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#1
Old 02-16-2017, 07:10 PM
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Colonoscopy/prostate question

I'm 56. I've had a few colonoscopies in my life, and will get another this summer (routine check because of age).

It's also time for another prostate check.

I'm just wondering, would a colonoscopy also include, or detect an enlarged prostate? I'll talk to my Doc before I get the colonoscopy, but I was just wondering.
#2
Old 02-16-2017, 07:17 PM
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The fickle finger of fate would be far more useful in detecting an abnormally enlarged/nodular/suspicious prostate than a colonoscopy. The gastroenterologist doing the colonoscopy would likely not notice anything untoward unless the prostate was especially huge, in which case its owner would probably already suspect something was amiss.

Last edited by Jackmannii; 02-16-2017 at 07:17 PM.
#3
Old 02-16-2017, 09:21 PM
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Originally Posted by Jackmannii View Post
The fickle finger of fate would be far more useful in detecting an abnormally enlarged/nodular/suspicious prostate than a colonoscopy. The gastroenterologist doing the colonoscopy would likely not notice anything untoward unless the prostate was especially huge, in which case its owner would probably already suspect something was amiss.
Thanks. As I said I was going to ask my Doc. Wasn't sure if even a small problem would be obvious to the scope, or they wouldn't really be looking for it.
#4
Old 02-16-2017, 09:30 PM
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Most colonoscopists will also do a digital rectal exam at the time of the scoping. Heck, you're already snowed, so it's a good time to really check out the prostate.

However, know that screening for prostate cancer in a low risk population really isn't terribly effective, or even recommended, as it often uncovers things for which the treatment turns out to be worse than the disease. So check with your doc to see what's right for your particular situation.
#5
Old 02-16-2017, 10:24 PM
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For suitable definition of "low risk population", at least.
#6
Old 02-17-2017, 12:22 PM
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Why a "routine" colonoscopy? I have just sent my biennial specimen off for routine testing. This involves sending smears from three separate bowel movements to a central test lab. A rectal exam would follow if the test proves positive.

Is this another example of an unnecessary (and uncomfortable) test to bump up profits?
#7
Old 02-17-2017, 12:27 PM
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Originally Posted by bob++ View Post
Why a "routine" colonoscopy? I have just sent my biennial specimen off for routine testing. This involves sending smears from three separate bowel movements to a central test lab. A rectal exam would follow if the test proves positive.

Is this another example of an unnecessary (and uncomfortable) test to bump up profits?

Not sure where you're located, but my understanding is that a colonoscopy is still the "gold standard" for screening in the U.S.

That may be changing, but that's the lay of the land now.

http://npr.org/sections/health-s...it-to-be-tried
#8
Old 02-17-2017, 01:17 PM
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Originally Posted by Qadgop the Mercotan View Post
...However, know that screening for prostate cancer in a low risk population really isn't terribly effective, or even recommended, as it often uncovers things for which the treatment turns out to be worse than the disease. So check with your doc to see what's right for your particular situation.
IANAD, but as an aggressive prostate cancer survivor diagnosed at age 50, I disagree with Qadgop's statement.
Recent studies do show that getting a PSA blood test without other indicators pointing to prostate cancer can be overly alarming, and may lead to unneeded intervention (surgery, radiation/chemo treatments, etc.).

However, there is no study that I am aware of that says getting a digital prostate exam has the same issues. I would recommend asking for a prostate check along with the colonoscopy, or during a medical checkup.

My experience: I was offered a free PSA test, and the results came back >20 (normal range 0-4). Digital exams before that showed no indication of cancer, but one done just after the blood test did show abnormalities. Had I waited a year or two to get a digital exam, there's a very good chance the cancer would have spread beyond the prostate and led to much more severe issues. I had the prostate removed 5 years ago; there are side effects but I can deal with them pretty easily, and there is no sing of cancer now.

My suggestion: at 50 or older, discuss it with your doctor(s), mention any family history and any prostate-related issues like BPH, and get the digital exam. Repeat yearly.
#9
Old 02-17-2017, 01:37 PM
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I was diagnosed with ulcerative colitis about 15 years ago. As a result, I have a colonoscopy every year (or two). The silver lining is that my doctor does a prostate exam each time so I don't need to have it performed when I'm awake.
#10
Old 02-17-2017, 02:05 PM
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Originally Posted by bob++ View Post
Why a "routine" colonoscopy?
Colonoscopies for people with no special risk factors are recommended every 10 years starting at age 50, more frequently if there are risk factors (e.g., direct ancestor or sibling had colon cancer).
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#11
Old 02-17-2017, 03:38 PM
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Originally Posted by tallcoldone View Post
IANAD, but as an aggressive prostate cancer survivor diagnosed at age 50, I disagree with Qadgop's statement.
Recent studies do show that getting a PSA blood test without other indicators pointing to prostate cancer can be overly alarming, and may lead to unneeded intervention (surgery, radiation/chemo treatments, etc.).

However, there is no study that I am aware of that says getting a digital prostate exam has the same issues. I would recommend asking for a prostate check along with the colonoscopy, or during a medical checkup.

My experience: I was offered a free PSA test, and the results came back >20 (normal range 0-4). Digital exams before that showed no indication of cancer, but one done just after the blood test did show abnormalities. Had I waited a year or two to get a digital exam, there's a very good chance the cancer would have spread beyond the prostate and led to much more severe issues. I had the prostate removed 5 years ago; there are side effects but I can deal with them pretty easily, and there is no sing of cancer now.

