There continues to be considerable debate about whether men should have PSA (prostate-specific antigen) testing, but have you noticed there seems to be no such debate about DREs—digital rectal exams? Both are quick tests that serve similar purposes (diagnosing prostate issues, among others), so I have to wonder why the PSA bashers don’t also attack the DRE. Could it be they’ve never had one?
I am not among the PSA bashers and frankly wish they would stop discouraging its use. Maybe I can tempt those buttinskies to divert some of their anti-PSA meddling to attacking the DRE, thereby splitting their attention and hopefully dooming both campaigns to fail. So just for fun, I’d like to help them get started with DRE-bashing by providing a list of five reasons to eliminate the DRE. These reasons are every bit as good as the ones they typically present for banishing the PSA test, so they should be happy to use them.
#1: Nobody likes DREs
… my doctor didn’t really want to give me one and I didn’t really want to get one, and when responsible adults agree, well then …
Without taking a formal survey I feel safe in asserting that with rare exception, nobody likes getting a DRE. And with equally rare exception, nobody likes giving one, either. For many years I have been on the receiving end at least annually, but last time had an interesting twist. When I was in Jacksonville for my third annual prostate cancer checkup I was asked whether I wanted a DRE. I had never been asked before—it was always an assumed part of the visit—and I was truly stunned and speechless at the question. So after a pregnant pause I said like a fool, “Sure, why not? After all, that’s why I’m here!” But it is now clear in hindsight that my doctor didn’t really want to give me one and I didn’t really want to get one, and when responsible adults agree, well then, where’s the argument?
#2: DRE results are inconclusive
The DRE is not a definitive diagnostic tool, and if it causes so much as an eyebrow to be raised, the patient may have to endure other diagnostic tests or procedures. In effect, it’s like a gateway drug. Just as smoking marijuana can lead to cocaine addiction, a DRE can lead to other more serious and costly tests that we would rather avoid. So if you are anti-pot, you should logically be against DREs, too.
#3: DREs can be habit-forming
Once you have one, I’m willing to bet you’ll have another, and another …
Not only is a DRE like a gateway drug to bigger and better ones (see #2 above), it is addictive in and of itself. I know of nobody who has had just one DRE and called it quits. Once you have one, I’m willing to bet you’ll have another, and another, and many more. That’s just the way it happens. The reasons can be debated, but it really doesn’t matter why this phenomenon exists. It clearly does, and the best way to avoid the habit is to just say no to the first one.
#4: There is a price to pay
… every time a DRE is given, someone is reaching into the piggy bank, and our society can no longer afford such wastefulness.
Even if a digital rectal exam is supposedly included as part of the office visit, it is reasonable to assume that the cost of the giver’s time and material (gloves, lubricant, towels) for the DRE is in some way paid by the getter. It’s just basic economics that every time a DRE is given, someone is reaching into the piggy bank, and our society can no longer afford such wastefulness. Of course, there is also an emotional cost. When this intimate test becomes part of the one-on-one meeting between doctor and patient, their relationship necessarily changes, not usually for the better.
#5: It could make you nervous
I am stealing this from Dr. Ian Haynes (a published PSA-basher), who stated that men should not have PSA tests (see Does the PSA Test Rule Your Life?) because the information gained from them could lead to a prostate biopsy, and the constant fear of this would make him and other men constantly and needlessly nervous. It’s obvious that the same can be said of DREs, so I assume the same Haines-logic would apply there, as well. No more PSA tests! No more DREs! No news is good news, and ignorance is bliss for at least for as long as our blissful ignorance remains blissful.
Where I stand
I am pro-PSA testing and (reluctantly) pro-DREs for one simple reason: The information gained could lead to the diagnosis of a condition that, if treated soon enough, could save my life or my quality of life. Or yours.
Next month I will head to the University of Florida Health Proton Therapy Institute for my fourth annual post-proton prostate checkup. If I am asked if I want a DRE, like a fool I will again say, “Sure! That’s why I drove five hours to get here!” I will grin and bear it, and hope my doctor has had a recent manicure.
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