• Posted May 31, 2023

Need a Prostate Exam? Here's What to Expect

You're due for a prostate exam, but you don't know what to expect.

So, what is this exam like?

Regular check-ups are essential for maintaining your health, and a prostate exam is crucial to preventive care for men. Not only is it a screening test for early signs of prostate cancer, but it also helps detect other potential health issues.

Here, experts walk you through what a prostate exam entails, when to consider scheduling one, how to prepare, and what the results might mean for you. So, dive in and learn more about this medical examination that every man should get at some point in his life.

What is a prostate exam?

Per the Cleveland Clinic, a prostate exam is a screening method to detect early signs of prostate cancer. Typically, the exam involves two main components: a prostate-specific antigen (PSA) blood test, and a digital rectal exam.

The PSA blood test measures the levels of PSA in the bloodstream. According to the U.S. Centers for Disease Control and Prevention, PSA is a substance produced by the prostate gland, and higher levels can indicate the presence of prostate cancer. However, it's important to note that elevated PSA levels can also be caused by other prostate-related conditions and factors such as age and race.

Medical procedures, medications, an enlarged prostate or a prostate infection can all influence PSA levels. Therefore, it is crucial to consult with your doctor to accurately interpret PSA test results. If the PSA test shows abnormal results, your doctor may recommend a biopsy to determine if prostate cancer is present.

The other test that is often conducted during a prostate exam is the digital rectal exam, or DRE. The prostate gland is located just in front of the rectum. The Prostate Cancer Foundation says that during this part of your prostate exam, your doctor will gently insert a lubricated, gloved finger into the rectum to assess the size, shape and texture of the prostate for any irregularities. Although the test is brief, it may cause some discomfort, but it should not be painful.

By combining the PSA blood test results and the digital rectal exam, health care providers can gather vital information to evaluate the health of your prostate.

When should men get a prostate exam?

The ideal prostate exam age can vary, depending on individual risk factors. According to the American Cancer Society (ACS) recommendations, men should have an informed discussion with their health care provider about the potential benefits and risks of prostate cancer screening starting at age 50 for average-risk individuals.

• For men at higher risk, such as those with a family history of prostate cancer or Black men, the discussion should take place at age 45.
• Men at even higher risk, such as those with multiple close relatives diagnosed with prostate cancer before age 65, may consider starting the discussion as early as age 40.

Further, the Prostate Cancer Foundation suggests that Black men are 1.6 times more likely to get prostate cancer. For this reason, if you are Black or if you have a family history of prostate cancer, you should talk with your doctor about starting a prostate exam at age 40.

The frequency of prostate exams also depends on the individual's risk profile and the results of previous screenings. Based on the ACS guidelines, if the initial PSA blood test and digital rectal exam results are normal, further testing is typically recommended every two years. However, if the results indicate a higher risk, more frequent screenings may be necessary.

How to prepare for a prostate exam

Preparing for a prostate exam typically requires minimal effort. As per the Cleveland Clinic, there is little specific preparation needed. However, it is important to inform your health care provider if you have existing conditions such as hemorrhoids, anal fissures or anal tears, as they may cause discomfort during the exam. Additionally, your health care provider may advise abstaining from sexual activity for 48 hours prior to the exam. Ejaculation can temporarily raise PSA levels, which might affect the accuracy of your test results.

Regarding the common question on whether you should poop before a prostate exam, urologist Dr. Wagner Baptiste suggested in a recent article that it is acceptable to do so if you feel the need.

"But don't force it if you don't need to move your bowels," Baptiste added. "There's no specific bowel prep necessary. It's common for poop to appear during the exam, but your doctor is used to it and knows what they're doing and knows where your rectal wall lies to move feces out of the way."

What is a prostate exam like?

"A prostate exam is a digital or finger exam in the rectum to feel the prostate through the rectal wall,"Dr. Matthew Sand, a urologist at Piedmont Physicians Urology in Atlanta, said in a recent article. "We estimate the size of the prostate and then we feel around for nodules, which are concerning for prostate cancer."

Sand explained that the purpose of the exam is to assess the size of the prostate and check for any nodules that could indicate prostate cancer. The procedure is fairly straightforward and typically lasts only a few seconds.

"The whole procedure probably takes three to five seconds," Sand noted. Despite its brevity, the prostate exam serves as a crucial step in monitoring prostate health.

What do the results mean?

"Screening can lead to earlier prostate cancer detection, and with earlier detection, you're eligible for multiple different treatments or active surveillance,"said Dr. Sia Daneshmand, director of urologic oncology at Keck Medicine of USC and a professor of clinical urology at USC's Keck School of Medicine. "So we encourage patients who are candidates for screening to discuss it with their urologist and/or primary care physician so that we can determine what's the best course of treatment for them."

According to the CDC, the goal of screening for prostate cancer is to detect cancers that may be at a high risk of spreading if left untreated and to identify them before they have a chance to spread.

However, the U.S. National Cancer Institute states there is no specific normal or abnormal level of PSA in the blood. While PSA levels below 4.0 ng/mL were previously considered normal, it is important to note that some individuals with levels below this threshold can still have prostate cancer, while many with levels between 4 and 10 ng/mL do not have prostate cancer.

PSA levels can fluctuate due to age, prostate gland size, inflammation or infection, recent prostate biopsy, ejaculation and intense exercise. Certain medications used to treat an enlarged prostate can lower PSA levels. Generally, a higher PSA level increases the likelihood of prostate cancer, but it is crucial to interpret PSA results in consultation with a health care provider who can assess the individual's overall risk profile and consider additional factors for a more accurate diagnosis.