Page 6 - Boca Exposure - June '18
P. 6

Page 6, Boca Exposure

Prostate Cancer,

Digital Rectal Exams, PSA And Screening

By Steven E. Reznick,                                          	 This received much media hype and the blur between         first, and still do. How can you tell if something is
M.D., FACP                                                     the efficiency of detecting prostate cancer via a rectal     abnormal if you haven’t performed normal exams?
	 The PSA blood test,                                          exam and the use of the rectal exam to detect rectal and     	 Last but not least, Finesteride, a medicine used to
to detect prostate cancer,                                     colon disease has been lost. We perform digital rectal       shrink an enlarged prostate by inhibiting male hormones,
clearly has saved lives                                        exams to detect prostate cancer and look at the perirectal   has finally been shown to be protective against developing
according to numerous                                          area for disease. We test the strength and performance of    prostate cancer. A study published in the journal of the
studies. The United States                                     the anal sphincter muscle. We feel for rectal polyps and     National Cancer Institute found that men taking it for 16
Preventive Task Force                                          growths and, in certain situations, test the stool for the   years had a 21 percent lower incidence of prostate cancer.
(USPTF) recognizes this but                                    presence of blood.                                           	 Board Certified in internal medicine, with added
has decided that screening                                     	 During my internal medicine training my teachers           qualifications in geriatrics, Dr. Reznick has practiced
for prostate cancer is not a                                   always required a digital rectal exam, stool blood test      in Boca Raton since 1979. For information about
great idea in men aged 55                                      and slide of the stool as part of the exam. As trainees, we  his concierge medicine practice, or to schedule a
to 69. They point out the PSA can be elevated from an          realized the invasiveness of the exam and did our best to    complimentary meeting with Dr. Reznick, call (561) 368-
enlarged prostate, an inflamed or infected prostate, a recent  be polite, gentle and caring. I always asked for permission  0191 or visit
orgasm while having sex and other causes.
	 Elevated PSAs led to trans-rectal ultrasound views of                                   ASSISTED LIVING | MEMORY CARE
the prostate and biopsies of the prostate. These biopsies
were uncomfortable, even painful, and often followed by                                                   BOCA RATON
inflammation and infection of the prostate. Many times
the prostate biopsy was benign with no cancer detected.        SonataEmpowers
The USPTF felt the cost, worry, and potential side effects
were a risk far outweighing the benefits of screening. They    hope • understanding • support • confidential • safe
consequently came out against screening men in this age
group. Naturally this position produced a tidal wave of
criticism from urologists and others.
	 So, the USPTF has produced new recommendations
calling for patient education and making a shared decision
whether or not to obtain a PSA measurement before you
send it out. This is a bit confusing because we always
discuss the pros and cons of a PSA before we draw it.
Adult men are entitled to hear the pros and cons so they
can make their own informed decision.
	 To complicate matters, a study out of McMaster
University in Canada reveals physicians are poorly trained
in performing a digital rectal exam. They cite the lack of
experience coming out of school and going into training
and cite numerous research studies showing a rectal exam
is a low yield way to detect prostate cancer. They do not
recommend performing digital rectal exams for prostate
cancer screening.

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                                                               Connecting with others who have the same                     Please join us
                                                               kinds of struggles as you do is an important                 Thursday, July 5, 2018
                                                               part of coping with Alzheimer’s disease.                     300PM - 4:00PM
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                                                               sionals or former family caregivers, whose                   Every First Thursday of the Month
                                                               primary purpose is to provide knowledge                      Seating is limited
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