Does a prostate exam hurt: Take the prostate exam like a man
Take the prostate exam like a man
- Overview
Overview
Back to
top
Cancer
Men’s Health
Mr Gareth Brown
Consultant Urological Surgeon
Too embarrassed to get your prostate checked? Mr Gareth Brown, Consultant Urological Surgeon at Nuffield Health Cardiff & Vale Hospital, explains why it’s well worth a few awkward moments.
When I meet a man to check his prostate, the first thing I do is shake his hand. That’s the point when many of them realise I have big hands – and big fingers. It can add trepidation to a situation already fraught with insecurity and embarrassment. But I’m quick to reassure them that this gives us an advantage: I can examine more of their prostate and it won’t be any less comfortable. Here are a few truths about the exam.
It’ll just take a minute
There’s no shying away from the fact that this exam involves inserting a gloved and lubricated digit into the rectum.
While that may not sound pleasant, it’s over very quickly. The whole appointment might take just few minutes and the part you’re dreading – probably less than 20 seconds.
You’ll be granted some privacy to take off your lower clothing before being asked to lie on your side and draw your knees up to your chest. While it’s natural to tense up in these situations, you be surprised at how easily a lubricated finger slips in. Once it’s in there it usually takes just a few seconds for the anal sphincter to relax around it.
You’ll be aware of some pressing – this shouldn’t be painful but it may make you feel a brief urge to urinate. If you do experience any pain you should tell the examiner straight away. If the exam is physically intolerable for you but deemed necessary it can be performed under general anaesthetic. Once the surface of the prostate has been inspected, the digit is removed and the area around the anus cleaned of any residual lubricant.
What are we looking for?
Many men experience issues with their prostate gland as they age.
The symptoms for benign prostate enlargement and prostate cancer are very similar – most men present first with urinary issues. When your prostate has simply enlarged the surface is usually smooth. We begin to suspect prostate cancer when the surface is hard and lumpy. It’s a key difference and the best way to find out is via a rectal exam.
What will I know afterwards?
A rectal exam can’t definitively diagnose prostate cancer. Only a biopsy can do that and you wont be offered one if you don’t need it. Rectal exams are part of a suite of diagnostic tests, including PSA blood tests and MRI scans, that help to either build or break the case for further investigation.
Can’t I just get a blood test?
If you have concerns about prostate cancer you certainly should have a Prostate Specific Antigen (PSA) blood test. Knowing your PSA level can help to establish what’s normal for you so that a spike (which could indicate the presence of cancer) is more easily identified.
But a blood test alone is not enough. The test has been known to deliver ‘false-positive’ results in some cases – leading men into have invasive biopsies for no reason. Up to 20% of men with prostate cancer show no increase in PSA levels*. So it’s best used to check against the result of a rectal exam but can’t be relied upon in isolation.
What if we find something?
A rectal exam can give us an indication that cancer may be present but discovering a lump is not a cancer diagnosis. If the examiner finds the surface of your prostate to be hard and lumpy or your PSA levels are higher than expected you may be referred for additional tests. If you haven’t already seen a Consultant Urologist they may conduct another rectal exam to check the GP’s initial assessment.
The next step is usually to have an MRI scan so an image of your prostate can be examined. If necessary, you may then be referred for a biopsy to take a sample from your prostate. Even then, finding cancer cells in your prostate doesn’t necessarily mean you’ll need cancer treatment.
Find out more on the truth about prostate cancer diagnosis here.
*Reference: NHS England
Last updated Friday 20 November 2020
First published on Monday 23 November 2015
Cancer
Men’s Health
What to Expect During a Prostate Exam
- What is a prostate exam?
- Who should get a prostate exam?
- What happens during a prostate exam
- Prostate-specific antigen (PSA) test
- Results and follow up
- Risks and benefits of prostate cancer screening
- Overall recommendations
If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
If your healthcare provider has recommended you get your first prostate exam, you might feel a bit nervous, but don’t worry! While it may not be the most comfortable test, it’s certainly not painful, and the whole test takes just a few minutes.
Let’s go over what to expect during a prostate exam, who should get tested, and the risks and benefits.
The prostate exam, or digital rectal exam (DRE), allows your healthcare provider to check on the health of your prostate gland. Some providers have used it as an element of prostate cancer screening.
After reviewing several studies, experts now recommend against using the prostate exam in prostate cancer screening because the DRE may not be effective for prostate cancer screening. However, many healthcare providers still use it for other purposes or combined with the PSA test for prostate cancer screening (Naji, 2018).
The prostate gland sits just in front of the rectum. Your healthcare provider can reach it by gently inserting a finger in the rectum via the anus. They’ll manually feel your prostate to look for larger than usual areas, lumps, hard spots, tenderness, or any other problems. While performing the DRE, the healthcare provider can also check for other issues in or around the rectum, like hemorrhoids, anal fissures, blood in the stool, etc.
