Overview
The prostate is a gland that helps make semen, which is the fluid that carries sperm. The prostate is located just below the urinary bladder in front of the rectum.
As men age, the prostate can become enlarged and start causing problems. Prostate problems include:
- bacterial infection
- dribbling after urination
- bladder outlet obstruction with urine retention
- an increased need to go (especially at night)
- enlarged prostate, also known as benign prostatic hyperplasia (BPH)
- prostate cancer
In the United States, prostate cancer is the most common cancer in men. It typically grows slowly and has few early symptoms.
Cancer screenings are tests that doctors can do to help them spot cancer before symptoms arise, or before the cancer becomes more advanced. Doctors perform prostate exams to screen for abnormalities that may indicate a problem, such as cancer.
Prostate exams may not be recommended for everyone. Read on to learn more about this exam and when you may need it.
When to get a prostate cancer screening
A prostate screening can help your doctor find prostate cancer early, but you’ll need to decide if the benefits of the exam outweigh the risks. Have a discussion with your doctor about prostate cancer screenings.
The U.S. Preventive Services Task Force (USPSTF) now recommends that men ages 55 to 69 decide for themselves whether to undergo a prostate-specific antigen (PSA) screening test, after talking it over with their doctor.
They recommend against screening for men at or above the age of 70.
The American Cancer Society (ACS) strongly recommends that no one be screened without discussion of the “uncertainties, risks, and potential benefits of prostate cancer screening.”
They give these specific recommendations for the date at which these discussions with a healthcare provider should take place:
- Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
- Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than 65).
- Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).
You should also speak with your doctor about a prostate exam if you’re experiencing symptoms of a prostate problem such as frequent or painful urination or blood in your urine.
After this discussion, if you decide to get a prostate cancer screening, the ACS and the American Urologic Association (AUA) recommend getting a prostate-specific antigen (PSA) blood test.
A digital rectal exam (DRE) may also be a part of your screening.
Should you get a prostate exam?
The ACS recommends that men thoroughly discuss the pros and cons of prostate screenings with their doctor before making any decisions. Similarly, the AUA suggests discussing reasons with one’s doctor before deciding to get a screening.
This is because prostate cancer screenings have both risks and benefits.
Because there are risks (such as overdiagnosis) that may outweigh the benefits, the USPSTFrecommends against prostate screening with blood tests for men ages 70 and above. However, as with any test, discuss with your doctor if this is appropriate for you.
Early detection of some types of cancer can make the cancer easier to treat and improve your outlook.
In the United States, prostate cancer screening has been more common since the early 1990s. Since that time, the prostate cancer death rate has gone down. It’s unclear whether this drop is a direct result of the screenings. It could also reflect improved treatment options.
There’s nothing special that you need to do to prepare for a prostate exam. Tell your doctor if you have anal fissures or hemorrhoids, as a DRE may aggravate these conditions.
If you decide to get a prostate cancer screening, your doctor will likely order a blood test, so inform the person drawing your blood if you’re prone to dizziness.
Your doctor may ask you to sign a consent form before performing a cancer screening.
What to expect during the exam
You can get a prostate exam easily and quickly at your doctor’s office. Generally, for cancer screenings, your doctor will take a simple blood test.
Your doctor might also choose to perform a DRE. Before performing this exam, your doctor will ask you to change into a gown, removing your clothing from the waist down.
During a DRE, your doctor will ask you to bend over at the waist or lie on the exam table in a fetal position, with your knees to your chest. They will then insert a gloved, lubricated finger into your rectum.
Your doctor will feel for anything abnormal, such as bumps or hard or soft areas that might indicate a problem. Your doctor may also be able to feel if your prostate is enlarged.
A digital rectal exam can be uncomfortable, especially if you have hemorrhoids, but isn’t overly painful. It will last only a couple of minutes.
A DRE is one of your doctor’s tools that can help them detect several prostate and rectal problems, including:
- BPH
- prostate cancer
- abnormal masses in your rectum and anus
Your doctor will be able to tell immediately if there are any areas of concern that may warrant further testing.
The results of a DRE exam are either normal or abnormal but doctors typically rely on several different tests to help them make a prostate cancer diagnosis.
If your doctor feels something abnormal during the DRE, they will probably recommend getting a PSA blood test, if you haven’t done so already.
A PSA level that’s elevated may indicate prostate cancer, but it may also indicate other conditions such as BPH or prostate infections.
If you have an abnormal DRE and high PSA levels, your doctor may recommend additional tests including:
- transrectal ultrasound (TRUS)
- prostate biopsy
- MRI scan
If the results of your DRE are normal, your next steps will depend on your age, health, and PSA levels. If no suspicion for prostate cancer is found during a regular screening, the ACS makes these recommendations:
- Men with a PSA level of less than 2.5 nanograms per milliliter (ng/mL) may only need to be retested every two years.
- Men with a PSA level of 2.5 ng/mL or greater should be screened annually.
If either or both of your prostate cancer screening tests are abnormal, you and your doctor will discuss next steps.
These next steps will depend on your age, general health, and family history. More invasive testing carries increased risk, which you will need to discuss with your doctor.
