PSA

How A Doctor Performs A Prostate Exam

The male reproductive system relies on a healthy prostate to function. The prostate is a relatively small gland. It has the size of a chestnut1. The prostate produces a fluid that combines with sperm.

The prostate fluid helps to nourish sperm. In turn, reproduction is possible, and semen can survive in the acidic environment of the vagina. 

There are times when a prostate may give a man problems. Several complications have been linked to the prostate gland. Benign prostatic hyperplasia is generally considered the most common type of prostate condition.

Other common issues that men are concerned about include prostate cancer and prostatitis

 Prostate screening is one of the first diagnostic tools used to detect these problems. While men generally find this to be an uncomfortable procedure, its benefits need to be considered. We take a look at how a prostate exam is done. The post also considers why a prostate exam is done. 

Why Are Prostate Exams Performed?

A lot of men do not realize the importance of a frequent prostate exam. When a man goes for a general check-up with his doctor, a prostate exam may be advised. This is considered part of a general health check-up. 

It is generally advised that men undergo frequent health screenings once they reach the age of 402. Research shows that this is the time when the risk of several prostate conditions is increased. For this reason, after 40, a man should ensure they obtain a prostate exam as part of their health screening. 

The main reason why a doctor may advise on a prostate exam is to feel for any abnormalities with the man’s prostate. This helps detect prostate disease. It is usually possible for a doctor to determine the health of the man’s prostate through this examination. Further testing may be needed too. 

The doctor can detect different prostate problems through a prostate exam. It is often considered the initial diagnostic option. The prostate exam itself can give a doctor an indication if there is an enlargement or swelling in the prostate gland. It also helps to determine prostate health. 

In most cases, a prostate exam alone will not be the only diagnostic tool. After a digital rectal exam is done, the doctor will order additional tests if abnormalities are identified. This will help to diagnose problems like cancer and prostate enlargement. 

Another important reason for regular prostate exams is early diagnosis. Some conditions become worse when they are not treated. Cancer can cause serious complications. In some cases, cancer cells can become metastatic. In this scenario, cancer spreads to other parts of the patient’s body. It can lead to life-threatening problems. 

Benign prostatic hyperplasia also becomes worse when the condition is left without treatment. This can lead to more severe lower urinary tract symptoms. The patient may also be at risk of a urinary tract infection and issues with their bladder. 

When these conditions are diagnosed at an early stage, the treatment can usually provide more successful results. It is also generally easier to treat a condition when it is still in an early developmental stage.

With cancer, active surveillance may be advised. This is after a man’s average risk is considered. Routine screening may then be required. It helps to ensure prostate cancer treatment is provided at an early stage when needed. 

Who Should Get A Prostate Exam?

Men should understand what the importance of a prostate exam is. This will help men determine when it is essential for them to get a digital rectal exam, also sometimes called a DRE. 

Age is one of the most important risk factors associated with prostate problems. The risk tends to increase once a man reaches the age of 40. Thus, men over 40 should ensure they get regular health screening. The man should also provide a prostate exam is part of the health screening. 

This becomes especially important once the man reaches the age of 60. The majority of prostate problems occur in men of this age and older. Thus, at the age of 60, a man should never avoid delaying a prostate exam. 

There are other reasons for men to get a prostate exam, apart from age. 

Men who experience certain symptoms should ensure they get a prostate exam. A man should educate himself on common symptoms associated with prostate problems. 

The sooner the prostate exam is done once the symptoms appear, the earlier a diagnosis can be made. 

Most prostate conditions will cause an enlargement of the gland. Sometimes inflammation may affect the gland instead. The prostate gland is situated directly beneath the bladder. It also surrounds the urethra. This is why men will usually experience lower urinary symptoms when they have a prostate problem. 

Symptoms that men should look out for include3:

  • There may be a frequent urge for the man to urinate. 

  • The man may need to get up frequently to urinate throughout the night. (nocturia)

  • Even though there is an urge to urinate, there may only be a few dribbles of urine, also known as urinary hesitancy.

