What Is a Prostate Exam?

A prostate examination is also called a digital rectal exam (DRE). During the exam, your healthcare provider inserts their finger into your rectum to feel your prostate gland. This gland is under your bladder and behind your penis. It's where semen is made.

A prostate exam is done to check the shape of your prostate. If it is bigger than normal or has an unusual shape, it could be a sign of a condition like cancer.

While it's common to feel uneasy about getting a prostate exam, it only takes a few minutes and usually does not hurt.

This article will go over why a prostate exam is done and what to expect when you have one.

Purpose

Prostate exams are very common. The exam is considered standard medical care. A prostate exam is part of the general health screening recommendations for people with prostates who are age 50 and over. They are also recommended for younger people who are at risk of getting prostate cancer.

A DRE is also done if a person has symptoms of a prostate that is bigger than usual (an enlarged prostate) or symptoms of prostate cancer.

Symptoms that could prompt a prostate exam include:

• Being unable to empty your bladder completely (urinary retention)
• Feeling strong, sudden urges to urinate (urinary urgency)
• Leaking urine
• Urinary dribbling

Screening Guidelines

There are different guidelines for prostate screening for people who do not have symptoms. The screening can include a DRE or a PSA (prostate-specific antigen) blood test. PSA is a protein that is produced by some prostate cancers.

Your provider might want you to have both tests. Usually, they can both be done during the same appointment.

The American Cancer Society (ACS) recommends talking to your doctor about a prostate exam if you're age 50 or older. However, you might need to have the conversation sooner:

• If you are African American or have a first-degree relative that was diagnosed with prostate cancer before the age of 65, the ACS recommends talking to your provider about an exam before the age of 45.
• If you have more than one first-degree relative who was diagnosed with prostate cancer before the age of 65, the ACS recommends talking to your doctor about screening by the time you turn 40.

Why Do Guidelines Change?

Screening recommendations change over time. They can also differ between organizations. The changes are necessary because of the cost of testing and the accuracy of the tests.

One example is the rate of false positives and false negatives. This means that sometimes, a test says that a person has cancer when they do not. Other times, a person has cancer but the test says that they don't.

This can happen with PSA and DRE tests, depending on how sensitive they are. If the test is too sensitive, a person might be diagnosed when they do not really have cancer. On the other hand, if the test is not sensitive enough, the diagnosis can be missed.

Step-by-Step

After talking to your provider, you will need to give them permission to do the exam. This is called giving consent.

A prostate exam usually doesn't hurt. You should not have side effects or problems when it's over.

Results and Follow-Up

Your provider will be able to tell how big your prostate is and what shape it is during the exam. They might compare it to a previous DRE exam if you've had one.

A normal prostate gland is about two to four centimeters long, shaped like a triangle, and feels firm and rubbery.

The results of a DRE depend on what your provider felt. In addition to screening for prostate cancer, a DRE can also tell if the prostate is enlarged or if there is a mass of the rectum or anus.

Follow-Up

If your provider finds an abnormality on your prostate exam, you may need to have more testing. They might want you to do a PSA blood test, an imaging test, or a biopsy, to get a better idea of how your prostate is working.

A test called transrectal ultrasonography (TRUS) can be used to take pictures of the prostate. It can also guide a provider when they're getting a sample of tissue to test (biopsy).

Another imaging test your provider might use is magnetic resonance imaging (MRI). It can be used to get a better picture of the prostate and the areas around it like the lower spine and the bladder. These structures can be affected by prostate disease or cancer.

If a PSA test was not done when you had a DRE, that might be the next step. If your PSA level is high, your provider will tell you what other tests are needed.

Scheduling Your Next Exam

After the age of 50, you will probably need to schedule prostate exams regularly. Usually, they are recommended every year if your first exam did not find any abnormalities and you are otherwise healthy.

However, recommendations vary. Your provider will let you know when you need to have your next prostate exam.

Treatment

If your provider finds that you have a condition affecting your prostate, they might want to do more tests. You may need imaging tests, additional exams, or a biopsy.

Once your provider gets more information from these tests, they can recommend the best treatment for your condition. For example, you might need to start medication, have surgery, or have radiation therapy.

Summary

A prostate exam is also called a digital rectal exam (DRE). A healthcare provider places a finger into a patient's rectum to feel the prostate. This allows them to see if the prostate is normal in shape and size.

If a person's prostate is larger than normal or unusually shaped, they can have other tests to figure out what is causing the abnormalities.

Most people with a prostate need to start talking to their doctor about DREs when they're about age 50. However, people with certain risk factors, like a family history of prostate cancer, need to have the conversation sooner.

A Word From Verywell

Many people are anxious or scared to have a prostate exam. Sometimes, people put off having the exam completely even if they have symptoms that are concerning.

It's understandable to be nervous about the exam or even feel embarrassed about it. However, it's a very important preventive health step to take. Prostate exams can help catch conditions like cancer early.

Once you've had your first prostate exam, scheduling the next will be easier. You can talk to your provider about how often you need to have the exam, as well as whether you need other tests.