One of the big questions that experts have examined over the years is when men should get a prostate exam. According to the American Urological Association (AUA), if you are over the age of 50 and have an average risk of developing prostate cancer, you should talk to your healthcare provider about the risk and benefits of a prostate exam (Carter, 2013).
Prostate
Last updated: May 10, 2021
7 min read
However, suppose you are at a higher risk of prostate cancer or are experiencing urinary or sexual symptoms. In that case, you should have a discussion with your healthcare provider about prostate cancer screening sooner rather than later. People who may have a high risk of prostate cancer include (Carter, 2013):
- African Americans
- Men with a family history of prostate cancer or who have tested positive for BRCA1, BRCA2, or HOXB13 gene mutations
- Men with symptoms like blood in the urine, painful or frequent urination, or sexual problems—these may be signs of problems with the prostate, including prostate cancer.
If you’ve never had a DRE before, you may be concerned about what happens during a prostate exam and what it feels like. Don’t worry—it is not a painful experience.
Before performing a prostate exam, your healthcare provider will ask you to remove your clothes from the waist down and will provide you with a gown to wear. During the DRE, you will stand and bend at the waist or lie on your side with your knees bent. Your healthcare provider will apply lubricant to a gloved finger, gently insert it into your rectum, and sweep their finger along the wall of the rectum—this allows them to feel any abnormalities in the prostate.
Your provider may press down on your lower abdomen during this process, potentially causing mild discomfort and the urge to urinate—this is normal. The good news is these sensations only last a few minutes.
You don’t have to do anything special to prepare for a prostate exam. You may get one as part of your annual checkup or during an appointment to discuss a specific issue.
Along with the DRE, many healthcare providers will also order a test for prostate-specific antigen (PSA), a protein produced by the prostate. The PSA blood test has become the mainstay of prostate cancer screening as it’s far more sensitive than the DRE at picking up cancers.
While measuring PSA levels is important in prostate cancer screening, an abnormal PSA test does not necessarily mean that you have prostate cancer. A PSA outside of the normal range could be due to an enlarged prostate, prostatitis, a urinary tract infection (UTI), among other reasons. Your healthcare provider will help you interpret PSA test results and recommend further testing if necessary.
Various organizations have slightly different recommendations regarding screening. This table illustrates the American Urological Association (AUA) recommendations for prostate cancer screening (Carter, 2013).
The United States Preventive Services Task Force (USPSTF) has very similar recommendations to the AUA.
However, they do not comment on men under age 55 or 70+ in excellent health (USPSTF, 2018).
After a DRE, your healthcare provider will know right away if there are any problems like lumps or a prostate that is larger than usual (as in benign prostatic hyperplasia, or BPH). You will discuss any findings with your provider and plan the next steps. The results from a PSA test typically take around two weeks to come back, and your healthcare provider will go over these with you.
If all of your test results are normal, and you and your provider decide to continue screening, you will most likely need testing every two years. However, if the PSA test is abnormal, your healthcare provider may refer you to a urologist for additional testing.
There are two main benefits of prostate cancer screening.
One is potentially preventing death from prostate cancer. Many men have prostate cancer without experiencing symptoms, so screening can potentially identify prostate cancer early on when it can be treated more easily.
Another benefit of screening and early detection is potentially catching prostate cancer in its early stages, allowing for more effective treatment. Earlier treatment can help prevent prostate cancer from spreading beyond the prostate (metastatic prostate cancer), which can cause several symptoms.
Unfortunately, there are drawbacks to prostate cancer screening. The DRE is not very sensitive or specific. This means that people who have prostate cancer can still have a normal DRE, while patients with an abnormal DRE may not have prostate cancer. For these reasons, healthcare providers are no longer performing DRE alone for routine prostate cancer screening and relying instead on the PSA test (Naji, 2018).
PSA testing also has limitations in screening for prostate cancer. Elevated PSA levels do not only occur in prostate cancer. Prostatitis (inflammation of the prostate) or an enlarged prostate (BPH) can also cause PSA levels outside the normal range. Abnormal test results can ultimately lead to undue anxiety and further testing that may prove unnecessary (Hoffman, 2021).
Another problem with the PSA test is the potential for overdiagnosis and overtreatment. Screening uncovers patients with prostate cancer who would otherwise never have had any issues resulting from the disease.
This overdetection means that PSA testing leads to more men getting prostate cancer diagnoses. Once someone is diagnosed, he may elect to undergo prostate cancer treatment, which is not without risks. Treatment risks include infections, bleeding, and urinary problems due to biopsies. Treatment can also cause erectile dysfunction (ED), urinary incontinence, and fecal incontinence (Hoffman, 2021).
