Everything You Need to Know Before a Prostate Exam

A prostate exam is a digital rectal exam (DRE) — a rectal exam performed with a finger — to feel the prostate. The prostate is a small gland that is part of the male reproductive system. It's located between the penis and bladder and helps produce essential parts of semen. 

During a prostate exam, a healthcare provider gently inserts a gloved, lubricated finger into the rectum. This allows them to check the prostate's size, shape, and texture. Healthcare providers use prostate exams to detect inflammation, infection, enlargement, and some types of prostate cancer, which is the most commonly diagnosed cancer in men. In fact, the average American male has an 11% chance of getting prostate cancer in their lifetime.

Keep reading to find out more information about prostate exams, and if you should get one. 

Prostate Exam vs PSA Test 

A prostate exam and prostate-specific antigen (PSA) test are two different tests. Each gives healthcare providers clues about the condition of your prostate, including infections, inflammation (swelling), hyperplasia (enlargement), and cancer. 

A prostate exam is part of a physical examination where your healthcare provider manually palpates (feels) the edges of your prostate. This exam provides them information about your prostate's shape, size, and texture. 

The PSA test, on the other hand, is a blood test that checks for a protein called prostate-specific antigen, which can indicate prostate cancer risk. To perform this test, your healthcare provider sends a blood sample to a laboratory for analysis. 

Healthcare providers often use both tests together to screen and monitor for prostate cancer since prostate exams sometimes find cancers that PSA tests don’t, and vice versa. Neither test alone will tell you for sure if you have prostate cancer. If either is abnormal, and cancer is suspected, your healthcare provider will order a biopsy to confirm. A biopsy is when a healthcare provider places a small needle into the prostate. They remove tiny pieces of tissue and view them under a microscope to check for cancer cells

Who Should Get a Prostate Exam?

If you are having symptoms of prostate problems, it’d be a good idea to get a prostate exam. Screening for cancer may not be as straightforward for several reasons, including: 

• There is no standard recommendation, guideline, or consensus among all professional organizations
• Risk is not the same for everyone
• Not all prostate cancers are the same 
• Some types of prostate cancers grow slowly and don’t cause problems
• High-risk or aggressive cancers can spread fast and can be fatal
• There is a risk of false positives, overtreatment, treatment side effects, and anxiety

Prostate cancer risk increases with age. Men over 50, who are expected to live at least 10 more years, should routinely be screened for prostate cancer. 

Those older than 75 do not need regular screenings. This is because most prostate cancers are slow growing, and the risks of screening and treatment often outweigh the benefits after this age.

Healthcare providers often encourage earlier screenings (age 40-45) for those at higher risk, including:

• Men of African ancestry or descent
• Men with a family history of prostate cancer (especially for first-degree relatives (brother or father) diagnosed at 65 or younger)
• Men with a family history of multiple cancers
• Men with genetic mutations that put them at higher risk

The frequency of prostate screening depends on your cancer history, PSA levels, general health, and preferences.

Talk with your healthcare provider to make an informed, shared decision about how to move forward. Some men find that using a decision aid regarding prostate and PSA screening can help. 

Signs of Prostate Problems

Early prostate cancer does not typically cause symptoms and not all men with prostate cancer have symptoms. However, advanced prostate cancer may cause problems with urination (peeing), including:

• Straining
• Difficulty starting and stopping urination
• Urinary frequency (peeing a lot, especially at night)
• Weak urine flow
• Interrupted urine flow
• Problems emptying the bladder
• Burning or pain with urination
• Urinary incontinence (dribbling or not able to control pee)

Prostate cancer can also cause:

• Blood in the semen or urine
• Erectile dysfunction 
• Hip, back, or chest pain
• Numbness or weakness in legs and feet
• Bowel incontinence (not able to control bowel movements or pooping)

These symptoms can stem from benign (non-cancerous) problems. For example, urinary or prostate infections and benign prostatic hypertrophy (BPH) (prostate enlargement) can cause urination problems. Diabetes, smoking, cardiovascular disease, and aging can cause erectile dysfunction.

How Is a Prostate Exam Performed? 

Your healthcare provider will perform a digital rectal exam (DRE) to feel the prostate. Before completing the exam, the healthcare provider will ask you to lie on your side or lean over the examination table. 

They will gently spread your buttocks and insert one lubricated and gloved finger into the rectum through the anus. Next, they will rotate their finger in a circular motion to feel the size and texture of the prostate. 

If your healthcare provider is checking your anal sphincter, they may also ask you to relax, bear down, or cough before removing their finger. Depending on your symptoms, they might also check their gloved finger for evidence of bleeding.

What Does a Prostate Exam Feel Like?

It’s normal to feel nervous before your first prostate exam because you don’t know what to expect. This is completely common. A prostate exam may feel invasive or uncomfortable physically, emotionally, and mentally. 

While you will feel some pressure or discomfort, it is not typically painful. It may also make you feel like you have to urinate. This is especially true if your prostate is enlarged.

Many people find it helpful to practice breathing or visualization exercises during any healthcare exam that feels invasive. This includes having your blood drawn, getting a shot, or having a prostate exam.

What To Expect After a Prostate Exam

A prostate exam should only take a couple of seconds. Once your healthcare provider is done examining your prostate, they will remove their finger from your rectum. They may offer you a tissue so you can clean up before getting dressed. 

You can go back to normal activities after the exam. If you have hemorrhoids or anal fissures, you may have some mild rectal bleeding for a little while. Notify your healthcare provider or go to an emergency room if you have large amounts of bleeding. 

Your healthcare provider should let you know if you need recurrent prostate exams. They will base this on your overall health, history, age, family history, risk, and environmental risk.

Understanding Prostate Exam Results

During a prostate exam, your healthcare provider will check the size, shape, and texture of your prostate. The average size of the prostate is 2-4 centimeters. It’s typically triangular in shape and has a firm, smooth, or rubbery consistency. Your provider will note any bumps, inflammation, or enlargement. 

When everything seems normal, your provider will discuss screening options with you. With abnormal results, they may ask you more questions and may want to perform more tests. This might include a PSA test or biopsy.

An abnormal prostate exam or an elevated PSA could indicate prostate cancer. But, it may also indicate benign (non-cancerous) conditions. This includes prostatitis (inflamed or swollen prostate) or benign prostatic hyperplasia (BPH) (an enlarged prostate).