What Is a Prostate Exam?

A prostate exam is done by a healthcare provider to feel for problems with the prostate, a walnut-sized gland located between the bladder and penis. It's also called a digital rectal exam because it involves the insertion of a gloved, lubricated finger into the rectum.

A prostate exam can check for an infected, enlarged, or inflamed prostate. If you have symptoms such as trouble urinating, your healthcare provider may recommend a prostate exam to find the cause.

A digital rectal exam is also used to screen people who are at risk for prostate cancer. Prostate cancer screening recommendations are based on your age (usually over 50), overall health, and risk factors.

How often you need a prostate exam depends on your age and health. This article will explain what a prostate exam is used for, what to expect during and after a prostate exam, and what the results of a prostate exam mean. You'll also learn how often you should have a prostate cancer screening.

Who Should Get a Prostate Exam?

A prostate exam is usually recommended if you have symptoms that indicate a problem with your prostate, such as difficulty passing urine.

Signs and Symptoms of Prostate Problems

Signs and symptoms of a problem with your prostate include:

• Difficulty starting or stopping urination
• Straining when urinating
• Having the urge to urinate again soon after urinating; not emptying the bladder completely
• Increased urinary frequency
• Urgency (a sudden need to urinate)
• Getting up multiple times at night to pee
• Weak urine stream
• Prolonged dribbling of urine
• Blood in the urine or semen

While urinary problems can be a sign of prostate cancer, there are also causes that are not cancer, like an infected, inflamed, or enlarged prostate.

Prostate Exams to Screen for Cancer

However, you may benefit from a prostate exam even if you have no symptoms, especially if you're at risk for prostate cancer.

Your risk for prostate cancer increases if you:

• Are over the age of 50 years old
• Are African-American
• Have a family history of prostate cancer

A DRE is one of two tests that healthcare providers may use to screen for prostate cancer. The other is the prostate-specific antigen (PSA) test, a blood test that measures the amount of PSA in the blood. Sometimes, high levels of PSA are linked to prostate cancer.

Note that prostate cancer screening is controversial. The United States Preventive Services Task Force (USPSTF) does not recommend a DRE, saying that there is a lack of evidence of its benefits.

In addition, the USPSTF and other groups argue that whether or not to get screened with a PSA test should be an individual decision between a person and their healthcare provider. This is because the tests often have false positive results or lead to unnecessary treatments that can have serious complications.

The American Cancer Society suggests having that conversation by age 50, or sooner if:

• 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.
  

What Happens During a Prostate Exam?

If you're going to have a prostate exam, it's normal to feel nervous or even embarrassed about the test. It will help to know what to expect during a prostate exam.

You don't need to do anything specific to prepare for a DRE. Your provider will walk you through the steps of a DRE, but ask them questions if any parts of the exam are not clear.

A DRE can be done while you are standing or lying down. Your position will depend on factors like the layout of the exam room and any health conditions you may have.

If you're going to stand during a DRE:

1. First, you will be asked to face the exam table or bed, with your feet apart, your body bent forward, and your arms or elbows on the table or bed.
2. Next, your provider will coat their gloved finger in lubricant.
3. Then, they will put their finger into your rectum at a downward angle. You may feel a little pressure or slight discomfort, but it should not hurt. It is important to relax, take deep breaths and let your provider know if you feel any pain during the exam.
4. It may take a few seconds for the muscle that opens and closes when you have a bowel movement (external sphincter muscle) to relax. Your provider may ask you to bear down as if you are having a bowel movement.
5. Then, they will move their finger in a circular motion to feel for the lobes of your prostate gland. 
   

During a DRE, your provider will be checking for:

• Lumps on or around the prostate
• Swelling 
• Tenderness
• Hard spots or bumps
• Abnormalities in the prostate

After a Prostate Exam

When they are done with the exam, your provider will take their finger out of your rectum. You might be offered some tissue or wipes to clean off the lubricant.

From start to finish, a prostate exam only takes a few minutes. You don't need to do anything after the exam and can go about the rest of your day as usual.

What Your Prostate Exam Results Mean

If the results of your prostate screening are not normal, your provider may want you to have more tests done, like a magnetic resonance imaging (MRI) of your prostate. They might also want to do a prostate biopsy to look for signs of cancer.

If your prostate screening is normal, your provider can look at your PSA blood test results to figure out when you should have your next prostate cancer screening.

How Often Do I Need a Prostate Exam?

There are different factors that will determine how often you need to have a prostate exam and prostate cancer screening.

While PSA levels are one factor, they vary by age. Other factors like your family history, overall health, diet, and lifestyle, also play into how often you should have your prostate checked.

Your provider will take all of these factors into account when they are recommending the timing and frequency of your future prostate cancer screenings.

If you're not due for a prostate cancer exam yet but notice changes in your health or are having symptoms that you think might be related to your prostate, don't wait. You can always ask your provider for a checkup sooner.

Summary

A prostate exam or digital rectal exam (DRE) is when a healthcare provider uses a gloved finger to examine the prostate gland through the rectum. The exam only takes a few minutes and should not hurt.

Your provider can do a DRE as a screening tool for prostate cancer or to figure out if you have an infected, enlarged, or inflamed prostate that is causing symptoms.

The screening recommendations for prostate cancer depend on your age (usually when you're older than 50), overall health, family history, race/ethnicity, symptoms, and other risk factors.

A prostate-specific antigen (PSA) test is an additional screening or diagnostic tool. If your provider is concerned about your DRE results, they may want to do more tests, like an MRI or biopsy.

If you don't have symptoms but are worried about getting prostate cancer, go over the risks and benefits of having a prostate cancer screening with your provider.