What Happens During A Prostate Exam

How Is The Test Performed

To perform a DRE, your doctor will gently insert a gloved, lubricated finger into your anus. This allows them to feel for any abnormalities. For example, an enlarged prostate feels like a bulge behind the rectum wall. Prostate cancer may feel like bumps on the normally smooth surface of the prostate.

Read more: What do you want to know about prostate cancer? »

Men may feel pain or the urge to urinate during the exam. This is because your doctor is applying firm pressure to the prostate.

A DRE is typically done as part of a routine physical examination for both men and women. During a gynecological exam, your doctor may perform a DRE to check the space between the rectum and the vagina for any abnormalities. Most men and women feel only minor discomfort during the procedure. People with hemorrhoids or anal fissures may experience a small amount of bleeding.

A DRE isnt suitable for detecting colon cancer. Only a small portion of the lower colon may be accessed during a DRE. However, a DRE may be used to obtain a stool sample. If blood is present in the stool, it may indicate colon cancer or other problems.

Blood isnt always visible to the naked eye in a stool sample, so your doctor may wish to conduct a fecal occult blood test to confirm.

Worried About Having A Dre

Its natural to feel worried or embarrassed about having tests, but some men find the idea of having a DRE upsetting. For example, if youve been sexually abused as a child or an adult, you might feel very upset about having this test. Theres no right or wrong way to feel about this, and it is your choice whether or not you have tests for prostate cancer.

It might be helpful to talk to a counsellor about your experience, thoughts and fears. Or you could contact a charity for people whove been sexually abused, such as the National Association for People Abused in Childhood or SurvivorsUK. If you do decide to have a DRE, explain your situation to your doctor as they can talk through the test with you and help to reassure you.

When I had the DRE I thought, For a few seconds of discomfort, I can live with it. Yeah its uncomfortable, but it could save your life. A personal experience

What Do The Numbers Mean

PSA levels are measured as a number of nanograms in each milliliter of fluid tested. This is written as ng/mL.

• PSA level 2.5 ng/mL or lower: This is a normal PSA level for men under age 60, but in some cases, prostate cancer may still be present.
• PSA level between 2.5 and 4 ng/mL: This is a normal PSA level for most men.
• PSA level between 4 and 10 ng/mL: This indicates that prostate cancer might be present. At this level, there is about a 25% chance that you have prostate cancer.
• PSA level 10 ng/mL or above: There is a 50 percent chance that prostate cancer is present. The higher the PSA rises above 10 ng/mL, the greater the chance that you have prostate cancer.

Your doctor may also monitor your PSA velocity, or doubling time, which means recording your baseline PSA the level at your very first PSA test and seeing how fast the PSA level increases over time. Rapid increases in PSA readings can suggest cancer. If your PSA is slightly high, you and your doctor may decide to keep an eye on your levels on a regular basis to look for any change in the PSA velocity.

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What If We Find Something

A rectal exam can give us an indication that cancer may be present but discovering a lump is not a cancer diagnosis. If the examiner finds the surface of your prostate to be hard and lumpy or your PSA levels are higher than expected you may be referred for additional tests. If you haven’t already seen a Consultant Urologist they may conduct another rectal exam to check the GP’s initial assessment.

The next step is usually to have an MRI scan so an image of your prostate can be examined. If necessary, you may then be referred for a biopsy to take a sample from your prostate. Even then, finding cancer cells in your prostate doesn’t necessarily mean you’ll need cancer treatment. Find out more on the truth about prostate cancer diagnosis here.

*Reference: NHS England

Your Doctor Might Also:

• Give you a physical exam
• Perform a digital rectal exam on men with prostate issues
• Perform a pelvic exam on women
• Order tests
• Perform a cough stress test if you have urinary incontinence

Although some of these tests may be uncomfortable, they can provide important information about your condition. Even though its all new to you, it might help to remember that your urologist has done hundreds of exams and tests. He or she is a professional who wants the best possible outcome for every patient. Your urology staff will do their best to make you feel comfortable and safe.

After your exam, your urologist will talk to you about your condition and possible solutions. When the results of any tests are available, youll discuss the best treatment plan together. Treatments might include medication, physical therapy, or even surgery.

Going to a specialist can be scary but getting the answers you need is important to your health and your peace of mind. When you know what to expect and how to prepare, your first urology appointment will be more comfortable than you ever expected.

Think you need to visit a urologist? Schedule an appointment today.

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Prostate Health: 6 Ways To Keep Your Prostate Healthy

However, suppose you are at a higher risk of prostate cancer or are experiencing urinary or sexual symptoms. In that case, you should have a discussion with your healthcare provider about prostate cancer screening sooner rather than later. People who may have a high risk of prostate cancer include :

• African Americans
• Men with a family history of prostate cancer or who have tested positive for BRCA1, BRCA2, or HOXB13 gene mutations
• Men with symptoms like blood in the urine, painful or frequent urination, or sexual problemsthese may be signs of problems with the prostate, including prostate cancer.

