What Is a Prostate Exam?

A prostate examination, also called a digital rectal exam (DRE), is when a physician inserts his or her finger into your rectum to directly feel the prostate gland, which produces semen and is located underneath the bladder and behind the penis. This is done to evaluate for enlargement or irregularity in the shape of your prostate, which can indicate abnormalities or cancer. While it's common to have some hesitancy about getting one, a prostate exam only takes a few minutes and is relatively painless.

Prostate exams are very common and are considered standard medical care. A prostate exam is part of the general health screening recommendations for men age 50 and over and for younger men who have a risk of prostate cancer.

A DRE may also be performed on men who have symptoms of prostate enlargement or cancer are present, the most common of which include:

• Urinary retention
• Urinary urgency
• Leaking urine
• Urinary dribbling

If you begin to experience any of the above symptoms, it's important to mention them to your physician, as this may change the recommended frequency of your prostate exams.

Screening Guidelines

There are a few different guidelines for prostate screening for men who do not have any symptoms. Screening can include a DRE or a PSA (prostate specific antigen) blood test, or both, typically during the same appointment. (PSA is a protein that is produced by some prostate cancers.)

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

Interestingly, the U.S. Preventative Services Task Force (USPSTF) stopped recommending screening with PSA in 2012, but has not issued a statement about DRE.

The reason that screening recommendations change over time and differ between organizations is based on the cost of testing and the rate of false positives and false negatives. PSA and DRE can both be too sensitive, over-diagnosing prostate cancer, and not sensitive enough, sometimes missing the diagnosis.

After a discussion with your doctor, you will need to give consent to proceed with a prostate exam.

The procedure itself is not painful, and after having it, you should not feel any side effects or have any problems. Be sure to tell your doctor if you have hemorrhoids or anal fissures, as they can be irritated by the examination.

When your doctor is ready to begin:

• You will be asked to remove your pants and underwear, and to put on an examination gown.
• Usually, you will be asked to stand, with your feet apart, facing the examination table while bending forward so that your arms or elbows are resting on the table. If you're nervous about not being able to see what's going on, this is a good time to ask the doctor to describe each step to you before it happens. If you pay attention to your breathing, this can also help you stay calm for the next few minutes.
• Your doctor will put on a surgical glove and cover a finger with a lubricant prior to inserting the finger into your rectum in order to examine your prostate gland.
• Your doctor will insert the finger ​at a downward angle. You may feel a little pressure, but you should not feel any pain or discomfort. If it hurts, tell the doctor immediately.
• A few seconds may pass as your doctor waits for your external sphincter muscle, which is the opening through which you poop, to relax.
• As your doctor examines your prostate, you may notice that his or her finger moves in a circular motion. This is to identify the lobes and groove of the entire prostate gland and make sure that no problems are missed. This whole step should take less than five minutes.
• Your doctor will then remove his or her finger.

When the exam is done, your doctor or an assistant will offer you some tissue or pre-moistened wipes to clean the lubricant from your body.

Your doctor evaluates the size and shape of your prostate and may compare it to a previous DRE exam if you had one. A normal-sized prostate gland is around two to four centimeters long, triangular in shape, and should feel firm and rubbery.

Results of a DRE are entirely determined by your doctor's assessment of what he or she felt during the exam. In addition to screening for prostate cancer, a DRE can also identify prostate hypertrophy, which is enlargement of the prostate that can cause trouble urinating, or a mass of the rectum or anus.

Follow-Up

If your doctor identifies an abnormality on your prostate exam, you may need another test, such as a PSA blood test, an imaging test, or a biopsy, to further asses your prostate anatomy or function.

In particular, a transrectal ultrasonography (TRUS) can be used for imaging of the prostate, as well as for guidance with a biopsy. An MRI is used to visualize the prostate itself as well as the surrounding area to identify whether nearby structures, such as the lower spine and the bladder, are affected by prostate disease or cancer.

If a PSA test was not done at the time of your DRE, one will likely be done after the fact if there is a concern.

After age 50, you may need to regularly schedule prostate examinations, often recommended every four years, if your prostate exam was unremarkable and you are otherwise healthy. However, recommendations vary, and you will need to discuss this with your doctor.

Treatment

In the event prostate disease is confirmed after additional testing, you may need medication, surgery, or radiation therapy, as well as follow-up testing with DRE, blood tests, imaging, or biopsy.

Many men are anxious or scared to have a prostate exam. In fact, apprehension can cause some men to put off the exam or avoid it altogether, and even ignore warning signs of potential issues. While that trepidation is perfectly understandable, remember that a prostate exam can catch medical problems before they become serious. After taking the step to have your first one, you may come to feel—as many men do—that the test is not as concerning as you may have originally thought.