The prostate is a small gland, roughly the size of a walnut, located just below the bladder in males. Its primary function is to produce the fluid that nourishes and transports sperm. A prostate exam is a preventive screening tool used to check the gland’s health, primarily for the early detection of prostate cancer or an enlarged prostate (Benign Prostatic Hyperplasia, or BPH). Understanding the step-by-step process can help demystify the experience.
Screening Guidelines and Rationale
Prostate screening typically begins for men at age 50 who are at average risk for prostate cancer. Men with a higher risk profile should start this discussion earlier, often between ages 40 and 45. This high-risk category includes men of Black ancestry and those with a strong family history, such as a father or brother diagnosed before age 65.
The rationale for screening is that early detection significantly improves treatment outcomes for cancer. Screening also helps identify an enlarged prostate, a common, non-cancerous condition that can cause urinary problems. Men aged 55 to 69 benefit most from screening, as this age range balances the likelihood of developing cancer with the benefits of early treatment.
Screening after age 70 is often individualized based on a man’s overall health and life expectancy. If initial tests are normal, most recommendations suggest a re-screening interval of two to four years.
Discussion Before the Exam
Before the physical examination, the appointment begins with a consultation focused on medical history and current symptoms. The provider will ask about changes in urinary habits, such as frequency, urgency, or a weak stream, which can indicate prostate enlargement or other issues. They will also review your personal and family medical history to assess your risk for prostate cancer.
This is the time to discuss any concerns about the procedure, as the provider aims to ensure your comfort and obtain informed consent. This initial conversation helps determine the most appropriate screening approach, which often includes both a physical check and a blood test.
Details of the Physical Examination
Digital Rectal Exam (DRE)
The DRE is a quick physical procedure where the provider directly assesses the prostate gland. The patient assumes a position that allows access to the rectum, typically standing and leaning over the exam table or lying on one side with knees drawn toward the chest.
Using a gloved, lubricated index finger, the provider gently inserts the finger a short distance into the rectum. The prostate is located directly in front of the rectum, allowing the provider to feel its posterior surface. The sensation is usually brief pressure, not pain, and the entire palpation takes only a few seconds.
The provider checks for the size and symmetry of the two prostate lobes, as well as the gland’s consistency, which should normally feel rubbery. Any hard areas, lumps, or firm spots (induration or nodules) are noted, as they may indicate a potential problem.
Prostate-Specific Antigen (PSA) Test
The PSA test is a simple blood draw that measures the level of prostate-specific antigen (PSA) in the bloodstream. PSA is a protein produced by cells in the prostate gland. While small amounts are normal, elevated levels can suggest an abnormality.
This blood test is typically performed either before the DRE or on a different day. This timing ensures the physical examination does not temporarily inflate the PSA level.
Interpreting Test Results
PSA blood test results are reported in nanograms per milliliter (ng/mL). There is no single cutoff point for a normal result, but levels are interpreted based on age. For example, a PSA greater than 4.0 ng/mL in men in their 60s is often considered abnormal, while a level above 2.5 ng/mL may be concerning for men in their 40s and 50s.
An elevated PSA score does not automatically indicate cancer. Non-cancerous conditions like an enlarged prostate (BPH), a urinary tract infection, or inflammation (prostatitis) can also cause PSA levels to rise. If the PSA is elevated or the DRE reveals a suspicious area, the provider will discuss further steps. These may include a repeat PSA test, additional imaging, or a prostate biopsy to definitively check for cancer.