My doctor has happily given me physical prostate exams since I was in my early thirties. I have a family history of prostate cancer and we both knew that at some point there was a very good likelihood that I’d end up with the disease, so he regularly did a rectal exam at least once a year and often more than that.
At least once a year, I had a PSA (Prostate Specific Antigen) blood test done as well. It’s a simple blood test that measures the level of the PSA in your blood, and I think it’s a valuable extra tool doctors should use to help determine someone’s prostate health. There’s a lot of debate about using the PSA test alone, for a myriad of reasons, but in my case we had a long-standing baseline measurement that, combined with regular manual exams, gave us a pretty accurate picture of my prostate health.
Lots of poking and prodding over the years! At one point, I asked him why he did both tests on me, since I’d been having PSA tests regularly for as long as the physical tests, and he had a really good PSA baseline reading for me to work from. His answer was, “Because I like to.”
He’s hilarious. I’ve been going to the same guy pretty well ever since he got into practice, so we go way back. He’s four years older than me, and he used to hang out with my older sister. I went out with his younger sister in high school, so we’ve known each other for over 45 years. We laugh a lot, so he can say things like that for the sheer fun of it.
The serious answer to my question is, of course, that the prostate is a gland that’s very easy for doctors to get a good feel for, because of where it’s situated in the body. A finger up the rectum can easily examine the prostate. It’s not the most comfortable thing in the world, but it’s over in a few seconds.
The prostate sits right underneath the bladder. A normal one is about the size of a golf ball and smooth and firm to the touch. A chart in my doctor’s office shows three phases of possible enlargements and equates an enlarged prostate to about the size of a racquetball, with a really enlarged prostate being the size of a baseball. Mine ended up halfway between a racquetball and a baseball.
I went to see my doctor in September of 2012 with a slight fever and some difficulty passing urine. It burned a bit to pee; the flow was restricted a little, and sometimes when I was done it still felt like I had to go. Most men notice a restricted flow as they get older, so that alone isn’t a red flag for prostate cancer.
I had been for a PSA test a few weeks before, so my doctor noticed my number had gone up, from around 3.2 to above 6. It’s not a good thing to have your PSA spike. After a physical exam, he proclaimed that my prostate was a bit enlarged and felt “boggy.” My first reaction was “What the hell does ‘boggy’ mean?” Because of the slight fever, he put me on an antibiotic for a couple of weeks and made arrangements for me to see a urologist. My prostate was slightly larger than a golf ball and smaller than a racquetball then, and ‘boggy’ meant it felt squishy, for lack of a better word.
A couple of weeks later, I visited the urologist and had what I can best describe as a “thorough and rigorous” manual rectal exam. He agreed with my doctor’s assessment of a ‘boggy’ prostate and said I had prostatitis, an infection in my prostate. He put me on a six-week course of Cypro, a very effective antibiotic designed for prostate and bladder issues. At the end of six weeks, my PSA had gone down to just over 4 and I was symptom-free. I danced out of my doctor’s office, thinking I had dodged a bullet.
In December it happened again, only this time my PSA was at about 7.6, so back on the antibiotics I went for another six weeks. This time the symptoms went away but the PSA stayed the same, so I was sent back to the urologist for another “rigorous and thorough” exam.
When he was done the exam, we went back to his desk and it was time for “the talk.” He said things didn’t feel right. He should know ‑ I think he grabbed my prostate and rolled it around in his hand! He said it was time to get a biopsy to be sure of what was going on.