My suggestion: at 50 or older, discuss it with your doctor(s), mention any family history and any prostate-related issues like BPH, and get the digital exam. Repeat yearly.
A sort of counter story about being too attentive to PSA tests: my blood tests showed up one year with my PSA creeping up into the 5 or 6 range. After two of these tests my PCP referred me to a specialist, who did a very thorough digital exam, ran another PSA test which was still a little elevated, and recommended a biopsy. I said OK, and scheduled the procedure.

Let me describe this biopsy. Unlike the 2 colonoscopies I have had, there was no general relaxant/anesthetic. A device was inserted into my rectum, from which they proceeded to inject a local anesthetic into several locations in my prostate. This procedure was exquisitely painful*. After the local took effect the same device took several many samples from different areas of the prostate. The device was removed, I was warned about possible blood in my urine and semen for a few days, and was sent home. The biopsy was 100% clean, for which I was grateful. I kept making followup visits to this specialist, but my PSA had gone down** to acceptable levels, so eventually I stopped those followup visits on my own.

*The prostate is not some insensate internal organ. It has nerve endings and it can feel pain as well as pleasure. I can attest to this at first hand. You do not want to have anyone or anything shoving needles in there if you can possibly avoid it.

**"What's your secret?" asked the specialist when my PSA went back down. I didn't say anything, but what I had found out is that one should refrain from sexual activity for 48-72 hours before a blood test that checks PSA, because sex can elevate PSA temporarily. Neither my PCP nor the specialist ever mentioned this to me. So not only was the procedure painful and expensive (not to me, thankfully, but I'm sure the specialist was well-rewarded by my insurance) but it was completely unnecessary.
#12
Old 02-17-2017, 03:53 PM
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Prostate. Cancer. Totally fascinating topic.

PSA. If you are lucky enough to have a really high one, you might catch a prostate cancer before it kills you. If it's low, great. If it's in that horrible intermediate range, it is almost impossible to show that acting on that will reduce all-cause mortality.

One of the stupidest things we do is a PSA draw after a nice vigorous digital exam, after a buncha really good sex, or without checking to see if the prostate is inflamed. Voila. Intermediately high PSA. The level of PSA in the prostate is very high, and it don't take much to squish some out into the blood. Bam. "Sir, we gotta track you down for cancer."

I could wax on, but to the OP: Don't trust a colonoscopy to get a prostate screen. Proctologist v Urologist and a zillion other nuances.

Read a lot about PSA before you get one done. There's nothing wrong with getting one done, per se, but at a bare minimum read enough to get one done when your prostate has not been manipulated or stimulated. It is a screen for cancer fraught with landmines.

Last edited by Chief Pedant; 02-17-2017 at 03:54 PM.
#13
Old 02-17-2017, 04:51 PM
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Originally Posted by tallcoldone View Post
IANAD, but as an aggressive prostate cancer survivor diagnosed at age 50, I disagree with Qadgop's statement.
You disagree? You feel that Digital Rectal Exam (DRE) screening in a low-risk population is effective? You're in the minority who feel that way.

The American Urological association in its 2013 report said it could find no evidence to support the continued use of DRE as a first-line screen. http://auanet.org/education/guid...-detection.cfm

The United States Preventive Services Task Force (USPSTF) updated its recommendations in 2012 to recommend that men not be screened for prostate cancer, concluding that there is moderate certainty that the benefits of such screening do not outweigh the harms.

The United Kingdom National Screening Committee does not recommend screening for prostate cancer

The Australian Cancer Council states that the evidence does not support population-based screening and recommends a patient-centered approach that individualizes the decision.

The European Society for Medical Oncology (ESMO) recommends against population based screening and in favor of an individualized approach using shared decision making.

The American College of Physicians guidance statement recommends that clinicians inform men ages 50 to 69 about the limited potential benefits and substantial harms of prostate cancer screening and only screen men who express a clear preference for being screened.

Even the American Cancer Society, one of the few organizations that still recommend checking PSA for men over 50, doesn't recommend DRE be done. (They do have a neat little calculation device for figuring out what your prostate cancer risk is based on your age, race, and PSA score. It doesn't require a DRE result to calculate your odds, but will add that variable into the calculations if it was done).

There is no good, one size fits all way to screen for prostate cancer for the average-risk man. If you're worried about it, talk to your doc about what's right for you. That's the individualized approach, which I favor.

Last edited by Qadgop the Mercotan; 02-17-2017 at 04:52 PM.
#14
Old 02-21-2017, 12:32 PM
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Well, Qadgop, thanks for the bigly amount of evidence - ignorance fought.

I suppose my position should be modified to "Don't rely only on a PSA test. Discuss it with your doctor, especially if you have relatives that have been diagnosed with prostate cancer, especially at an early age".

I was told 50 was quite early for it to have developed for me, so I made sure all my brothers (all older than me) knew all about it.
#15
Old 02-21-2017, 12:42 PM
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Originally Posted by tallcoldone View Post
Well, Qadgop, thanks for the bigly amount of evidence - ignorance fought.

I suppose my position should be modified to "Don't rely only on a PSA test. Discuss it with your doctor, especially if you have relatives that have been diagnosed with prostate cancer, especially at an early age".

I was told 50 was quite early for it to have developed for me, so I made sure all my brothers (all older than me) knew all about it.
Can we not use 'bigly' or 'sad' for a bit with serious questions.

Thanks all for the input. Right now I'm looking at possible shoulder surgery for a bone spur. The colonoscopy will wait till summer. No cancer history in the family at all. I'll talk to my Doc though.
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