  • Dribbling may sometimes occur after the man urinates. 

  • Some men experience a burning sensation when they urinate. 

  • In some cases, blood may appear in the semen or urine of the man. 

There are also cases where areas other than the groin may be affected by symptoms. Men should be concerned about the pain that develops in these areas:

  • Rectal region

  • Thighs

  • Lower back

  • Hips

  • Pelvis

Pain in these areas can indicate various problems with the prostate. It can also be a sign of prostate cancer. Prostate cancer screening is essential in such a scenario. Cancer screening helps to ensure this type of disease is diagnosed early. 

What Is A Digital Rectal Exam?

Men need to understand what exactly a rectal examination is. This education should be important, in addition to understanding why this process needs to be done. Prostate exams are commonly performed in male patients. 

A digital rectal exam is a procedure that doctors use to identify problems with the prostate gland. This is a standard method for doctors to analyze the health of the prostate in a male patient. It is also a procedure that does not require any invasive tools. The process is quick and easy for the doctor to conduct. 

Men need to realize that the test may be a little uncomfortable. It is still a non-invasive process, however. 

There is a specific step-by-step process that doctors use for a digital rectal exam. Here is an overview of how the procedure works:

  • The doctor asks the man to lay on their side. Some doctors rather prefer the man bends at their risk. If this is the case, the patient will stand up while the procedure is being performed. The knees will be bent forward if the man is asked to lie down. 

  • The doctor will place a glove over their finger or entire hand. The finger that will be used during the prostate exam is lubricated. The doctor uses a safe lubricant on the glove. This ensures no unneeded irritation occurs in the rectum of the patient. 

  • The doctor places the hand without lubrication on the man’s prostate.

     
  • A finger from the other hand is then slowly and gently pushed inside the rectum. The doctor will be gentle to avoid excessive discomfort. 

  • One the finger is inside the man’s rectum, the doctor will feel around to determine if there are any abnormalities with the man’s prostate. 

  • The doctor will also feel the prostate area on the outside while doing the prostate exam. 

The test does not last long. The doctor will be done within just a couple of minutes. The man may experience a little discomfort during the procedure. Once the procedure is over, the discomfort will no longer be experienced. 

Some men experience an urge to urinate during the exam. The sensation may be more significant if the prostate is inflamed. The same can happen if the patient has an enlarged prostate

There are no serious risks associated with a digital rectal examination. 

Abnormalities will be detected during this exam. If this is the case, the doctor will discuss their findings with the patient. The doctor may then advise the patient to undergo further testing. This will help to ensure suspected conditions can be identified. 

What Is A PSA Test?

If the doctor finds abnormalities during the DRE, then the patient needs to undergo more tests. A PSA test is very commonly requested. It is also called a prostate-specific antigen test, or a PSA blood test.

A PSA test measures the level of prostate-specific antigen in the patient’s bloodstream. This is an indicator of various prostate-related conditions. The doctor may use the results from a PSA test to determine the abnormality of the male patient’s prostate. 

Several conditions may be detected through a PSA test. This is because the level of PSA in the body increases when certain things affect the prostate gland. 

When the prostate is affected by inflammation, the PSA levels will generally increase. The same happens when the man develops an infection in their prostate. 

An enlargement of the prostate gland is also known to elevate the protein levels in the man’s body. This is an indication of benign prostatic hyperplasia. It is a prevalent condition in men. When left untreated, an enlarged prostate can cause problems. This includes a risk of infections – bladder infection and urinary tract infections can occur. 

A PSA test can also help in the diagnosis of prostate cancer. When cancerous cells develop in the prostate gland, the PSA levels in the man’s body will also rise. 

A PSA test cannot provide a definite diagnosis for prostate cancer. It can, however, help the doctor determine if his suspicions are correct. If the PSA levels are significantly high, the doctor will generally request imaging tests. 

These imaging tests will provide a view of the prostate gland. It can be used to determine if there is abnormal growth affecting the prostate. This may be an indication of cancer. The doctor can also use imaging tests to see if there is an enlargement of the patient’s prostate gland. 

