Are you perhaps overdue for your first visit to a urologist? And how uncomfortable is a prostate examination really? Berlin (dpa) – Many a man may feel anxious before seeing a urologist for the first time, perhaps even to the point of getting sweaty palms and going weak at the knees. A digital rectal exam can be a particular object of dread. When should you make an appointment? And what can you expect during your visit? Two urologists have answers: According to Dr Axel Merseburger, spokesman for the German Society for Urology (DGU), a man should see a urologist in cases of frequent or painful urination, blood in urine, recurrent urinary tract infections, kidney stones, erectile dysfunction, testicular pain or unexplained lower abdominal pain. External signs of inflammation in the genital region or lumps in or around the testicles are also cause for an examination by a urologist, says Dr Robert Frese, executive board chairman of the Association of Urologists in Private Practice in Hamburg (VUHH). In addition, urologists can provide consultation on matters relating to fertility, sexual problems or sexually transmitted diseases. "But you should always see your GP first, who can refer you to the proper specialists," Merseburger says. If for nothing else, every man should see a urologist for cancer screening. "Prostate cancer is the most common cancer in men, as breast cancer is in women," points out Frese. Worldwide, there were an estimated 1,414,259 cases in 2020, according to the Global Cancer Observatory, a specialized agency platform of the World Health Organization. At what age should a man be screened for prostate cancer? Annual screening is recommended for men aged 45 and over. However, even though the procedure may be covered by their health insurance, a large percentage of men typically don't get screened regularly, and many don't at all. How does the initial appointment generally go? Whether it's a cancer screening or you want to have acute symptoms checked, a proper visit with a urologist should begin with a thorough conversation about your medical history, touching on such things as any cancer cases in your family, pre-existing conditions you may have, and your use of medicines. "Your sexual function shouldn't be left out for fear of embarrassment either," Frese says. Depending on any symptoms you may have, a physical examination then follows, perhaps complemented by a urinalysis and/or blood test. What exactly is done during a cancer screening exam? Along with examining and palpating – or feeling – the penis and scrotum for any abnormal areas, the urologist palpates the prostate gland and checks the lymph nodes, Frese says. Prostate palpation, also known as a digital rectal exam (DRE), is somewhat controversial because "not every small, early tumour can be adequately felt." For this reason, professional medical associations such as the DGU recommend prostate-specific antigen (PSA) screening too. PSA is protein produced by cells of the prostate gland, and men with prostate cancer often have an elevated level in their blood. Some non-cancerous conditions can also raise the level, however. Merseburger advises men to consult their urologist about the suitability of having both a DRE and PSA test. Frese, for his part, discourages leaving out a DRE, as "it can provide essential information on the size and shape of the prostate gland as well as palpable abnormalities that could indicate colon cancer." Is the dreaded DRE really so bad? How uncomfortable it's felt to be depends on the individual. In any case, it's not painful and generally takes only a few seconds. You typically lie on your side, knees bent, and the doctor inserts a gloved, lubricated finger into your rectum and palpates the prostate – located just below the urinary bladder – for any hard, lumpy or abnormal areas. "It's a bit unpleasant, but a blood test is worse," remarks Frese. "When you explain its purpose to the patient, they all agree to have it." Along with background information, a little humour can help to ease any embarrassment, he says. Merseburger advises his patients to simply relax and breathe calmly. He also thoroughly explains the importance of a DRE to allay any anxiety or embarrassment. As Frese sees it, the reason that men often neglect to get screened for prostate cancer lies in their psyche: "Men don't like going to a doctor. They tend to regard their body as a machine, and a doctor as a mechanic that you call on only when something isn't working properly." Do only men go to a urologist? No. "Roughly 40% of my patients are women," Frese says, noting that recurrent urinary tract infections, kidney stones or incontinence are the main causes of their visits. "Women can also develop tumours that are treated by a urologist, such as bladder cancer or a kidney tumour." Children, too, get urological treatment. Common causes, according to Merseburger, are congenital anomalies or an undescended testicle. The following information is not intended for publication dpa/tmn ada yyzz a3 bzl rid cja ob
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