Potential Outcomes of Your Prostate Exam

It's normal for men of a certain age—50 years old for most men and 45 for those at higher risk—to get a prostate exam every couple of years. But apart from an expectation of feeling a probing sensation, many men may not know much about the reasons, implications and overall importance of this screening.

So, let's begin at the beginning...

A walnut-sized gland located at the front of a man's rectum and below the bladder, the prostate produces a fluid that, when expelled, mixes with sperm from the testicles to make semen. The prostate is also partially responsible for pushing semen up the urethra and out of the penis.

Abnormalities in the prostate can develop into prostate cancer, and the digital rectal exam (DRE) is the first line of defense in detecting such anomalies. The exam can also detect prostate inflammation and certain infections.

Since the prostate gland partially surrounds the urethra, any abnormal prostate growth can affect a man's urinary function and cause issues, including:

• Urinary retention
• Frequent need to urinate
• Urinary urgency
• Urinary dribbling

The DRE: what to expect

In preparation for a digital rectal exam, your doctor will ask you to either bend over an exam table or lie atop it on your side with one or both legs pulled up to your chest. The physician will then gently insert a gloved, lubricated finger into your rectum to feel for any irregularities on the surface of your prostate, through the wall of your rectum.

Your doctor may spend up to a minute feeling the lobes of the prostate, to ensure that everything is normal and that there are no hard spots or irregularities on the surface of the prostate. Your doctor may compare notes with previous exams, if any, to see if there have been any changes.

By far, the most common outcome for a man's DRE is to be given a clean bill of health and sent on their way until the next checkup. However, if the doctor detects irregularities, the next steps may include a prostate-specific antigen (PSA) blood test, a transrectal ultrasound and/or a biopsy.

PSA blood test

The prostate-specific antigen blood test is a method for detecting prostate cancer before symptoms occur. If the DRE is the first line of prostate health defense, the PSA test is the second.

However, even if your test shows elevated prostate-specific antigen levels, you should be aware this test isn't conclusive. In fact, PSA has been a source of controversy in recent years. Various experts suggest that some physicians trust its results too much and tend toward an overly aggressive approach to treating what is often a very slow-growing cancer.

In addition to developing prostate cancer, other factors that can cause elevated PSA levels include a non-cancerous enlarged prostate, prostatitis, recent ejaculation, riding a bicycle and even the DRE itself. So don't panic. You'll likely be asked to come back for another PSA in a week or two to see if the levels have changed.

Transrectal ultrasound

If a second PSA test shows elevated levels, the usual next step is a transrectal ultrasound, which sounds a lot scarier than it is.

The transrectal ultrasound is just a device that's attached to a probe and inserted into your rectum, using soundwaves to create images of your prostate. It only takes about 10 minutes, and while it may feel a little uncomfortable, it's not painful.

Biopsy

Based on your age, risk factors for prostate cancer, and the PSA and DRE findings, the doctor will determine whether a prostate biopsy is necessary.

For this exam, the doctor anesthetizes the area, then uses a needle to extract several bits of tissue directly from your prostate. Your doctor can go in either through the rectum, through the perineum or via the urethra, extracting cells that will be examined for signs of cancer cells.

As frightening as this might sound, the worst that most men report is some tenderness for a day or two and minor bleeding following the 10- to 15-minute procedure. The results of the biopsy are used to determine how to proceed.

While an estimated 248,530 new cases of prostate cancer will be diagnosed in 2021 in the United States, and more than 34,000 deaths from prostate cancer are predicted, the prognosis for most men is generally good if the cancer is detected early.

Don't hesitate to get a prostate exam, and don't fear the results, because there are many options available for treatment and successful outcomes.