What to Expect During a Prostate Exam

Aside from skin cancer, prostate cancer is the most common cancer in American men, and an estimated 191,930 new cases and 33,330 deaths from prostate cancer were reported in 2020, according to the American Cancer Society (ACS). The ACS also estimates that 1 in 8 men will be diagnosed with prostate cancer during his lifetime, and 1 in 41 will die from prostate cancer.

The morbidity associated with prostate cancer should lead more men to explore whether they are at risk for it, but many men are reluctant to address the situation with their doctor. Some men have concerns about how tests are performed, and that creates some unease and difficulty addressing the topic.

Prostate risks

Let’s get something straight from the start: It’s important to get tested regularly for prostate cancer. The National Cancer Institute (NCI) has said that about one death from prostate cancer could be avoided for every 1,000 men ages 55 to 69 years if they would have regular screenings.

Prostate cancer is not automatically fatal. In fact, statistics from the ACS show that 3.1 million men in the United States who were diagnosed with prostate cancer are still alive today.

Types of prostate tests

There are essentially two kinds of prostate exams: the digital rectal exam (DRE) and the prostate-specific antigen (PSA) test.

The Centers for Disease Control and Prevention (CDC) notes that there is no standard test to screen for prostate cancer. These two tests may both be performed, or a doctor could perform one and not the other.

With the DRE, the doctor will insert a finger into your rectum to directly feel the prostate gland, which is located underneath the bladder and behind the penis. The process lasts less than a minute, and the doctor is simply evaluating the prostate for any enlargement or irregularity.

The PSA exam involves a blood test that measures the amount of prostate-specific antigen that a prostate is producing. High levels of PSA may indicate prostate cancer, but it is also possible that other factors could be contributing to a high PSA level. The CDC notes that PSA levels can also be affected by certain medical procedures, various medications, an enlarged prostate or a prostate infection.

Additional procedures

After PSA and/or DRE tests have been performed, a doctor could order a transrectal ultrasound (TRUS), which is a roughly 15-minute procedure that uses sound waves to create an image of the prostate gland. This painless test helps tell the difference between noncancerous and cancerous changes in the prostate.

A doctor may also order a prostate biopsy, in which the doctor collects tissue samples of the prostate to examine under a microscope. The biopsy is an outpatient procedure that could lead to blood in a person’s urine for a number of days, but most patients can return to normal activities quickly without any lingering issues.

When should I get tested?

Considering the possible risks of doing nothing about prostate concerns, it is wise for all men to discuss prostate health issues with their physician as soon as they turn 40 years old.

Black men and men with relatives who have had prostate cancer should be even more proactive in their efforts to be tested. One study published in 2017 in the journal Cancer reported that 30 to 43 percent of Black men develop preclinical prostate cancer by age 85—a risk that is 28 to 56 percent higher than in the general population.

The ACS also notes that having a father or a brother with prostate cancer may more than double a man’s risk of developing prostate cancer.

Am I covered?

Medicare currently provides coverage for annual PSA tests for all eligible men age 50 and older, but many private insurers cover PSA screenings as well.

The ACS recommends that men 50 years of age and older speak with their doctor about screening for prostate cancer. Black men or men who have a first-degree relative diagnosed with prostate cancer before age 65 should have the conversation earlier, at 45.

Finally, men who have more than one first-degree relative diagnosed with prostate cancer before age 65 should engage in the discussion around their 40th birthday.

Prostate cancer examinations remain a continuing field of study, and it is important for men to speak to their physicians about undergoing exams so they can take quick action when any problems arise. Testing is never humiliating but it is crucial: Ignoring the need to be tested could complicate recovery in some cases, and men need to understand that prostate cancer screening is largely a short and painless process.