Prostate Exam

Overview

What is a prostate exam?

A prostate exam is a screening method used to look for early signs of prostate cancer. In general, a prostate exam includes a PSA blood test (which measures the level of prostate-specific antigen in your blood) and a digital rectal exam (DRE).

During the digital rectal exam portion, your healthcare provider carefully inserts their gloved finger (digit) into your rectum. This allows them to feel the edges and surface of your prostate gland to detect any potential abnormalities.

When should men get a prostate exam?

According to the American Cancer Society, men and people who were assigned male at birth (AMAB) should have their first prostate exam by age 50. If you have a family history of prostate cancer, you should consider having your first prostate exam at age 45.

Additionally, Black men are at a higher risk for being diagnosed with prostate cancer. For this reason, healthcare providers often recommend that Black men have their first prostate exam around age 45.

Prostate exam vs colonoscopy: What’s the difference?

At first glance, it might seem that a prostate exam is similar to a colonoscopy. After all, both exams involve your rectal area. However, these two tests are quite different.

While a prostate exam involves feeling the prostate with a gloved finger, a colonoscopy examines the walls of your colon by inserting a flexible camera into your rectum. The prostate is not examined at all during this procedure unless your healthcare provider manually performs an exam.

A prostate exam is a fairly quick procedure performed in an office setting. A colonoscopy, on the other hand, is an outpatient procedure in the hospital that requires IV (intravenous) sedation.

Test Details

How do I prepare for a prostate exam?

Little preparation is needed before a prostate exam. However, be sure to let your healthcare provider know if you have existing conditions that could cause discomfort, such as:

Your healthcare provider may ask you to abstain from sex for 48 hours before your prostate exam. This is because ejaculation can cause your PSA levels to increase temporarily, which could affect your test results.

Should I poop before a prostate exam?

You don’t need to change any bathroom habits prior to your appointment. If you feel like you need to poop before your exam, then it’s fine to do so. But don’t worry if you just don’t have the urge. The prostate exam shouldn’t make you feel like you need to go.

There’s no need to be embarrassed about fecal matter (poop) during your prostate exam. Your healthcare provider is experienced in performing this exam and will do everything to ensure your comfort during the process.

What should I expect during a prostate exam?

As mentioned above, there are two types of screenings that your healthcare provider may use to detect prostate cancer: a PSA (prostate-specific antigen) blood test and a digital rectal exam (DRE). Research shows that the PSA blood test is more effective for detecting prostate cancer. However, the DRE can still find cancer in people with normal PSA levels. For this reason, many healthcare providers recommend both.

Neither test confirms you have prostate cancer, which is why they’re considered screening assessments rather than diagnostic tests.

PSA blood test

For this test, your healthcare provider simply draws a sample of your blood and sends it to a lab for analysis. The PSA blood test measures the amount of prostate-specific antigen in your blood.

There is no official cutoff score that can determine whether or not you have prostate cancer. Instead, the results are used as a gauge to determine if more testing is needed.

If you have a high PSA, you may need further testing — such as a prostate biopsy, MRI or other lab tests — to determine if prostate cancer may be present.

Digital rectal exam (DRE)

During a DRE, your healthcare provider inserts a lubricated, gloved finger (digit) into your rectum. This way, they can feel your prostate to see if there are any lumps or bumps on the back portion of the gland (where many cancers start).

How painful is a prostate exam?

While a DRE may be uncomfortable, it’s usually not painful, and it only takes a few seconds to complete. Be sure to let your provider know if you have hemorrhoids, anal fissures or anything else that could make the exam uncomfortable.

Results and Follow-Up

What do my PSA test results mean?

Once your test results are back, your healthcare provider will let you know if any additional testing is recommended. PSA levels can vary over time for several reasons unrelated to prostate cancer (such as ejaculation, certain medications or enlargement of the prostate). So, if you have a borderline PSA, your provider may simply recommend another PSA test in six months or so.

What happens if PSA is high?

If you have an elevated PSA level, your healthcare provider may recommend further evaluation and testing with a urologist.

When should I know the results of my prostate exam?

In general, it takes about one day to receive the results of your PSA test.

With a DRE, your provider will tell you the results immediately.

When should I call my healthcare provider?

If you’re 50 and you haven’t had your first prostate exam yet, call your healthcare provider to set up an appointment. If you’re at higher risk, such as if you're Black or prostate cancer runs in your family, you should have your first prostate exam by age 45.

Furthermore, if you develop symptoms of urinary tract obstruction, schedule a visit with your provider right away. This may indicate an enlarged prostate, benign prostatic hyperplasia (BPH) or a urinary tract infection. (Note: Prostate cancer usually doesn’t exhibit symptoms unless it’s advanced.)

A note from Cleveland Clinic

Most people are understandably apprehensive about their first prostate exam. Learning all you can about the process can help abate any fears or uncertainties you have. Talk to your healthcare provider about your screening options. A prostate exam is the first step in the early detection of prostate cancer — and early detection is key to successful treatment.

Last reviewed by a Cleveland Clinic medical professional on 04/04/2022.

References

  • American Cancer Society. Screening Tests for Prostate Cancer. (https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/tests.html) Accessed 3/4/2022.
  • Cancer.Net. Prostate Cancer: Screening. (https://www.cancer.net/cancer-types/prostate-cancer/screening) Accessed 3/4/2022.
  • Cancer.Net. Prostate Cancer: Symptoms and Signs. (https://www.cancer.net/cancer-types/prostate-cancer/symptoms-and-signs) Accessed 3/4/2022.
  • National Cancer Institute. Prostate Cancer Screening (PDQ®) Health Professional Version. (https://www.cancer.gov/types/prostate/hp/prostate-treatment-pdq) Accessed 3/4/2022.
  • Prostate Cancer Foundation. Prostate Exam. (https://www.pcf.org/about-prostate-cancer/what-is-prostate-cancer/prostate-exam/) Accessed 3/4/2022.

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