When To Get Your First Prostate Exam

Whats The Recommended Age For Your First Prostate Exam

Starting at age 50, all men should discuss getting a prostate exam with their doctor.

The reason for this is prostate cancer. In the UK, about one in eight men will be diagnosed with this in their lifetime. It mainly affects men aged 50 plus, but your risk increases as you get older, and the most common age to be diagnosed is between 65 and 69 years. Most men with early prostate cancer dont have any noticeable signs or symptoms.

The exception to this rule is if you are experiencing symptoms, or if your genetics predispose you as higher risk. Doctors are increasingly finding the tendency towards some prostate cancers can be inherited from your fathers family. Additionally, black men are at a higher risk, with one in four getting prostate cancer in their lifetime.

If youre experiencing no symptoms, heres the recommended age for prostate exam:

• If you have a family history, first prostate exam at age 40
• If you are black, first prostate exam at age 45
• If you have no family history and youre not black, first prostate exam at age 50

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.

When To Get A Prostate Cancer Screening

A prostate screening can help your doctor find prostate cancer early, but youll need to decide if the benefits of the exam outweigh the risks. Have a discussion with your doctor about prostate cancer screenings.

The U.S. Preventive Services Task Force now recommends that men ages 55 to 69 decide for themselves whether to undergo a prostate-specific antigen screening test, after talking it over with their doctor.

They recommend against screening for men at or above the age of 70.

The American Cancer Society strongly recommends that no one be screened without discussion of the uncertainties, risks, and potential benefits of prostate cancer screening.

They give these specific recommendations for the date at which these discussions with a healthcare provider should take place:

• Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
• Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative diagnosed with prostate cancer at an early age .
• Age 40 for men at even higher risk .

You should also speak with your doctor about a prostate exam if youre experiencing symptoms of a prostate problem, such as frequent or painful urination or blood in your urine.

After this discussion, if you decide to get a prostate cancer screening, the ACS and the American Urologic Association recommend getting a prostate-specific antigen blood test.

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Weighing Your Options For Treatment

If you test positive for prostate cancer, you have some options as to what youd like to do about it. Until recently, nearly everyone opted for surgery or radiation, while some patients choose not to undergo treatment, instead opting for active surveillance, during which the cancers are left alone but regularly monitored to be certain that theyre not growing.

Certainly, screening can lead to earlier prostate cancer detection, and with earlier detection, youre eligible for multiple different treatments or active surveillance, said Sia Daneshmand, MD, associate professor of urology at Keck School of Medicine of USC and director of urologic oncology at the USC Institute of Urology at Keck Medicine of USC. 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 whats the best course of treatment for them.

There also is a new option for those seeking prostate cancer treatment. Its called High-Intensity Focused Ultrasound , which uses ultrasound beams to non-surgically destroy prostate tumors.

If you are in the Los Angeles area, schedule an appointment with one of our urologists by calling or by visiting Urology.KeckMedicine.org/request-an-appointment.

Men At Higher Risk Of Prostate Cancer

Some men are at higher risk of prostate cancer than others. These are:

• black men
• men who have a family history of prostate cancer

The risk of prostate cancer also increases as men get older.

The evidence so far doesnt suggest that routinely screening these men would help prevent deaths from prostate cancer. In fact, it might lead to men having treatment for prostate cancer even though that cancer wouldnt have caused any problems or symptoms.

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Another Option: Digital Rectal Exams

Most prostate biopsies are driven by PSA results. Urologists also use the digital rectal exam, or DRE.

“The American Urological Association hasn’t recommended rectal exams because there has yet to be a randomized trial in which some men get the rectal exam and some don’t. Based on who lives and dies, this would show if rectal exams have value,” says Dr. Freedland. “Many people, myself included, think they do have value. It’s part of the evaluation that we use even if it’s not officially in our guidelines.”

The DRE may cause momentary discomfort, but it can also detect prostate cancer for those patients with normal PSA levels. “We use the exam because we think it should work and be helpful, even if it hasn’t been studied,” Dr. Freedland adds. “Most people are screened with PSA and DRE.”

What Should I Look Out For

The above recommendations apply to screening only i.e. if youre not experiencing symptoms. For many men, prostate cancer can be symptomless because of the way it grows: youll only notice changes if it grows too close to your urethra, disrupting the urinary process. The symptoms of this include:

• Trouble starting a urine stream
• Having a weak urine stream
• Dribbling at the end of urination
• Urinary retention
• Pain after urination or ejaculation.

If youre experiencing these, you should come in for a prostate exam. However, dont panic: the most common cause of the above isnt cancer its benign prostatic hyperplasia . This is when your prostate naturally grows large enough to block your urinary tract. 50% of men aged 51 60 suffer from it, and the number rises as you age. There are a number of treatment options available, from lifestyle changes and medications to minimally invasive procedures and surgery.

Another cause of these symptoms could be prostatitis, which is when your prostate becomes infected. This usually affects men aged 30 50. Additional symptoms include pain in and around your penis, testes, anus, abdomen or lower back, or erectile dysfunction. Usually, this will improve over time and with treatment.

The other symptoms to look out for are signs that prostate cancer has spread. If the cancer breaks out of the prostate, symptoms could include back, hip or pelvis pain, erectile dysfunction, blood in urine or semen, and unexplained weight loss.

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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.