How Should I Prepare For The Exam?

Men need to understand how they should prepare for a prostate exam. The first thing to know is how the process works. Men should know exactly what to expect. This will help them to remain relaxed during the procedure. The man will also be able to breathe normally if they know how the procedure works. 

Men do need to ensure that they tell the doctor if they have any problems with their anus or rectum. This includes telling the doctor about hemorrhoids. The man should also tell the doctor if they have an anal tear. 

When the man needs to undergo a PSA test, there are a few things they should tell their doctor too.

A list of medications and supplements taken by the man should be noted to the doctor. There are a few products that can interfere with the results of a PSA test. The doctor will be able to determine if any drugs the patient takes may alter the PSA test results

The man also needs to understand that ejaculation can affect their PSA levels. If the man had recently ejaculated, they should note this to the doctor too. Men should also ensure they do not ejaculate too closely to a PSA test. A doctor will be able to tell the patient if they need to avoid having sexual intercourse prior to the test. 

What Do The Results Mean?

If the doctor identifies an abnormality with the prostate, they will discuss the findings with the patient. The doctor may be able to tell the patient what the abnormality may mean. This could include cancer, prostatitis, and an enlarged prostate

Men need to understand what PSA levels mean too. If a PSA test is done, the doctor will be able to tell the patient how much prostate-specific antigen is in their blood. 

The PSA test provides a measurement in ng/ml. 

Here is an indication of what the measurements mean:

  • If the PSA levels are under 4ng/mL, then the test is normal. This means the man’s prostate should be healthy and not have serious abnormalities. 

  • If the PSA levels are between 4ng/mL and 10ng/mL, then it means there might be a problem with a man’s prostate. In these cases, it might mean there is inflammation or infection in the prostate gland. 

  • When the PSA level is higher than 10ng/mL, then it is considered to be too high. In this case, the doctor may order further tests. The doctor may suspect prostate cancer in this case4. There may also be an excessive enlargement of the prostate gland. 

A urologist also needs to look at how fast changes in PSA levels occur. For this reason, multiple PSA tests may be ordered. 

There are several things that can affect PSA levels. The doctor needs to ensure it is not affected by medication or other factors before making a final diagnosis. 

What Happens After The Exam?

When abnormalities are found with the rectal exam, the doctor will order a PSA test. After the results for PSA testing are returned, the doctor will analyze the measurements of prostate-specific antigen in the patient’s blood. 

The findings of the PSA test determine what the doctor will do next. 

If the doctor suspects prostate cancer, other tests may be requested. A transrectal ultrasound is often requested. This gives the doctor a visual view of the patient’s prostate gland.

Cancerous growths can be observed through this type of ultrasound test. The test is also relatively quick to perform. Men may experience discomfort when an ultrasound is performed. The discomfort should not last long, however. 

A prostate biopsy is sometimes done. This helps to provide a more accurate test for cancer. A colonoscopy is sometimes needed too. This is especially the case when prostatic carcinoma is suspected.

Conclusion

The prostate gland is important in the male body. It is essential for reproductive health. A prostate examination can help a doctor identify abnormalities with a man’s prostate. In such a case, additional tests may be ordered. This can help to detect BPH, prostate cancer, and other conditions early on. We shared some essential information on how a prostate exam is done in this post. 

Sources

  1. InformedHealth.org. (2011) How does prostate work? [online] Available at: https://www.ncbi.nlm.nih.gov/books/NBK279291/
  2. MedlinePlus. Health screenings for men ages 40 to 64. [online] Available at: https://medlineplus.gov/ency/article/007465.htm
  3. National Institute on Aging. Prostate Problems. [online] Available at: https://www.nia.nih.gov/health/prostate-problems
  4.  InformedHealth.org. (2020) Localized prostate cancer: PSA tests for prostate cancer screening. [online] Available at: https://www.ncbi.nlm.nih.gov/books/NBK284938/

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