How Physicians Can Help Promote Early Detection of Prostate Cancer

Prostate Cancer Awareness Month, recognized each September, brings awareness to a disease estimated to impact one in every eight men. Physicians play an important role in leading conversations about the disease and using physical exam techniques to properly screen patients for abnormalities.

In this blog post, we’ve outlined key resources to help physicians identify signs of prostate cancer at the patient bedside, plus tips for initiating conversations about the disease.   

Physical Exam Techniques to Screen for Prostate Cancer

The rectal exam, which should be performed on most patients with abdominal pain and any concern for blood loss, plays an important role in detecting prostate cancer.

Visit Stanford Medicine 25’s guide to the rectal exam, which describes:

·      three ways to position patients for the exam;

·      tips for anal inspection;

·      steps to palpate the rectum and prostate and;

·      a reminder to use a guaiac kit to test for occult blood in fecal material.

Stanford Medicine 25 also outlines several physical exams related to the rectal exam, including the spleen, liver, ascites and venous patterns and the bedside ultrasound. 

Tips to Help Physicians Discuss Prostate Health with Patients

Some patients may, understandably, be hesitant to discuss prostate health and screening. Therefore, it’s vital that physicians initiate these conversations with compassion and understanding.

Reviewing the Presence 5 framework, developed by Stanford Medicine 25’s Abraham Verghese and Donna Zulman, can help physicians facilitate these interactions. The guidance recommends preparing with intention, listening intently, agreeing on priorities, connecting with the patient’s story and exploring emotional cues.

Additionally, a CME training module developed by Medscape and the National Association of Chronic Disease Directors encourages physicians to incorporate shared decision-making when talking to patients about prostate cancer and screening. The guidance emphasizes using the Three-Talk Model, which includes:

a.     Team Talk: Invite patients into the decision-making process, define the decision that needs to be made and seek the patient’s partnership.

b.     Option Talk: Describe the options, including potential benefits and harms.

c.     Decision Talk: Ask the patient about their goals and preferences, then encourage them to make a decision or defer the decision until a later time.

The module also encourages physicians to make sure patients have complete and unbiased information about the topic. Talking points about prostate cancer may include:

Prevalence and Outcomes

o   Prostate cancer is the most commonly diagnosed cancer in America (excluding skin cancer) and the second leading cause of cancer in men worldwide, according to the Prostate Cancer Foundation (PCF).

o   The American Cancer Society estimates that 268,490 new cases of prostate cancer and 34,500 deaths will occur in 2022.

o   Fortunately, when prostate cancer is detected early, survival rates tend to be high. According to PCF, the 5-year survival rate in the United States for men diagnosed with early-stage prostate cancer is greater than 99%.

Risk Factors for Prostate Cancer According to PCF

o   Age: Incidence of prostate cancer increases with age, meaning that the older a person is, the more likely they are to develop it. In fact, nearly 60% of prostate cancer is diagnosed in men over age 65.

o   Family History: Prostate cancer is the most heritable form of major cancer. 58% of prostate cancer is driven by genetics.

o   Race: Men of African descent are 75% more likely to develop prostate cancer compared to white men and are more than twice as likely to die from the condition. Although healthcare inequities play a role in this disparity, ongoing research seeks to identify further biological explanations.

o   Other: Additional risk factors include diets that are high in processed meat and saturated fat and low in vegetables, unhealthy weight, sedentary lifestyle, very high calcium intake and Agent Orange exposure.

Clinical Signs and Symptoms of Prostate Cancer

o   The American Cancer Society emphasizes that most prostate cancer can be detected early through screenings. In beginning phases, prostate cancer does not typically cause symptoms, but in more advanced stages it can cause:

§  difficulty with urination;

§  blood in urine or semen;

§  erectile dysfunction;

§  pain in hips, spine or ribs;

§  weakness or numbness in legs and/or feet; and

§  loss of bladder or bowel control.

Screening for Prostate Cancer

·      There are a variety of tests that can identify potential signs of prostate cancer, including:

o   prostate-specific antigen (PSA) blood tests;

o   digital rectal exam (DRE);

o   imaging tests, such as an MRI or transrectal ultrasound; and

o   prostate biopsy.

For more from Stanford Medicine 25 on patient interactions and the importance of physical exam skills, visit StanfordMedicine25.stanford.edu.