Word: rectal
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...based in New Jersey, sponsors free prostate screenings all over the U.S. An estimated half a million American men will allow themselves to be poked, prodded and bled in hopes of being reassured of their good health or of spotting trouble before it gets serious. In addition to the rectal exam, men can undergo a new blood test that measures levels of a protein called prostate-specific antigen. If present in large quantities, PSA may signal malignancy. The goal is to detect cancer while it is still confined to the prostate and therefore more likely to be curable...
...worthy as the goal may be, however, the effectiveness and value of the mass screening are matters of dispute within the medical community. One-third of the tumors picked up by the rectal exam are already inoperable. Yet the PSA blood test is also far from infallible. It misses at least 20% of malignancies and can often give an indication of cancer where none exists. Furthermore, prostate cancers are not all the same; many grow so slowly that they do not need to be treated at all. A man could easily die of something else before his prostate condition proved...
Unfortunately, even a low PSA level is no guarantee of good health. "A third of the men I operate on have PSAs less than 2.8," says Walsh. "So the idea that if your PSA is low, you don't have cancer, is wrong. But if you have a negative rectal examination and a low PSA, you probably don't have prostate cancer...
...Rectal examinations have been the standard for early diagnosis for nearly a century. But this method, in which doctors probe the prostate gland manually, has not been very popular with patients or their doctors. In West Germany, where men over 40 can be tested for free, a recent study found that only 15% actually agreed to have it done. Physicians point out that the exams often fail to detect smaller cancers and those that originate on the front of the gland. The method is also subjective. One expert remarked that all he can tell his medical students is that...
...method is by no means foolproof. Catalona stresses that 21% of the men in his study with prostate cancer actually had "normal" PSA levels. Thus the test should be used only in combination with a rectal exam, he said, and even then some cancers will be missed...