One reason so many cases of prostate cancer are not caught early is obvious: Too many men don’t get regular physicals that include a digital rectal examination (DRE), the first step in diagnosis, when a doctor feels for a knot, lump, or anything abnormal that might be a tumor. (In men with cancer, the doctor uses the rectal exam to learn as much as possible about the cancer—does it encompass part of one lobe, one entire lobe, or both lobes of the prostate? Has the cancer spread outside the prostate, into the pelvic side wall or the seminal vesicles?)
But even for those who do get checked yearly, the digital rectal exam is not an ironclad guarantee that cancer will be found in time. As many as 40 percent of all prostate cancers begin their growth in an inopportune spot, at a point where a doctor’s finger simply can’t reach. Therefore, many patients have advanced disease by the time it is diagnosed with a digital rectal exam. Also, the digital rectal exam is only as good as the doctor performing it; it is a subjective test.
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