Routine prostate cancer screening, especially for men younger than 40, is not recommended. The prostate exam is no longer used for routine prostate cancer screening, though it is sometimes still used in conjunction with a PSA test. Screening tests have their own risks and benefits. The most significant risk is overtreatment, a direct result of overdiagnosis.
Current prostate exam screening recommendations vary based on your age, risk factors, and any symptoms you may or may not be experiencing.
There is no “one-size-fits-all” for prostate exams and cancer screenings. Discuss your risk of prostate cancer with your healthcare provider. Together, you can decide whether to screen for prostate cancer and the best screening plan for you.
- American Cancer Society (ACS). (2021). American Cancer Society recommendations for prostate cancer early detection. Retrieved on May 3, 2021 from https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/acs-recommendations.html
- Carter, H. B., Albertsen, P. C., Barry, M. J., Etzioni, R., Freedland, S. J., et al. (2013). Early detection of prostate cancer: AUA Guideline. The Journal of Urology, 190(2), 419–426. doi: 10.1016/j.juro.2013.04.119. Retrieved from https://pubmed.ncbi.nlm.nih.gov/23659877/
- Hoffman, R.M. (2021). Screening for prostate cancer. In UptoDate. Elmore, J.G., O’Leary, M.P, and Givens, J. (Eds.). Retrieved from https://www.uptodate.com/contents/screening-for-prostate-cancer
- Naji, L. , Randhawa, H., Sohani, Z., Dennis, B., Lautenbach, D., Kavanagh, O., et al. (2018). Digital rectal examination for prostate cancer screening in primary care: a systematic review and meta-analysis. The Annals of Family Medicine, 16(2), 149–154. doi: 10.1370/afm.2205. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29531107/
- US Preventive Services Task Force (USPSTF), Grossman, D. C., Curry, S. J., Owens, D. K., Bibbins-Domingo, K., Caughey, A. B., et al. (2018). Screening for prostate cancer: US Preventive Services Task Force recommendation statement. JAMA, 319(18), 1901–1913. doi: 10.1001/jama.2018.3710. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29801017/
, Randhawa, H., Sohani, Z., Dennis, B., Lautenbach, D., Kavanagh, O., et al. (2018). Digital rectal examination for prostate cancer screening in primary care: a systematic review and meta-analysis. The Annals of Family Medicine, 16(2), 149–154. doi: 10.1370/afm.2205. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29531107/Dr. Tzvi Doron is Board Certified in Family Medicine by the American Board of Family Medicine and is Ro’s Chief Clinical Officer.
Rectal examination of the prostate by a urologist
Rectal examination of the prostate
Rectal examination of the prostate by a urologist – a complete description of the diagnosis, contraindications, methodology, norms, interpretation of the results.
Rectal Prostate Exam is an examination of the prostate through the rectum using the doctor’s index finger. The method is also called “digital examination of the prostate through the rectum.”
The prostate gland is located anterior to the rectum, posterior to the bladder, its location makes it difficult to access it for examination. Therefore, a rectal examination of the prostate is the only way to study it without the use of special tools, with which you can assess the structure, size and consistency of the prostate, the degree of pain and the state of the surface.
Indications for rectal examination of the prostate
- Screening examination of men over 40 years of age to detect asymptomatic prostate pathology.
- Diagnosis of chronic prostatitis.
- Diagnosis of prostate adenoma.
- Diagnosis of prostate cancer.
Procedure
A rare man does not feel psychological discomfort before this procedure, but urologists perform a rectal examination with the utmost care and tact.
Before the manipulation, the doctor explains the sequence of his actions.
Examination is carried out in the knee-elbow position of the patient on the couch. The doctor puts on a rubber glove, lubricates his finger with petroleum jelly and injects it into the rectum. With maximum relaxation of the patient, the procedure is not painful, rather, it simply causes discomfort. A healthy prostate gland does not hurt when examined, but when pressed on it, there may be a pronounced urge to urinate.
If you experience severe pain during the examination, be sure to inform your doctor.
Probing the prostate, the doctor determines its density, size, pain. At the end of the study, elements of prostate massage are applied, which leads to the release of prostate juice. This juice, or prostate secretion, is sent for analysis, since its composition also evaluates the function of the gland.
Interpretation of results
Acute pain during palpation of the prostate indicates the presence of an inflammatory process in it, confirms the diagnosis of acute or exacerbation of chronic prostatitis.
In chronic prostatitis, the consistency of the gland is “doughy”, and the surface is softer. Areas of compaction can be detected – scars formed as a result of inflammation.