What Happens During A Male Physical Exam

Physical exams assess all systems of the body to determine your overall health. Gender-specific tests are also performed to evaluate the health of your reproductive system. For males, this includes examination of the penis and testicles, to screen for conditions that affect these areas.

If you are experiencing serious medical symptoms, seek emergency treatment immediately.

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What Will I Know Afterwards

A rectal exam can’t definitively diagnose prostate cancer. Only a biopsy can do that and you wont be offered one if you don’t need it. Rectal exams are part of a suite of diagnostic tests, including PSA blood tests and MRI scans, that help to either build or break the case for further investigation.

Table 1 Why A Low Psa Does Not Mean You Are Cancer

The Prostate Cancer Prevention Trial included a provision that men randomized to receive placebo undergo a prostate biopsy at the end of the study, even if they had normal PSA levels and digital rectal exams. To their surprise, investigators found that many of these men had prostate cancer in some cases, high-grade prostate cancer.

PSA level 13 *Note: A PSA level over 4.0 ng/ml traditionally triggers a biopsy. Adapted with permission from I.M. Thompson, et al. Prevalence of Prostate Cancer Among Men with a Prostate-Specific Antigen Level 4.0 ng per Milliliter. New England Journal of Medicine, May 27, 2004, Table 2.

This study inadvertently provided evidence not only that prostate cancer occurs more often than once believed, but also that PSA levels may not be a reliable indicator of which cancers are most aggressive. Both findings add weight to the growing consensus that many prostate tumors currently being detected may not need to have been diagnosed or treated in the first place.

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The Psa: Its More Complicated

An additional test for prostate cancer involves testing your blood for PSA levels. PSA is a protein that helps liquefy semen. Some forms of prostate cancer can lower your PSA, although there may be other reasons why your PSA levels are off.

To guarantee an accurate test, a patient must not have a urine infection, must not have ejaculated for 48 hours before the test, must not have exercised heavily in the previous two days nor had a prostate biopsy within the last six weeks.

You may decide to do the test every one or two years. If the PSA level is high, youre likely to be asked to have more tests done. These might include an examination of the prostate gland and a prostate biopsy. This will depend on your age, family history, ethnicity, body weight and previous medical history.

You will need to consult your doctor about the pros and cons of having a PSA test done. This test may result in false positives and false negatives for prostate cancer. It could lead to additional testing and treatment and may not be recommended for everyone.

If Screening Test Results Arent Normal

If you are screened for prostate cancer and your initial blood PSA level is higher than normal, it doesnt always mean that you have prostate cancer. Many men with higher than normal PSA levels do not have cancer. Still, further testing will be needed to help find out what is going on. Your doctor may advise one of these options:

• Waiting a while and having a second PSA test
• Getting another type of test to get a better idea of if you might have cancer
• Getting a prostate biopsy to find out if you have cancer

Its important to discuss your options, including their possible pros and cons, with your doctor to help you choose one you are comfortable with. Factors that might affect which option is best for you include:

• Your age and overall health
• The likelihood that you have prostate cancer
• Your own comfort level with waiting or getting further tests

If your initial PSA test was ordered by your primary care provider, you may be referred to a urologist for this discussion or for further testing.

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What To Expect During Your Prostate Exam

If you’ve been avoiding a prostate exam, you could be putting your health at risk. Knowing the facts about the procedure will help put any fears, concerns, or squeamishness to rest.

If you’re a man older than 40 and have not yet had a prostate exam, it’s a good time to talk to your doctor. If you’re also African American or have a family history of prostate cancer, it’s a really good time. One of six men eventually gets a prostate cancer diagnosis. And even though most men have a slow-growing type, prostate cancer is still the leading cause of cancer deaths in men older than 75. So if you’re afraid of a prostate exam, it’s time get over it and protect your prostate health.

“Start talking about your prostate care plan at age 40, and if you and your doctor think the time is right, get a digital rectal exam and a PSA blood test during your annual physical,” suggests Dan Zenka, senior vice president of the Prostate Cancer Foundation and a prostate cancer survivor who was diagnosed at age 51 in 2010.

What to Expect During a Primary Care Prostate Health Exam

Your doctor will probably start by asking you if you have any prostate health symptoms like a weak urine stream, dribbling, straining to urinate, or blood in your sperm or urine. Your doctor may also ask if you have a father or a brother with prostate cancer – and if the doctor doesn’t ask, volunteer the information.

Here are the two tests that will be done:

What to Expect if You Need a Prostate Cancer Exam

Questions To Ask Your Health Care Team

Before having a DRE, you may want to ask these questions:

• Why do you recommend that I have a DRE?

