Prostate exams are screening tests used to check for the signs of prostate cancer in men. Most men start getting prostate cancer screenings at the age of 50. However, some men may need to start getting screened earlier.
This article will provide an overview of what to expect during a prostate exam. It will also offer general recommendations about when to start screening, early signs of prostate cancer, and more.
What is a prostate exam?
Prostate exams are routine cancer screening tests used to check for the early signs of prostate cancer in men. Prostate cancer affects the prostate gland—a small gland located below the bladder and in the front of the rectum.
Prostate cancer is the most common form of cancer among American men, according to the National Cancer Institute and the American Cancer Society (ACS). The ACS suggests that 1 in 8 men will receive a prostate cancer diagnosis in their lifetime. In 2024, it is estimated that there will be about 299,010 new cases of prostate cancer and 35,250 deaths from prostate cancer.
Prostate screening tests play a key role in early detection. These tests are used to check for prostate gland abnormalities, such as enlargement or a change in texture. However, they do not provide a definitive diagnosis for prostate cancer. If your healthcare provider notices concerning indicators of cancer, they will order a prostate biopsy (a tissue sample) to check for cancer cells.
It’s important to note that there is disagreement among medical organizations about the necessity and safety of prostate exams. Prostate biopsies can result in medical complications. In addition, some prostate cancers grow so slowly that they will never cause health problems during the patient’s life. This can lead to unnecessary treatment.
The benefits of prostate cancer screening may not outweigh the potential risks of screening and treatment for most men. Because of this, it’s important to discuss risk factors and testing recommendations with your healthcare provider.
What are the different types of prostate exams?
Healthcare providers use two tests to check for signs of prostate cancer.
Prostate-specific antigen blood tests
PSA blood tests use a blood sample to screen for PSA levels in the blood. PSA is a protein produced by the prostate. Problems with prostate health prompt the gland to release PSA. The higher the levels of PSA in the blood, the more likely it is that there is something wrong with the prostate.
PSA is measured in nanograms per milliliter (ng/ mL).
Here’s what PSA levels may mean:
PSA levels under 4 ng/ mL: Most men with PSA levels under 4 ng/mL are unlikely to have prostate cancer. However, this is not absolute.
PSA levels over 4 ng/ mL: Men with PSA levels between 4-10 ng/ mL have a 25% chance of having prostate cancer.
PSA levels over 10 ng/ mL: PSA levels over 10 ng/ mL mean that the likelihood of prostate cancer is over 50%.
PSA levels have no set cut-off point, as several conditions can affect these numbers.
Other causes of high PSA levels include:
- An enlarged prostate: Conditions like benign prostatic hyperplasia (BPH) can result in prostate enlargement, which can affect PSA levels.
- Age: PSA levels often rise as you age.
- Medication usage: Certain medications, like testosterone supplements, can increase PSA levels.
- Ejaculation: Ejaculation can temporarily elevate the amount of PSA in the body. Because of this, men may be asked to refrain from ejaculating 48 hours before a PSA test.
PSA tests do not provide a definitive diagnosis for prostate cancer. If a patient has high PSA levels (over 3 ng/ mL), a healthcare provider may recommend further testing to check for signs of cancer.
Digital rectal exams
Digital rectal exams are physical examinations used to determine prostate health.
During a digital rectal exam, a provider inserts a gloved finger into the rectum to physically inspect the prostate for abnormalities such as a change in size, texture, or shape.
A DRE may be uncomfortable, but it shouldn’t hurt. Nor does it last long. Most digital rectal exams take about a minute or two. Tell your provider if you have hemorrhoids or an anal fissure (a tear in the lining of the anus) before undergoing a DRE, as this test can aggravate these conditions. In addition, let your provider know if you have prostatitis (inflammation of the prostate), as this can cause pain during a DRE.
If your provider detects prostate abnormalities, they may order follow-up testing.
What is a prostate biopsy?
Prostate abnormalities may prompt your healthcare provider to order a biopsy test. Prostate biopsies test prostate tissue for cancer cells. This procedure is performed by a Doctor of Urology (also known as a urologist).