Pain when pressing on the gland may occur in the presence of stones in it.
In benign prostatic hyperplasia (adenoma), both lobes of the prostate increase symmetrically in size, the consistency of the prostate remains homogeneous.
Irregular contours of the prostate, its high density and uneven consistency of the tissue may be a sign of prostate cancer. Foci of cancer infiltration in 75-80% of cases are located at the edges of the gland, so its boundaries become uneven, the mobility of the gland relative to the rectal mucosa changes – the prostate moves poorly or does not move at all. The shape of the gland changes in the later stages of the process, one of the two lobes can increase significantly.
Enlargement of the inguinal lymph nodes is observed with inflammation of the prostate (prostatitis) and with its malignant lesion.
Each of the presumptive diagnoses requires confirmation by other instrumental methods – transrectal ultrasound of the prostate, its biopsy.
Ultrasound of the prostate at a price of 1,200 rubles in Rostov-on-Don
Ultrasound of the prostate allows you to diagnose diseases of the genitourinary system in men in a painless and informative way for the patient. This technique is based on the ability of body tissues to reflect ultrasonic waves. Ultrasound examination makes it possible to obtain highly accurate data on the structure and condition of the prostate.
In Rostov-on-Don, ultrasound of the prostate is performed at the Best Clinic medical center, equipped with the latest generation of diagnostic equipment. Our qualified specialists carry out the procedure quickly, and the low price of the medical service allows the clients of the clinic to be examined without significant financial costs.
The prostate or prostate is an exocrine tubular-alveolar gland located in the center of the small pelvis.
Rectal examination of the prostate is possible due to the fact that it is separated from the wall of the rectum only by a thin fascia. The prostate gland covers the upper urethra and the neck of the bladder. In the dorsal part, the seminal vesicles adjoin the prostate, the ducts pass through the parenchyma of the organ.
The main role of the prostate is to ensure the functioning of the male reproductive system.
The composition of the secret produced by the prostate gland includes a large number of useful substances such as enzymes, vitamins and immunoglobulins. This secret is contained in the male sperm, diluting it and positively affecting the ability of the ejaculate to fertilize the egg. Also, the seminal tubercle of this tubular-alveolar gland compresses the urethra during an erection.
Indications for prostate ultrasound
Men are referred for prostate ultrasound in order to identify the causes of infertility. In addition, this examination is indicated in the following situations:
- discomfort during urination
- abnormal values in blood, urine or semen tests
- diagnosed renal failure
- Pain radiating to the rectum
- inflammation in the pelvic organs
- sexual dysfunction
- the need to monitor the condition of the genitourinary system after treatment of sexually transmitted diseases
- Discomfort or pain in the lower abdomen
- atypical discharge that a man notices during urination
- infectious disease that can affect the male genitourinary system
- Identification of certain diseases in a patient during a rectal examination
Usually, diseases of the genitourinary system occur in men over the age of 40 years.
However, if warning signs appear at an earlier age, it is recommended that you see a urologist as soon as possible and undergo an examination.
What ultrasound of the prostate shows
As you know, the key to successful treatment of any disease is timely diagnosis. Ultrasound examination of the prostate can detect diseases and pathological conditions of the male urinary and reproductive systems, such as:
- prostatitis (acute or chronic)
- purulent formations localized in the prostate itself or in organs close to it
- malignant neoplasms of the prostate (oncology)
- abnormal, enlarged organ
- the presence of connective tissue indurations in the form of fibrosis or scars
With the results of prostate ultrasound, a man goes to his doctor, who, after making a diagnosis, will develop an individual treatment plan according to the specific clinical picture.
Ultrasound examination of the prostate and urinary tract makes it possible to draw conclusions about the following:
- presence or absence of benign hyperplasia or prostate adenoma
- basic parameters of the organ (dimensions, structure, homogeneity, density)
- confirmation and refutation of the diagnosis “prostatitis”
- assessment of the condition of the testis, spermatic cord and epididymis
- presence of cysts
- inflammation detection
- development of the inflammatory process of the testis and its epididymis
For men over the age of forty, doctors recommend regular prostate exams.
The ultrasound technique allows you to do this non-invasively and with a guarantee of obtaining accurate data.
Types of ultrasound of the prostate
In modern medicine, two types of ultrasound examination of the prostate are practiced:
- transabdominal
- transrectal
This procedure lasts no more than 15 minutes. The patient is placed on the couch in the supine position. The doctor applies a gel to the lower abdomen, which makes the ultrasonic device slide easily. The specialist performs a scan, after which the results are given to the patient.
This method is very informative, but associated with some discomfort for the patient.
During the transrectal ultrasound examination of the prostate, the patient is undressed below the waist and placed on the couch in the supine position with his back to the doctor.