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The Prostate Exam: What You Should Know

Why are prostate exams performed?

Key points

  1. A prostate exam can help your doctor diagnose an enlarged or inflamed prostate.
  2. It typically involves a DRE and a test for PSA levels.
  3. Starting at age 50, all men should discuss prostate cancer screening with their doctor.

Your prostate is a walnut-sized gland located near your bladder. The prostate helps in the production of seminal fluid.

A prostate exam can help your doctor diagnose an enlarged or inflamed prostate. It can also help them diagnose prostate cancer, which is the second most common form of cancer among American men.

The exam typically involves a digital rectal exam (DRE) and a test for prostate- specific antigen (PSA) levels. Your doctor may want to perform a prostate exam if you have symptoms of an enlarged prostate. Some doctors do it as part of a routine checkup.

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Risk factors

Who should get a prostate exam?

Starting at age 50, all men should discuss prostate cancer screening with their doctor. The American Cancer Society (ACS) advises men at higher risk to have this conversation at age 45.

You’re considered to have an increased risk if you’re African-American or if a first-degree relative had prostate cancer before age 65. If more than one first-degree relative had prostate cancer before age 65, you might want to consider beginning prostate cancer screening even earlier.

The ACS estimates there will be about 180,890 new cases of prostate cancer in the United States in 2016. About 26,120 men will die from it.

Prostate cancer is easier to treat before it spreads. However, some prostate cancers are so slow-growing that they don’t always require treatment. A lot depends on your age and other factors.

Discuss your risk factors with your doctor, and ask if you should have a prostate exam as part of your yearly checkup.

DRE

What is a digital rectal exam?

The most common way for doctors to check on the health of your prostate is with a DRE. It’s a fairly quick and simple procedure.

For the exam, you’ll bend at the waist while standing or lie on your side with your knees bent toward your chest.

Your doctor will lubricate a gloved finger and gently place it inside your rectum. They’ll press one hand on your prostate, and their other hand will feel your pelvic area. It should only take a few moments.

You may experience momentary discomfort. You may also feel the urge to urinate, especially if your prostate is enlarged or inflamed.

Your doctor will be able to tell you if your prostate seems to be a normal size and shape. In general, a DRE has no risks.

Learn more: Digital rectal exam »

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PSA

What’s a prostate-specific antigen exam?

Your doctor may also test your blood for PSA levels to screen for prostate cancer. PSA is a protein that helps liquefy semen.

It’s normal for some PSA to get into your bloodstream. Several things can cause your PSA levels to rise above normal, including:

  • an inflamed or infected prostate
  • an enlarged prostate
  • some forms of prostate cancer

Certain forms of prostate cancer can lower your PSA.

Before having the test, ask your doctor about the pros and cons. The PSA test can result in false-positives and false-negatives for prostate cancer. This can lead to additional testing and treatment, which may cause anxiety.

Learn more: Prostate-specific antigen (PSA) exam »

Preparation

How should I prepare for the exam?

You should tell your doctor if you have hemorrhoids, anal tears, or other problems with your anus. The exam will be easier if you breathe normally and try to relax.

Before having a PSA test, tell your doctor about any medications and supplements you take. Recent ejaculation can also affect your PSA levels. Ask your doctor if you should abstain from sexual activity before the test.

Cost of a Prostate Exam

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Results

What happens after the exam?

Your blood must be sent to a laboratory for analysis, so your PSA results won’t be available immediately. Your doctor will let you know when they have the results.

The lab report will show the level of PSA in your blood as:

PSA level in blood

In addition to looking at the amount of PSA in your blood, your doctor will assess how quickly this number is changing. Many things can affect PSA, so test results require careful analysis by an expert. Your doctor will take all of your health information into account.

If you have an abnormal PSA test result, it doesn’t mean you have prostate cancer. Most men with a high PSA level don’t have prostate cancer. About 25 percent of men who have a biopsy due to a high PSA level have prostate cancer.

It’s also possible for men with prostate cancer to have normal DRE and PSA test results.

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Outlook

What happens next?

If they find anything that concerns them during the DRE, your doctor will discuss it with you then. An enlarged prostate is fairly common, especially as you age.

An abnormal PSA result may require further study. Your doctor may want to repeat the test. If they suspect you have prostate cancer, they may recommend other diagnostic tests.

For example, a transrectal ultrasound uses sound waves to provide images of your prostate. For this test, your doctor inserts a small probe into the rectum. The test takes about 10 minutes. It can be uncomfortable, but it usually isn’t painful and doesn’t have lasting side effects.

A biopsy can also help confirm or rule out cancer. For a biopsy, a doctor uses a needle to remove several pieces of tissue from your prostate. They may use a transrectal ultrasound to guide the needle to the right position. The tissue samples are examined under a microscope for signs of cancer.

The biopsy takes about 10 to 15 minutes. You may have some tenderness and minor bleeding after the procedure.

The results will determine the next steps.

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