Introduction
The prostate exam is a screening procedure utilized to identify early indications of prostate cancer. It usually involves two different tests - the PSA blood test, which measures the level of prostate-specific antigen in the blood, and the digital rectal exam (DRE). In the DRE, the healthcare professional gently inserts a lubricated, gloved finger into the rectum to assess the surface and edges of the prostate gland and identify any potential abnormalities.
Which Individuals Should Undergo a Prostate Exam?
Men should talk to their doctor about prostate cancer screening starting at age 50, according to the American Cancer Society (ACS). However, men at a higher risk, such as African-American men or those with a first-degree relative who has had prostate cancer before 65 years, should undergo this examination at the age of 45. If there is more than one first-degree relative who had prostate cancer before age 65, the patient might consider starting prostate cancer screening even earlier.
Prostate cancer is easier to treat before it spreads, but some prostate cancers grow slowly and do not always require treatment. Age and other factors play a role in determining whether treatment is necessary. Patients should talk to their doctor about their risk factors and whether they should have a prostate exam as part of their yearly checkup.
What Is the Digital Rectal Exam?
A DRE, or digital rectal exam, is the most common method used by doctors to examine the health of the prostate. It is a quick and simple procedure that involves bending at the waist while standing or lying on the patient’s side with the knees bent toward the chest.
During the exam, the doctor will insert a lubricated, gloved finger into the rectum and gently press on the prostate with one hand while feeling the pelvic area with the other. The exam only takes a few moments and may cause momentary discomfort or an urge to urinate, particularly if the prostate is enlarged or inflamed. The doctor will be able to determine if the prostate is of normal size and shape. The DRE is generally considered a safe exam with no risks.
What Is a Prostate-Specific Antigen (PSA) Exam?
To screen for prostate cancer, the doctor may perform a blood test to check PSA levels. PSA is a protein that helps to liquefy semen, and some of it normally enters the bloodstream. However, several factors can cause the PSA levels to increase, such as an inflamed or infected prostate, an enlarged prostate, or certain forms of prostate cancer. Some types of prostate cancer can also cause PSA levels to decrease.
It is important to discuss the advantages and disadvantages with the doctor before undergoing the PSA test. This is because the test can produce false-positive and false-negative results, leading to further testing and treatment and potentially causing anxiety.
What Are the Steps to Prepare for a Prostate Exam?
To prepare for a prostate exam, the patient generally does not need to take any specific steps. However, informing the doctor of any pre-existing conditions that could cause discomfort during the exam, such as hemorrhoids, anal fissures, or anal tears, is important.
Sometimes, the healthcare provider may ask the patient to avoid sexual activity for 48 hours before the exam. This is because ejaculation can temporarily increase the PSA levels, which may impact the accuracy of the test results.
What Happens During a Prostate Exam?
The doctor may use two methods to screen for prostate cancer: a PSA (prostate-specific antigen) blood test and a digital rectal exam (DRE). While the PSA blood test is generally considered more effective at detecting prostate cancer, research suggests that the DRE can also detect cancer in individuals with normal PSA levels. That is why many clinicians recommend both screening tests.
It is important to note that neither of these tests can definitively diagnose prostate cancer. Instead, they are considered screening assessments that can help identify potential issues that require further diagnostic testing.
To perform the PSA blood test, the clinician will take a blood sample and send it to a lab for analysis. The test measures the level of prostate-specific antigen in the blood. However, no definite score confirms or rules out prostate cancer. Instead, the results are used to indicate whether further testing is necessary. If the PSA levels are high, additional tests, such as a prostate biopsy, an MRI, or other lab tests, may be needed to determine if a person has prostate cancer.
In a digital rectal exam (DRE), the healthcare provider will insert a lubricated, gloved finger into the rectum to feel the back portion of the prostate gland, where many cancers begin. This allows them to check for any lumps or bumps.
Is the Prostate Exam Painful?
The prostate exam is generally not considered painful, but it can be uncomfortable for some people. It usually takes only a few seconds to complete. The patient should inform the healthcare provider beforehand if there are any existing conditions like hemorrhoids or anal fissures that could cause discomfort during the exam.
What Do the Results of a PSA Test Indicate?
After the PSA test results are available, the doctor will inform the patient if further testing is necessary. PSA levels can fluctuate for various reasons unrelated to prostate cancer, like medication use, ejaculation, or an enlarged prostate. The doctor might suggest another PSA test after around six months if the PSA level is borderline. If the PSA level is higher than normal, the healthcare provider may suggest additional evaluation and testing with a urologist. PSA levels can be raised by several other factors, including:
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Older age.
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Recent ejaculation.
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Certain medical procedures like a DRE.
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Some urological investigations.
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Testosterone supplementation.
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An enlarged prostate due to benign prostatic hyperplasia (BPH).
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Prostatitis, which is inflammation and swelling of the prostate.
Inform the doctor about any herbal medicines or supplements before undergoing the test, as some of them can lower PSA levels. High PSA levels do not necessarily indicate cancer. However, if a DRE reveals changes in the prostate, a doctor may recommend a biopsy to obtain a more accurate diagnosis.
What Happens After the DRE and PSA Tests?
If the tests come back normal, the healthcare provider may suggest monitoring by repeating one or both tests every one to two years. If the results suggest the possibility of prostate cancer, the doctor may advise a biopsy. However, it is essential to note that a prostate biopsy can result in complications.
Conclusion
In conclusion, prostate exams are essential for men's health, primarily because they help detect early signs of prostate cancer. Two primary screening tests can be used: a digital rectal exam (DRE) and a prostate-specific antigen (PSA) test. These exams can be conducted by a healthcare professional and should be discussed with the doctor, especially for men over 50 and those at higher risk of prostate cancer, such as African-American men or those with a first-degree relative who had prostate cancer before age 65. False-positive or false-negative results can be produced, making it crucial to discuss the advantages and disadvantages of these exams with the doctor before undergoing them. It is necessary to inform the doctor of any pre-existing conditions that could cause discomfort during the exam.
