A digital rectal examination (DRE) is a routine physical assessment performed by a healthcare provider to check for abnormalities in the lower rectum and nearby organs. For men, this quick, in-office procedure is a traditional method used to evaluate the health of the prostate gland, which is situated directly in front of the rectum. The DRE serves as an important initial step in assessing prostate health. While the experience may cause brief discomfort, the test itself is fast.
The Primary Purpose of the DRE
The main objective of the DRE is to allow the physician to physically assess the consistency, size, and shape of the prostate gland. Because the prostate is accessible for palpation through the rectal wall, the physician feels for specific changes in the gland that can indicate various conditions, not solely malignancy. A healthy prostate typically feels rubbery, smooth, and symmetrical, resembling the size of a walnut in younger men. During the exam, the doctor checks for overall enlargement, which may suggest benign prostatic hyperplasia (BPH), or areas of unusual firmness, hard nodules, or an irregular texture suggestive of prostate cancer. Significant tenderness or pain during the examination might also point toward an infection or inflammation of the prostate, known as prostatitis.
How the DRE Procedure is Performed
The DRE requires no special preparation from the patient. The healthcare provider will first ask the patient to undress from the waist down and put on a gown. To maximize access, the patient is typically asked to assume one of two positions: lying on their side with the knees drawn up toward the chest, or standing and leaning forward over the examination table. The provider puts on a glove and applies a generous amount of lubricating gel to their index finger. The patient is instructed to relax as the physician gently and slowly inserts the finger into the rectum, rotating it to systematically feel the posterior surface of the prostate gland. During this assessment, the patient may feel an urge to urinate or a sensation of fullness or pressure, but the procedure should not cause significant pain. Upon completion, the finger is withdrawn, and the patient can immediately get dressed.
Interpreting the Results and Next Steps
The results of a DRE are often communicated immediately and are classified as either normal or abnormal based on the physical characteristics of the prostate. A “normal” finding means the gland was assessed to be of appropriate size, with a smooth surface and a consistent, rubbery texture. An “abnormal” finding refers to any deviation, such as a significantly enlarged prostate or one that has palpable hard, lumpy areas or distinct nodules. It is important to understand that the DRE is a screening tool, not a definitive diagnostic test for cancer, because the physician can only feel the posterior portion of the prostate. If an irregularity is detected, the next steps involve additional testing, commonly including a Prostate-Specific Antigen (PSA) blood test, which measures a protein level that may be elevated in the presence of cancer, BPH, or infection. If both the DRE and PSA test suggest a potential problem, the doctor may then recommend a prostate biopsy, which is the only procedure that can conclusively diagnose or rule out prostate cancer.
Screening Recommendations
Current medical guidelines recommend that the decision to undergo prostate cancer screening, which often includes the DRE, should be a shared discussion between a man and his healthcare provider. For men at average risk of prostate cancer, this conversation typically begins around age 50, provided they have a life expectancy of at least ten years. For individuals considered at higher risk, screening discussions should begin earlier. This includes African American men and men with a first-degree relative diagnosed before age 65, who often start discussions at age 45. Men at even greater risk, defined as those with multiple first-degree relatives diagnosed early, are advised to begin the conversation as early as age 40. When screening is pursued, many organizations recommend the combined approach of both the DRE and the PSA blood test, repeating the tests every one to two years if initial results are normal.