What To Expect From A Prostate Exam

In preparation for your exam, your healthcare provider will ask that you remove your clothes from the waist down and put on a hospital gown. Youll be asked to stand and bend at the waist or to lie to one side with your knees bent and pulled to your chest. The examiner will then put on rubber gloves if they havent already and apply lubricant to one finger. Theyll assess the area around the rectum for abnormalities, then insert the lubricated finger into the rectum to feel for bumps, swelling, nodules or other areas of concern on the prostate itself. This process typically takes less than 20 seconds3.

While the examination itself might be a little uncomfortable, it is not a painful procedure by any means. After a few seconds, the anal sphincter will relax and the pressure will be substantially less intense. Some men have a sudden urge to urinate once they feel pressure applied to the prostate, but this only lasts the duration of the exam. Keep in mind, this process only takes a few seconds and the corresponding discomfort is a small price to pay to ensure your health and your well-being.

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Can’t I Just Get A Blood Test

If you have concerns about prostate cancer you certainly should have a Prostate Specific Antigen blood test. Knowing your PSA level can help to establish what’s normal for you so that a spike is more easily identified. But a blood test alone is not enough. The test has been known to deliver ‘false-positive’ results in some cases – leading men into have invasive biopsies for no reason. Up to 20% of men with prostate cancer show no increase in PSA levels*. So it’s best used to check against the result of a rectal exam but can’t be relied upon in isolation.

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.

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Prostate Cancer Screening Recommendations

The American Cancer Society guidelines for PSA screening are based on a combination of your age and risk level. Men at average risk and below the age of 55 aren’t advised to get the PSA test.

Other recommendations based on age are as follows:

• Age 40 to 54 – Men at higher risk within this age range may want to consider a PSA screening. For example, if you have a close relative who has had prostate cancer, you may want to talk with your Mercy doctor about getting a PSA test.
• Age 55 to 69 – Men within this age group who are thinking about getting a PSA screening are advised to talk with their Mercy doctor about the pros and cons of the test. If you have no family history of prostate cancer, this is generally when you would have your first PSA screening.
• Age 70 and older – Most men within this age bracket aren’t advised to get the PSA test, since testing in this age group can cause more harm than good.

Some common factors that put men at high risk include:

American Cancer Society Recommendations For Prostate Cancer Early Detection

The American Cancer Society recommends that men have a chance to make an informed decision with their health care provider about whether to be screened for prostate cancer. The decision should be made after getting information about the uncertainties, risks, and potential benefits of prostate cancer screening. Men should not be screened unless they have received this information. The discussion about screening should take place at:

• Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
• Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative diagnosed with prostate cancer at an early age .
• Age 40 for men at even higher risk .

After this discussion, men who want to be screened should get the prostate-specific antigen blood test. The digital rectal exam may also be done as a part of screening.

If, after this discussion, a man is unable to decide if testing is right for him, the screening decision can be made by the health care provider, who should take into account the mans general health preferences and values.

If no prostate cancer is found as a result of screening, the time between future screenings depends on the results of the PSA blood test:

• Men who choose to be tested who have a PSA of less than 2.5 ng/mL may only need to be retested every 2 years.
• Screening should be done yearly for men whose PSA level is 2.5 ng/mL or higher.

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Are You Seeing Prostate Cancer Becoming More Prevalent In Younger Patients

Its pretty rare. Its less common that men in their 40s have prostate cancer, but, we also are very rarely screening them. The young men who come in to be screened tend to have one of those high-risk features. They most likely had a father who had prostate cancer, so theyre nervous about it. Or theyre African-American, and theyve been flagged by their health care providers.

If youre young, your quality of life is even more important to you right now. We know that, if diagnosed with low-grade prostate cancer, a person will need treatment at some time in life. If we can delay treatmentwhich could negatively impact urinary or sexual functionby several years, then we should do that and obviously discuss that there is a low but possible chance of metastasis developing during that time.

How Should You Prepare For A Prostate Exam

You dont need to do any sort of preparation for a prostate exam. You dont need to fast or drink any special liquids ahead of time. You will want to let your doctor know ahead of time if you have hemorrhoids, anal fissures, or other issues that could potentially become aggravated with the procedure3.

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What Is A Psa Test

If the doctor finds abnormalities during the DRE, then the patient needs to undergo more tests. A PSA test is very commonly requested. It is also called a prostate-specific antigen test, or a PSA blood test.

A PSA test measures the level of prostate-specific antigen in the patients bloodstream. This is an indicator of various prostate-related conditions. The doctor may use the results from a PSA test to determine the abnormality of the male patients prostate.

Several conditions may be detected through a PSA test. This is because the level of PSA in the body increases when certain things affect the prostate gland.

When the prostate is affected by inflammation, the PSA levels will generally increase. The same happens when the man develops an infection in their prostate.

An enlargement of the prostate gland is also known to elevate the protein levels in the mans body. This is an indication of benign prostatic hyperplasia, a prevalent condition in men. When left untreated, an enlarged prostate can cause problems. This includes a risk of infections bladder infection and urinary tract infections can occur.

A PSA test can also help in the diagnosis of prostate cancer. When cancerous cells develop in the prostate gland, the PSA levels in the mans body will also rise.

When Should You Have Your First Prostate Exam

· Age 40 for men at even higher risk . You should also speak with

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