By Dr. Michael Helms, Northwest Family Medicine & Saint Joseph Physician Network
As tough as we all like to think we are, men have a long way to go in terms of manning up to a simple medical procedure that could end up saving our lives or at least improve our quality of life.
For men approaching the age of 40 and above, a prostate exam – while admittedly slightly uncomfortable – only takes a minute but is as necessary a preventative health measure as a blood pressure test or cholesterol check.
Why a prostate exam? The primary reason is to check for the presence of three conditions:
- Rectal Cancer, which is very rare.
- Prostate Cancer, slightly little more common but still fairly rare.
- BPH, or enlarged prostate. BPH is not life threatening but can nevertheless be quite disabling at times. The benefit here is that if we find a prostate that is enlarging, we can treat it before symptoms become severe.
Fear Not
But why do men fear something that is so quick and simple and could save your life? First and foremost, I think there’s a stigma that it is somehow unmanly to get a prostate exam. We prefer to believe there should be some type of electronic or blood test to prevent a man from having a finger put in a place he really doesn’t want it.
Also, some men fear the discomfort of the test. To address this, I always like to reference the size of my index finger versus the size of an average bowel movement and submit it as “exhibit A.”
Sure, it’s uncomfortable but, by comparison, women often have to endure far worse. Not surprisingly, the women in our lives are not very sympathetic about our complaints.
I say “our” because I’m in the same situation. As a 47-year-old, I get my prostate exam every year from my physician so I’m doing what I am telling patients they need to do. And in reality, about 90 percent of the discomfort is psychological. Believe me, there are a lot of procedures out there that are worse than a prostate exam. Again, our better halves have been getting pelvic exams from the time they’ve been around 18, gone through childbirth and the exams that go with it – all of which are exponentially worse than a prostate check.
Finally, there’s a fear of the unknown. We are afraid of what the doctor will find or what the doctor will tell us we have to do. Certainly, the fear of prostate cancer is real and understandable. But there’s also anxiety about prostate cancer treatment as well –specifically, that treatment could render the patient impotent.
This fear is less prevalent than it used to be and for good reason. Cancer is seldom found. Most exams reveal a normal prostate condition. Plus, treatments are much better than they used to be in the sense that active surveillance (the strategy of closely monitoring patients with low-risk prostate cancer before prescribing specific therapy) is more common.
Other times, the condition is treated with hormones – some of which can cause impotence but this is less likely than it used to be. Prostate cancer can also be treated with radiation and, when it does require surgery, many times the procedure can be nerve sparing – meaning it will not impact sexual performance. These are certainly better treatment options than what used to be available to men.
How ‘bout those Bears?
Being mindful that most of the discomfort of a prostate exam is psychological, I like to do what I can to get the patients’ mind off the task at hand. For example, talking about sports – like Jay Cutler’s bum knee, sports cars, mutual funds, telling jokes – anything to lighten things up or put the patient at ease while he’s wearing a gown with no back and bending over. As a doctor, you have to build a rapport so that it is not psychologically threatening. One way to accomplish this is by conducting the bulk of the physical first – while engaging them in these discussions – before doing the prostate exam.
Additionally, a standard practice for me is to schedule physicals in the morning so I can tell guys I am making the rest of their day seem much better in comparison. Plus, I remind them that getting a prostate exam isn’t nearly as bad as going to the dentist. And while some may disagree, I can’t resist using this line as a good-natured tweak at my dentist friends.
Fortunately, most of the time I recommend giving an exam to a patient, they agree to it. Then again, if they are already in to see me, they are somewhat resigned to doing what comes with a physical. However, I worry about men of that certain age who may not be coming in for a standard physical – perhaps simply because of fear of this exam. If there are any of you out there, you may be forced to give back your “man card” if that’s really what’s keeping you away from an annual doctor visit.
Need to find a new primary care physician or want to learn more about Dr. Helms? Go to www.saintjoedocs.com.
