What to expect during a prostate exam

The prostate sits near the bladder and is a walnut-sized gland in men that helps with the production of semen.

As you get older, your prostate can become enlarged or inflamed, and some men will develop prostate cancer. It's the most common type of cancer in men, with almost 50,000 cases per year in the UK. Around eight in 10 men recover and live for at least 10 years after being diagnosed with it.

With many cancers, including prostate cancer, you may not notice any symptoms in the early stages. This means that the cancer can grow undetected and develop into a more serious stage or spread to other parts of your body.

Catching cancer early is one of the most effective ways to maximise your chances of making a full recovery. 

A prostate exam will help your doctor detect anything unusual happening with your prostate so that further investigations can be performed if needed.

What happens during a prostate exam?

Screening for prostate cancer typically involves two types of investigation: a digital rectal exam (DRE) and a prostate-specific antigen (PSA) test. Your doctor may advise having both or just one.

These investigations will show your doctor if there are any abnormalities in your prostate. Abnormalities don’t always mean cancer, and neither of these tests can tell you definitively if you have prostate cancer. But they are an important step in picking up prostate cancer because they show whether further investigations are needed.

The only way to know for sure whether you have cancer is to have a biopsy (where a sample of your tissue is taken for analysis in a lab) of the prostate.

Digital Rectal exam

A DRE is the most common type of prostate exam. It is a simple and relatively quick procedure.

During the exam, you’ll need to undress from the waist down. You’ll be asked to lie on your side and push your knees up to your chest or bend forward while standing up. Your doctor will carefully insert a lubricated, gloved finger inside your rectum so that they can feel your prostate gland and examine it for any lumps or soft or hard spots.

The examination might feel uncomfortable for a moment and you might feel the need to urinate. It’s over in less than a minute and you can normally go straight back to your regular activities after the examination.

Your doctor will be able to tell straight away whether there is anything unusual about your prostate and whether any further steps are needed. They’ll discuss the results with you immediately after your examination.

Prostate-specific antigen (PSA) test

You might also be screened for prostate cancer with a PSA test. PSA is a protein that your prostate produces. It enters the bloodstream in small amounts and the test involves taking a blood sample to see how much PSA you have in your blood. In some cases of prostate cancer, patients have a high level of PSA in their blood.

Getting the results

After the PSA test, your blood sample will be sent to a laboratory for analysis. Your doctor will then assess your results when they come back.

A high level of PSA in the blood can sometimes be a sign of prostate cancer. Most adult males have a PSA level lower than 4ng/ml (nanograms per millilitre). A PSA level of 4-10ng/ml is higher than what’s considered normal and means there’s roughly a one in four chance of cancer being present. A PSA level higher than 10 ng/ml indicates that there’s roughly a one in two chance that cancer is present.

If you receive a high PSA test result, your doctor will usually recommend further investigations.

It’s important to remember that PSA levels vary from person to person and a high level can be caused by a number of things other than cancer, such as having an inflamed or infected prostate.

Next steps

If your doctor recommends investigating your prostate further, they may suggest further tests, such as a transrectal ultrasound scan, a biopsy or a PCA3 test.

A transrectal ultrasound scan produces images of your prostate using sound waves and involves your doctor inserting a small probe into your rectum.

A biopsy involves your doctor taking tissue from your prostate using a needle. The tissue is then looked at under a microscope for signs of cancer. A biopsy takes about 15 minutes and may leave you feeling tender afterwards.

A PCA3 test looks for the PCA3 gene, which is found in high levels in prostate cancer cells. It involves taking a sample of urine and examining the prostate gland.

Aside from these three exams, you may also be referred for a CT scan, MRI scan or a bone scan, to see if the cancer has spread to your bones. 

Who should be screened?

Prostate cancer is most common in older men, and rates are highest in men aged 75-79. Statistics show that ethnicity is a risk factor and black men are more likely to develop it. You’re also more at risk if a close relative has had it before they reached the age of 65.

As it develops without symptoms, it’s a good idea to get screened from the age of 50. 

If you are at a very high risk eg if you’ve got more than one close relative who has developed prostate cancer before they reached 65, you should start getting screened at 40. 

If you are black or you have one close relative who developed prostate cancer at a young age, you should start getting screened at 45.

Preparing for prostate examinations

Due to the personal nature of a prostate examination, it’s normal to feel a bit anxious but it will be easier if you relax and practise some deep breathing.

You should tell your doctor if you have any conditions that might be made worse by a DRE, such as haemorrhoids or an anal fissure. You should also tell them about any medications you are taking.

Recent ejaculation can affect your PSA level, so your doctor might ask you to abstain from sexual activity for a period of time before your examination.