can’t empty the bladder all the way, weak urine stream, or difficulty starting a urine stream. This is a common factor in men as we get older. Simple medications can help reduce the size of the prostate, or you may need a referral to a urologist.

There is no sound evidence connecting BPH to TRT. In fact, there is growing evidence that because men lose testosterone as we age that we may be less susceptible to BPH if we are on weekly low-dose TRT.