A prostate exam is a common screening process designed to evaluate the health of the prostate gland, which is situated just below the bladder. It is a routine part of preventive healthcare for men, used to look for early signs of potential issues. Understanding the straightforward procedures involved can help alleviate anxiety about the examination.
Why and When Prostate Screening is Recommended
Early detection of prostate changes can lead to better outcomes, making screening recommended. The decision to begin screening is generally a shared choice between a patient and their healthcare provider, balancing potential benefits against possible harms. For men at average risk, the discussion about screening, which includes the Prostate-Specific Antigen (PSA) blood test, typically begins around age 50, assuming a life expectancy of at least ten more years.
Certain factors increase a person’s risk, suggesting that screening should begin earlier. Men who are African American or who have a first-degree relative diagnosed with prostate issues before age 65 are considered higher risk. For this group, the initial conversation about screening is often recommended to begin at age 45.
Step-by-Step The Digital Rectal Exam DRE
The Digital Rectal Exam (DRE) is a physical procedure that allows a physician to manually assess the prostate gland. No special preparation is typically required for a DRE, which is a brief component of a physical examination. The patient will be asked to undress from the waist down and may be positioned either standing and bending over the exam table or lying on their side with their knees pulled toward their chest.
The physician will put on a glove and apply lubricant to their index finger for comfort. They then gently insert the lubricated finger a short distance into the rectum. Since the prostate gland sits directly in front of the rectum, the doctor can feel its surface and structure.
During the brief examination, the physician assesses several characteristics of the gland. They check the overall size, shape, and consistency of the prostate. The doctor is primarily feeling for any hard areas, lumps, or nodules that might suggest a change in the tissue. While the procedure may cause a momentary sensation of pressure, it is usually fast and causes only minor discomfort.
Understanding the Prostate-Specific Antigen PSA Test
The Prostate-Specific Antigen (PSA) test is a simple blood test that measures the level of a protein produced by the prostate gland. PSA is made by both normal and abnormal cells within the prostate. A healthcare professional will draw a blood sample from a vein in the arm.
The level of PSA is measured in nanograms per milliliter (ng/mL) of blood. While a small amount of PSA is normal, an elevated level may indicate a prostate problem. Conditions like an enlarged prostate (benign prostatic hyperplasia or BPH) or inflammation (prostatitis) can cause PSA levels to rise.
Several other factors can temporarily influence the PSA level, making it important to discuss recent activities with the doctor. Ejaculation and vigorous exercise, particularly cycling, should be avoided for about 48 hours before the blood test, as they can transiently increase the PSA reading. A recent urinary tract infection or a biopsy procedure can also cause a temporary elevation.
Following Up on Screening Results
Interpreting the results involves looking at the PSA number and the DRE findings together. There is no single cutoff for a “normal” PSA level, but the probability of an issue increases as the number rises. For instance, a PSA level between 4 and 10 ng/mL is associated with about a 25% chance of a prostate issue being present.
If the PSA level is elevated or the DRE reveals a suspicious lump or hard area, the next step is not automatically a diagnosis of serious illness. The doctor may recommend repeating the PSA test a few weeks later to confirm the original finding, especially if a temporary factor may have caused the initial rise. If the PSA remains high or continues to increase quickly, further investigation is warranted.
This additional testing may include advanced imaging techniques like a multi-parametric MRI (MP-MRI) or a referral for a prostate biopsy. The biopsy is the only definitive way to determine if a condition is present. The goal of this follow-up process is to accurately identify any significant issues while avoiding unnecessary invasive procedures.