Prostate Exam

Who should have this exam?

If you're 50 or older, you should discuss whether to have the exam with your doctor. Sure, it's uncomfortable, maybe even a little embarrassing. But it may be worth it. The doctor will manually check your prostate -- a walnut-sized gland that surrounds the duct connecting the bladder with the penis -- to look for signs of prostate cancer.

The doctor will also check to see if your prostate is enlarged, a common problem in men who are middle-aged or older. If you've noticed problems with urination -- an urgent need to relieve yourself, a weak stream or leaking, or unusually frequent urination, especially at night -- you may have an enlarged prostate that's blocking the urine flow from your bladder. If you think this could be the case, call your doctor and ask about having the exam.

The American Cancer Society recommends that doctors offer this procedure, along with information on its potential risks and benefits, every year to all men aged 50 and up with at least a 10-year life expectancy. Men at particularly high risk of prostate cancer (including African Americans and anyone with a first degree relative who had prostate cancer before age 65) should be offered the exam yearly beginning at age 45. Because uncertain results may lead to unnecessary biopsies, and because prostate cancer is often very slow growing and is generally diagnosed late in life (and therefore may have never caused problems even if left untreated), the American Cancer Society does not recommend routing screening for all men at this time. Some men may choose not to be tested once they consider all the pros and cons.

What should I expect?

Usually painless, the digital rectal exam, or DRE, takes a minute or less (though it may seem longer). The doctor will ask you to bend over or lie on your side; then he or she will insert a gloved, lubricated finger into your anus and check the rear surface of the prostate for abnormalities. Hardness or a lump, for example, might be a sign of prostate cancer.

Are there other tests for prostate cancer?

There's a blood screening known as the PSA test. The PSA test is more effective than the digital rectal exam in detecting cancer, but the DRE sometimes picks up cancers the blood test misses. The manual exam isn't an ideal screening tool either, though. Your doctor can't feel tumors that are on the front of the prostate or buried in the middle. But because the exam is cheap and simple, you may decide theres little reason not to have it.

What if the doctor finds a lump?

Don't panic; it doesn't necessarily mean you're in trouble. About half of the time, a suspicious bump in the prostate turns out not to be cancer. If both your exam and your PSA test suggest that cancer may be present, your doctor will likely order a biopsy so that a sample of tissue can be examined under a microscope.

References

American Cancer Society. Can Prostate Cancer be Found Early? November 22, 2010

American Cancer Society. How is Prostate Cancer Found? July 1, 2010.

National Library of Medicine. Digital rectal exam. Updated November 5, 2009.

Adolfsson J, Steineck G, et al. Recent results of management of palpable clinically localized prostrate cancer. Cancer 1993;72:310-322.

Coley CM, Barry MJ, Fleming C, et al.: Early detection of prostrate cancer: part II: Annals of Internal Medicine 126(6): 468-479, 1997.

Chan EC, Sulmasy DP: What should men know about prostrate-specific antigen screening before giving informed consent? American Journal of Medicine 105(4): 226-274: 1998.

Chodak GW, Thisted RA, et al. results of conservative management of clinically localized prostrate cancer. N Engl J Med 1994;330:242-248.

Denis LJ: Prostrate cancer screening and prevention: "realities and hope". Urology 46(Suppl 3A): 56-61, 1995.

Schroder FH, Bangma CH: The European ramdomized study of screening for prostrate cancer(ERSPC). British Journal of Erology 79(Suppl 1):68-71, 1997.

American Cancer Society. Physical Exam Can Find Some Prostate Cancers with Normal PSA. June 7, 2002.

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