• What happens during the DRE?

• Who will do the DRE?

• How long will the DRE take?

• Will it hurt?

• Can a DRE find cancer?

• When and how will I get my test results?

• Who will explain them to me?

• Will I need more tests, such as a colonoscopy or a barium enema, if the DRE suggests cancer?

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What Was Your First Prostate

Fred: I didnt expect it, so it was a very new sensation. It was like feeling someone lighting a fire in my feet and feeling it slowly spread all the way up my body. Slowly moving through my torso and making me shiver. I was in shock!

Alan: My first prostate-induced orgasm felt like an out of body explosion. My head was dizzy for like a minute afterward, and I had this absolutely incredible rush of nothing but pleasure. Needless to say, I was hooked and wanted to keep going.

Evan: My first prostate induced orgasm was because of a prostate toy I bought a few years ago. I never had one before using it. It was pretty hot because the toy got me really close to ejaculating without touching my dick. Then all it took was a little stroke, and I shot everywhere.

Drew: I remember the first time pretty vividly. I was having sex with a fuckbuddy and they repositioned me on my back with my legs up on their shoulders. They started pounding away at my hole and must’ve found just the right angle or something because a whole new wave of pleasure and sensation came over me. I’ve never looked back since.

It was heaven. I almost didn’t understand what was happening. That there could be so much sensation, throughout every inch of my body, was brand new to me.

Ryan: The first time I realized I liked it up the butt and really hit my prostate myself was when I was 16. I got my first vibrator and really went to town on my own ass.

What Are We Looking For

Many men experience issues with their prostate gland as they age. The symptoms for benign prostate enlargement and prostate cancer are very similar – most men present first with urinary issues. When your prostate has simply enlarged the surface is usually smooth. We begin to suspect prostate cancer when the surface is hard and lumpy. It’s a key difference and the best way to find out is via a rectal exam.

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What Happens During A Prostate Exam And What Is A Digital Rectal Exam

Lets begin by clarifying a slightly confusing bit of terminology. A prostate exam and a digital rectal exam are one in the same, and although the word digital might conjure up some ideas of fancy gadgets, the meaning in this case is a bit more old school. Its digit as in finger were talking about here.

Prostate exams are performed in order to detect enlargements or irregularities in the shape of the prostate, and are primarily used to screen for prostate cancer. To do this, a doctor will insert a gloved, lubricated finger into the rectum to physically examine the prostate by feeling it through the rectal wall. In doing so, theyre both searching for any lumps or nodules, as well as estimating the size of the prostate gland.

Youre probably thinking, Yes, its easy to talk about inserting a gloved, lubricated finger casually in clinical terms, but what actually happens during a prostate exam. So, heres a real-world, step-by-step description of what you can expect:

When Do You Need A Prostate Exam

PSA is continuously present in the bloodstream for most men, and an increase in its number may be attributed to causes other than cancer. However, men who have an increased risk of prostate cancer should undergo a regular prostate exam.

Age, family history, and race are all possible factors that can increase your risk. Likewise, your doctor may also recommend that you undergo testing if you are experiencing discomfort or pain while urinating.

Symptoms which may indicate that you have a prostate issue include the following:

• Inconsistent flow of urine

How Often Is a Prostate Exam Necessary?

Your frequency of testing may be due to several factors, including your age and present health condition:

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What Happens During A Digital Rectal Exam

Your health care provider will insert a gloved finger into the rectum and feel the prostate for hard, lumpy, or abnormal areas. The test takes only a few minutes to complete.

You may feel slight, momentary discomfort during the test. The procedure does not cause significant pain or any damage to the prostate.

Experts In Urology Care

If you are experiencing symptoms consistent with urinary issues, we urge you to complete our urologic cancer risk assessment form.

Not everyone should get a PSA test. Why? Because many men in this country are treated for low-risk prostate cancer that is discovered through the PSA test, even when it is unlikely that the disease will ever cause symptoms or lead to death. And treatment is associated with significant side effects, including impotence and incontinence . So a PSA test is recommended only for men who might be at greater risk for dying of prostate cancer for example, younger men with a family history of prostate cancer or African-American men.

To avoid the risks of over-treatment, Roswell Park follows the guidelines established by the National Comprehensive Cancer Network . The NCCN brings together world-renowned experts from 30 of the nations top cancer centers to write guidelines that specify the best ways of preventing, detecting and treating cancer. The guidelines are updated at least every year, on the basis of the latest research.

Michael Kuettel, MD, PhD, MBA, Chair of Roswell Park’s Department of Radiation Medicine, serves on the NCCN Prostate Cancer Panel.

The NCCN recommends that only men in these categories receive a PSA test for early detection of prostate cancer:

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