A prostate exam is a routine screening procedure used to assess the health of the prostate gland, a walnut-sized organ located beneath the bladder in men. This examination is a common tool for the early detection of potential health issues, including non-cancerous enlargement and prostate cancer. Identifying these conditions in their earliest stages allows for the most successful treatment options.
Medical Professionals Who Perform the Exam
A variety of healthcare professionals are qualified to perform the Digital Rectal Exam (DRE), the physical component of a prostate exam. Primary Care Physicians (PCPs), including Family Practitioners and Internal Medicine specialists, commonly incorporate the DRE into routine annual physicals.
Specialists, such as Urologists, also perform the DRE, often during a focused evaluation if an abnormality is suspected. Urologists specialize in conditions of the urinary tract and male reproductive system.
The exam may also be performed by Physician Assistants (PAs) and Nurse Practitioners (NPs), who are licensed to provide primary care services.
The Examination Procedure and Purpose
The physical assessment of the prostate is known as the Digital Rectal Exam (DRE), named for the use of a finger, or digit. The prostate gland sits directly in front of the rectum, allowing a healthcare provider to palpate its surface through the rectal wall. The patient is typically positioned lying on their side with knees drawn toward the chest or standing and bending forward at the waist.
The provider inserts a gloved and lubricated finger a short distance into the rectum to systematically assess the gland. The procedure is brief, often lasting less than a minute, and while it may cause slight discomfort, it should not be painful.
The DRE serves a dual purpose: to check for signs of Benign Prostatic Hyperplasia (BPH) and to screen for potential prostate cancer. The provider feels for three characteristics: size, texture, and the presence of hard nodules or lumps. An enlarged prostate, a sign of BPH, will feel larger and may be uniformly firm. Areas of abnormal hardness or distinct lumps can raise suspicion for prostate cancer, since the DRE assesses the posterior section where most cancers begin.
Current Screening Recommendations
The timing and frequency of prostate screening, which often combines the DRE with a Prostate-Specific Antigen (PSA) blood test, are based on a man’s individual risk factors. For men at average risk, major medical organizations recommend discussing the start of screening with a healthcare provider around age 50. This discussion should cover the benefits and risks of testing to ensure an informed decision.
Men at higher risk are advised to begin this conversation earlier. This includes African American men and those with a first-degree relative (father or brother) diagnosed with prostate cancer before age 65. For these high-risk groups, screening may begin at age 45.
If a man has multiple first-degree relatives who had early-onset prostate cancer, the discussion may start as early as age 40. The frequency of subsequent testing is guided by initial PSA blood test results, with lower PSA levels allowing for less frequent screening intervals.