What to Expect During a Prostate Exam

A prostate exam , also called a digital rectal exam (DRE), involves a healthcare professional inserting their finger into the rectum to directly feel the prostate gland, which produces semen and is located under the bladder and behind the penis.

This is done to see if your prostate is enlarged or abnormally shaped, which could indicate abnormalities or cancer. While there are often some questions about how to get it, a prostate exam only takes a few minutes and is relatively painless.

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Prostate exams are very common and are considered standard medical care. The prostate exam is part of the general screening guidelines for men age 50 and older and for younger men who are at risk for prostate cancer .

DRE may also be performed in men who have symptoms of an enlarged prostate or cancer, the most common of which are :

  • Urinary retention
  • Urge to urinate
  • Leakage of urine
  • Leakage of urine

If you begin to experience any of the above symptoms, it is important to tell your doctor, as this may change the recommended frequency of prostate exams.

Screening recommendations

There are several different guidelines for detecting the prostate in men who have no symptoms. Screening may include a DRE or PSA (prostate specific antigen) blood test, or both, usually during a single visit. (PSA is a protein produced by some types of prostate cancer .)

The American Cancer Society (ACS) recommends that men age 50 and older talk with their doctor about screening for prostate cancer. For African American men or men with first-degree relatives diagnosed with prostate cancer before age 65, both risk factors for the disease, the ACS recommends this discussion at age 45. For men diagnosed with more than one first degree relative. with prostate cancer before age 65 The ACS recommends a discussion of screening at age 40.

Interestingly, the United States Preventive Services Task Force (USPSTF) stopped recommending screening for PSA in 2012, but did not issue a statement on the DRE.

The reason that screening guidelines change over time and differ between organizations is based on the cost of testing and the number of false positives and false negatives. Both PSA and DRE can be overly sensitive, leading to overdiagnosis of prostate cancer, and not sensitive enough, sometimes without being able to make a diagnosis.

Step by Step

After speaking with your healthcare provider, you will need to agree to have a prostate exam.

The procedure itself is not painful, and you shouldn't feel any side effects or problems afterward. Be sure to tell your healthcare provider if you have hemorrhoids or fissures in the anus, as the exam can irritate them.

When your PCP is ready to start:

  • You will be asked to remove your pants and underwear and change into a gown for your exam.
  • Typically, you are asked to stand with your legs apart, facing the exam table, while leaning forward so that your hands or elbows are on the table. If you are nervous about not being able to see what is happening, it is time to ask your doctor to describe each step before it happens. Paying attention to your breathing will also help you stay calm for the next few minutes.
  • Your doctor will put on a surgical glove and coat the finger with lubricant before inserting the finger into the rectum to examine the prostate gland.
  • Your healthcare professional will insert your finger at a downward angle. You may feel a little pressure, but you shouldn't feel pain or discomfort. If it hurts, tell your doctor immediately.
  • It may take your healthcare professional a few seconds to wait for your external sphincter, which is the opening through which you have a bowel movement, to relax.
  • When your doctor examines your prostate, you may notice that your finger moves in a circular motion. This is necessary to identify the lobes and sulci throughout the prostate gland and ensure that no problems are missed. This entire step should take less than a minute.
  • Then your doctor will remove your finger.

When the exam is complete, your healthcare professional or assistant will offer you a pre-moistened tissue or handkerchief to remove any lubricants from your body.

Results and follow-up

Your healthcare provider will evaluate the size and shape of your prostate and can compare it to your previous DRE test, if you had one. A normal-sized prostate is two to four centimeters long, triangular in shape, and should appear firm and elastic.

The results of the DRE depend entirely on your doctor's assessment of how you felt during the exam. In addition to detecting prostate cancer, the DRE can also detect prostate hypertrophy, that is, an enlarged prostate that can cause urinary problems or a mass in the rectum or anus.

Follow up

If your healthcare provider finds an abnormal exam of your prostate, you may need another test, such as a PSA blood test, imaging test, or biopsy, to further evaluate the anatomy or function of your prostate.

In particular, transrectal ultrasound (TRUS) can be used to visualize the prostate, as well as to guide the biopsy. MRI is used to visualize the prostate itself, as well as the area around it, to determine whether nearby structures, such as the lower spine and bladder, are affected by prostate disease or cancer.

If a PSA test was not done during your DRE, it will most likely be done ex post. If there is a suspicion or an increase in PSA levels, more tests will be done.

After age 50, you may need a regular prostate exam, which is often recommended every year if your prostate exam was unremarkable and you are otherwise healthy. However, the recommendations vary and you should discuss this with your doctor.

Watch out

If prostate disease is confirmed after additional tests, you may need medications, surgery or radiation therapy, and follow-up tests with DRE, blood tests, imaging, or biopsy .

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Many men fear or fear a prostate exam. In fact, fears can cause some men to postpone or avoid exams altogether and even ignore the warning signs of potential problems. While this concern is understandable, remember that a prostate exam can reveal health problems before they become serious. As you step into the first test, you may feel, like many men, that this test is not as important as you originally thought.

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