How a Healthcare Provider Performs a Prostate Exam

A prostate examination is also called a digital rectal exam (DRE). The prostate is a walnut-sized gland located between the bladder and the penis.

Your healthcare provider may perform a DRE to screen for prostate cancer or to evaluate urination problems which can be a sign of an infected, enlarged, or inflamed prostate. Prostate cancer screening recommendations are based on your age (usually over 50), overall health, and risk factors.

This article will explain what a prostate exam is used for, prostate cancer screening, what you can expect during and after a prostate exam, and how your healthcare provider interprets the results.

How a Prostate Exam Works
Verywell / Michela Buttignol

Prostate Cancer Statistics and Risk Factors

The following are statistics related to prostate cancer in the United States (U.S.):

  • The risk of a man being diagnosed is 11%
  • Their risk of dying from prostate cancer is 2.5%
  • The average age of death from cancer is 80

Risk for prostate cancer increase with:

  • Age (usually over 50)
  • Being African American
  • Family history

Prostate Cancer Screening

There are two types of tests that healthcare providers use to screen for prostate cancer:

A prostate-specific antigen (PSA) test is a blood test that measures the amount of PSA in the blood. Sometimes high levels can be associated with prostate cancer. A digital rectal exam (DRE) is a physical examination in which a healthcare provider places their gloved finger, or "digit," into the rectum to feel the edges of the prostate gland.

Some people are apprehensive about the DRE procedure. To ease your nerves, here is a breakdown of what a DRE entails.

Signs and Symptoms of Prostate Problems

Prostate cancer does not always show symptoms. That's why screening is important as you get older.

Urinary problems can be a sign of prostate cancer. However, there can be many benign (non-cancerous) reasons for an infected, enlarged, or inflamed prostate. Urination (peeing) symptoms that may be caused by prostate problems include:

  • Difficulty starting or stopping urination
  • Straining when peeing
  • Urge to urinate soon after peeing (not emptying your bladder completely)
  • Increased urinary frequency or urgency 
  • Nocturia (getting up multiple times at night to pee) 
  • Weak urine stream
  • Prolonged dribbling of urine
  • Blood in the urine or semen

During the DRE

A DRE can be done while you are either standing or lying down. This may depend on the examination room and any other health conditions that you have.

If standing, you will be asked to stand facing the examination bed, with feet apart, body bent forward, and your arms or elbows on the bed. Feel free to ask your healthcare provider to give you a heads up before each part of your exam.

Your healthcare provider will coat their gloved finger in lubricant. They will insert their finger into your rectum at a downwards angle. You may feel a little pressure or slight discomfort, but it shouldn't hurt. It is important to relax and take deep breaths and let your healthcare provider know immediately if you feel any pain.

It may take a few seconds for your external sphincter muscle (the muscle that opens and closes when you poop) to relax, and your provider may ask you to bear down as if you are having a bowel movement. They will move their finger in a circular motion to identify the lobes of your prostate gland. 

A normal prostate is usually around 2-4 cm long and has a triangular shape with a firm and rubbery texture.

During this exam, the healthcare provider checks for:

  • Lumps on or around the prostate
  • Swelling 
  • Tenderness
  • Hard spots or bumps (the gland should be smooth) 
  • Abnormalities in the prostate

Once finished, your healthcare provider will remove their finger from your rectum. You may be offered some tissue or wipes to clean off the lubricant. The whole procedure should take less than a few minutes from start to finish, and there are no special precautions that you need to take before the exam.

After the DRE

If any abnormalities are found during your DRE, your healthcare provider may order more tests, like a magnetic resonance imaging (MRI) of your prostate, and possibly schedule a prostate biopsy to see if there are any signs of cancer.

If your screening is normal, your doctor may use your PSA blood test results to determine the timing of your future prostate cancer screenings. PSA levels vary by age and other factors.

Ultimately, you and your healthcare provider will decide how often you should be screened. Your family history, diet, health, and lifestyle habits are all factors that affect the recommended timing and frequency of your prostate cancer screenings. Be sure to consult with your healthcare provider if you notice any changes in your health.

Summary

A prostate examination or digital rectal exam (DRE) is when a healthcare provider uses their gloved finger to examine the prostate gland through the rectum. The prostate is located between the bladder and the penis. The exam only takes a few minutes, and there are no instructions before or after the exam.

Your healthcare provider may perform a DRE as a screening tool for prostate cancer or to evaluate symptoms of an infected, enlarged, or inflamed prostate. Screening recommendations for prostate depend on age (usually over 50), overall health, family history, ethnicity, symptoms, and other risk factors.

A prostate-specific antigen (PSA) test may be ordered as an additional screening or diagnostic tool. If the provider is concerned about your DRE results, they may also order more tests such as an MRI or biopsy.

A Word From Verywell

Many men avoid prostate exams because they are embarrassed or concerned about pain. While it may feel a bit embarrassing or uncomfortable at first, it should not cause pain. 

Take deep breaths and think about something relaxing during the procedure. Keep in mind that your provider does this exam routinely, and it should not take more than a couple of minutes. If it does hurt, let your healthcare provider know as that may indicate an underlying health concern.

If you don't have urinary symptoms but are concerned about your risk for prostate cancer, you may want to have a discussion with your healthcare provider regarding the risks and benefits of prostate cancer screening.

Frequently Asked Questions

  • Why do you have to cough during a prostate exam?

    Your healthcare provider may ask you to cough during a rectal exam to determine what happens when your rectal or anal sphincter contracts and relaxes. This gives them information about pelvic floor strength, bladder control, or urinary incontinence (leakage).

  • When should you get a prostate exam?

    The American Cancer Society recommends that average-risk men age 50 and up discuss with their healthcare provider whether a PSA blood test to screen for prostate cancer is right for them. Men at increased risk due to family history or other factors may choose to start screenings earlier. A DRE may also be done as part of this screening.

  • What are symptoms of prostate diseases?

    Keep an eye out for the following symptoms that may indicate an issue with the prostate:

    • Frequent need to urinate
    • Painful or burning urination
    • Painful ejaculation
    • Blood in urine or semen
    • Dribbling of urine
    • Pain or stiffness in the lower back, hips, pelvic or rectal area, or upper thighs
  • Does a prostate exam hurt?

    You may feel a little pressure or slight discomfort, but it shouldn't hurt. It is important to relax and take deep breaths. Let your healthcare provider know immediately if you feel any pain.

Originally written by Lisa Fayed
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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