What to expect
The patient lies on their side with their knees bent to their chest. A thin ultrasound probe is inserted into the rectum, which tells the urologist where to use a numbing agent to prevent discomfort. After the ultrasound is removed, the injection area is numbed with a gel. Once the area is numbed, a tiny needle is inserted into the prostate to collect small tissue samples. This usually takes about 10-20 minutes.
You may be a little sore after the procedure. You may also notice small traces of blood in your semen or stool. If your pain worsens or you start getting a fever, contact your healthcare provider immediately.
If your test results show that you have cancer, your provider will reach out to discuss the best treatment options for you.
When should I start getting screened for prostate cancer?
Depending on your risk factors, there are pros and cons to prostate cancer screening. Early detection of cancer can help improve the efficacy of treatment. However, some forms of prostate cancer grow so slowly that they will never cause health problems. The presence of cancer doesn’t necessarily mean that it poses a risk to the patient, which can lead to overtreatment (unnecessary treatment).
The decision to undergo PSA testing is collaborative between the patient and the provider.
The American Urological Association (AUA) recommends:
- Men with a higher risk of prostate cancer should be offered PSA testing starting at 40-45 years of age.
- Men with a low-to-average risk of prostate should be offered PSA testing starting at 45-50 years of age.
- Men between the ages of 50 and 69 should be offered PSA testing every 2 to 4 years.
The U.S. Preventative Services Task Force (USPSTF) recommends:
- Men between the ages of 55 and 69 should be given the option to undergo screening based on their preferences and risk factors. Providers should not screen men who do not wish to undergo PSA testing.
- Men over 70 should not be screened for prostate cancer.
The USPSTF does not recommend digital rectal exams due to the lack of evidence that there are any benefits to this type of test.
The decision to start screening is one made between you and your provider. If you are concerned about your risk for prostate cancer or have questions regarding when (or how often) to start testing, discuss your personal factors with your provider.
Risk factors for prostate cancer
Some men are more at risk for prostate cancer than others. Men with an increased risk of prostate cancer may start screening earlier and more frequently than men with a low-to-average risk of prostate cancer.
Some risk factors for prostate cancer include:
Age: The risk of prostate cancer rises after age 50. This is why the AUA recommends that all men, regardless of other risk factors, be offered PSA tests every 2-4 years after age 50.
Race: African American men and Caribbean men of African descent are at greater risk of developing prostate cancer than men in other racial groups. Asian American, Hispanic, and Latino men have lower rates of prostate cancer than non-Hispanic white men.
Family history: Certain inherited gene mutations may increase your risk of developing prostate cancer. Men with a first-degree relative (i.e., a brother or father) who has had prostate cancer are at greater risk of prostate cancer than those who do not have a family history of prostate cancer.
Early signs of prostate cancer
Prostate cancer is usually detected through prostate exams. While rare, early stages of prostate cancer may result in certain symptoms.
Symptoms of prostate cancer include:
- Frequent urination: Prostate cancer may make you feel the need to urinate more often, especially at night
- Bleeding: Men with early prostate cancer may notice blood in urine or semen
More advanced stages of prostate cancer may cause symptoms such as:
- Erectile dysfunction
- Weight loss
- Pain in the back, hips, or chest
- Incontinence
Should I talk to my doctor about a prostate exam?
If you are over 40, discuss the risks and benefits of prostate cancer screening with your healthcare provider. If you are under 45 and are not at an increased risk of prostate cancer, your provider may recommend you hold off on testing. However, if you have an increased risk of prostate cancer and are over the age of 40, they may offer PSA testing. If you are 50 or older and have not had your first prostate exam, call your healthcare provider.
How Sesame can help
If you begin to notice symptoms that affect the urinary tract (like difficulty with urination or blood in urine), talk to a healthcare provider as soon as possible. These may be signs of prostate cancer or another prostate condition like BPH. If you want to speak to a provider right away, consider booking an online doctor appointment on Sesame. Providers on Sesame can diagnose medical conditions, offer medical advice, and prescribe medication if appropriate.
