A prostate exam is a common health screening tool used to check the health of a small gland that sits deep within the male pelvis. The prostate gland is roughly the size of a walnut, located just beneath the bladder and in front of the rectum. Its main function is to produce the fluid that nourishes and transports sperm in semen. Because of its location, changes in the prostate, such as enlargement, can affect urinary function. This screening procedure is a routine part of preventive medicine, and understanding the process can help demystify what is often a source of anxiety for many men.
The Purpose and Candidates for the Exam
The primary motivation for a prostate exam is to screen for early signs of prostate cancer and to investigate symptoms like difficulty urinating or a weakened stream. Screening guidelines suggest men with an average risk should begin discussing screening with their healthcare provider around age 50. This discussion involves weighing the benefits and risks of testing, leading to a shared decision.
Men in higher-risk categories are advised to start the conversation earlier, often around age 45. This includes African American men, who have a higher incidence of prostate cancer, and men who have a first-degree relative (a father or brother) diagnosed with the disease before age 65. For those with multiple first-degree relatives diagnosed at an early age, starting screening discussions as early as age 40 may be suggested.
The Digital Rectal Exam Procedure
The Digital Rectal Exam (DRE) is the physical portion of the prostate exam, allowing the physician to manually assess the gland. Before the exam begins, the healthcare provider will explain the steps and ask the patient to choose a comfortable position. This is typically either standing and bending forward over an exam table or lying on their side with knees pulled toward the chest. The physician will first inspect the area for any external abnormalities before proceeding with the internal assessment.
The provider then applies a generous amount of lubrication to a gloved index finger. They gently insert the finger a short distance into the rectum, which allows them to reach the prostate gland located on the anterior wall of the rectum. The patient may be asked to take a deep breath and relax the sphincter muscle during this brief insertion. The entire manual examination usually takes only a few seconds.
The doctor is feeling for several specific characteristics of the prostate during the DRE. A normal prostate should feel soft and rubbery, similar to the fleshy part of the palm at the base of the thumb. The physician assesses the gland’s size, shape, and symmetry, noting that the prostate has two lobes separated by a slight groove. The detection of any firm areas, hardness, or small lumps (nodules) raises concern, as these findings may indicate the presence of disease.
Understanding Related Screening Methods
The Digital Rectal Exam is most often paired with a blood test that measures the level of Prostate-Specific Antigen (PSA) in the blood. PSA is a protein produced by both normal and cancerous cells in the prostate gland, and a small amount is routinely found circulating in the bloodstream. The PSA test is a simple blood draw and is considered a marker specific to the gland but not specific to cancer itself.
Elevated PSA levels can be caused by a number of conditions besides cancer, including benign prostatic hyperplasia (BPH), which is a non-cancerous enlargement, or inflammation of the gland (prostatitis). This lack of specificity is a limitation of the PSA test, as it can lead to false-positive results that cause unnecessary anxiety and potentially lead to further invasive testing.
The PSA test is used to detect high levels that might signal a problem, but it cannot definitively diagnose cancer. Because of the potential for false positives and the possibility of identifying slow-growing cancers, the decision to undergo regular PSA screening is individualized. For men who choose to be tested, the frequency of future screening may depend on the initial result, with lower PSA levels suggesting a longer interval between tests.
Interpreting Results and Next Steps
A normal screening result means the DRE found a prostate that feels smooth and appropriately sized, and the PSA level is within an expected range. For most men, a PSA level below 4.0 ng/mL is generally considered normal, though this threshold can be adjusted based on age. If both the DRE and PSA are normal, the recommendation is typically to continue monitoring prostate health with routine check-ups.
If the DRE identifies a firm area or nodule, or if the PSA level is elevated, these are considered abnormal findings that warrant follow-up. An elevated PSA, particularly between 4.0 and 10.0 ng/mL, indicates an increased, but not definite, risk of prostate cancer. Only about 25% of men with PSA levels in this range are ultimately found to have cancer through subsequent testing.
The next steps after an abnormal result are determined through discussion with the healthcare provider. This may involve repeat testing to confirm the PSA elevation, ruling out temporary causes like a recent infection or ejaculation. The doctor may order additional tests, such as a Prostate Health Index (PHI) or a prostate MRI, to better assess the risk. If suspicion remains high, the definitive next step is typically a prostate biopsy, where small tissue samples are removed and examined for cancer cells.