Issue 10/2022
T. Genadiev,
Medical Center „Dr. Genadiev“ – Sofia
A digital rectal examination is the only physical examination for the diagnosis of the prostate gland. In this role, the method is not replaced by another. Tumor markers, genetic testing, and imaging can complement the physical findings of the rectal examination, but do not negate the diagnostic role and value of the method. We present a case from our practice of a 48-year-old man with initial dysuric complaints, diagnosed with chronic prostatitis by prostate-specific antigen and magnetic resonance imaging. Conducted a series of urological consultations within 3-4 months, without performing a rectal examination of the prostate gland.
From our review, we identify a locally advanced carcinoma of the prostate gland initially presenting with normal or mildly elevated total prostate-specific antigen values. Biopsy showed adenocarcinoma of the prostate gland from all sites, Gleason score 9. From the review of the literature, it is understood that rectal exam is optional and of debatable value in prostate cancer screening. On the other hand, the method is essential for early diagnosis and for determining the local status of the prostate gland. We have accepted the rectal examination of the prostate gland as mandatory in our practice, after informing the patient about the importance of the method. Magnetic resonance and tumor markers are not sufficient for the diagnosis of prostate gland, especially in patients under 50 years of age, with initial complaints and slightly elevated values of the general tumor marker. The urologist should determine the prostate-specific antigen value for each patient by performing a rectal exam to determine local status. In some cases, low-differentiated carcinoma occurs, which develops initially with a low or normal value of total prostate-specific anigen. We can conclude that rectal palpation of the prostate gland remains the main physical diagnostic method. In addition to prostate-specific antigen and/or magnetic resonance imaging, the method favors early and precise diagnosis, especially in patients with a long-term life expectancy.
Address for correspondence:
T. Genadiev
Urological practice „MD Genadiev“, Sofia
4, “Petar Protich” , Str.
1000, Sofia
e-mail: tsvetin.genadiev@gmail.com