Facts About Prostate Exams: Who Should Have One and How it is Performed

Behind lung cancer, prostate cancer is the second leading cause of cancer death in men living in the United States.

1 in 7 men will get a diagnosis of prostate cancer in their lifetime according to the American Cancer Society. Prostate exams are commonly performed to help reduce the high numbers of deaths from the disease.

What is involved in a prostate exam?

Screening for prostate cancer involves looking for early signs of a disease in healthy people who do not have any symptoms. The aim of screening is to diagnose the disease at an early stage because the earlier it is diagnosed the easier it is to treat and therefore the more likely it is to be cured.

Who should get a prostate exam?

Men over the age of 50 are strongly advised to have at least an informed discussion with their healthcare provider about screening for prostate cancer.

The American Cancer Society recommends that the discussion about screening should take place for men in the following groups:
• 50 years of age – for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
• 45 years of age – for men at high risk of developing prostate cancer. This includes African-Americans and men who have a father, brother, or son diagnosed with prostate cancer at a younger
than age 65.
• 40 years of age – for men with more than one first-degree relative who had prostate cancer at an early age.

What types of tests are available?

There are two main tests most commonly used to screen for prostate cancer. These are the digital rectal exam and the prostate-specific antigen test.

Neither test can confirm prostate cancer. However, they can reveal strong signs that a patient has a prostate problem and requires further testing such as a prostate biopsy.

Men who want to be screened should be tested with the PSA blood test. If a patient gives their consent, the digital rectal exam is usually conducted as an early part of the screening.

Having a digital rectal examination

A DRE is generally not painful and only takes a few minutes to complete.

The specialist will gently insert a lubricated, gloved finger into the rectum. The specialist will determine the size of the prostate and feel for bumps, soft or hard spots, and other abnormalities.

Prostate cancers often begin in the back of the gland, which may be felt during a rectal exam. If the prostate is enlarged, the patient may feel discomfort or mild pain during the exam.

If the doctor finds any areas of concern during the DRE, additional tests may be needed to examine them more closely.

Having a PSA test

The PSA test is a blood test used to detect prostate problems. It usually takes 14 days to get the results back. The test measures a protein called PSA that is made by the prostate gland. Some of this protein leaks into the blood and can be measured by doctors.

A variety of factors can affect PSA levels, such as age and ethnicity. Some prostate glands produce higher levels of PSA than others. In general, the higher the PSA level in the blood, the more likely it is that a prostate problem is present.

PSA levels also can be affected by some medical procedures, types of medications, an enlarged prostate or a prostate that is infected.

If the PSA level is normal, the healthcare specialist may leave further tests to the choice of the patient. They may decide to test the patient every 1-2 years.

If the PSA level is high, the specialist is likely to refer the patient for more tests. These tests might include an examination of the prostate gland and possibly a prostate biopsy.
The specialist will consider a number of factors such as the patient’s age, family history, ethnicity, body weight and previous medical history.

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