Hey, Guys: Here’s what to expect in your prostate exam

Hey, guys: Remember the other day when you were asking your friend how his prostate exam went? I’m going to guess the answer is a resounding “no.”

Most men don’t love the idea of a deep conversation about what to expect in a prostate exam. But it’s important information to know — whether you get it from your pal, doctor, parent or right here.

“Many men refrain from discussing any personal health concerns, let alone concerns about their prostate,” says Dr. Geoffrey Weinstein, Sharp HealthCare vice president of Oncology Medical Services. “There may be embarrassment surrounding the topic, which can preclude some men from even discussing their concerns with their physician.”

However, screening for prostate cancer can be an important test, not only for men but also for the sake of their family and loved ones. “Prostate cancer, when detected at an early stage, has a high probability of being cured,” Dr. Weinstein says. “And screening increases the chance that the cancer will be detected at an early stage.”

The American Cancer Society (ACS) reports screening for prostate cancer can be considered in all men over age 50 who are expected to live at least 10 more years. For those who are at higher risk, such as men who are African American or who have a family history of early-onset prostate cancer (diagnosed younger than age 65), the discussion may start at age 45.

About the prostate and how its examined

The prostate gland sits below the bladder, between the base of the penis and the rectum. It's about the size of a ping-pong ball and is responsible for making part of the fluid in semen.

Prostate cancer begins when cells in the prostate begin to grow out of control. About 1 in 8 men will be diagnosed with prostate cancer in his lifetime.

There are usually no symptoms of prostate cancer. And most prostate cancers are found through screening. However, urination issues — difficulty starting urination; weak or interrupted flow; urinating often, especially at night; trouble emptying the bladder; pain or burning during urination; and blood in the urine or semen — should be discussed with your doctor.

Prostate cancer screening can be performed using a prostate-specific antigen (PSA) blood test and a digital rectal exam (DRE). Screening may consist of a PSA with or without a DRE. If the results of either test are abnormal, your doctor may recommend an imaging test, such as an MRI of the prostate, and then a biopsy, when small samples of the prostate are removed and studied under a microscope.

The digital rectal exam: Quick and painless

While blood tests are a common form of health screening, it’s the digital rectal exam that worries most men. However, knowing what to expect during a DRE can help relieve some nerves.

Here’s what to expect in a digital rectum exam:

1. You and your doctor will discuss what will take place during the exam.

2. You will remove all clothing and undergarments below the waist and cover yourself with a gown.

3. Your doctor will ask you to either stand with your legs apart and bend at the waist, resting your arms on the examination table; or lie on your side on the examination table with your knees pulled up to your chest.

4. Your doctor will carefully insert a lubricated gloved finger into your rectum (bottom), ask you to relax, and press lightly on your prostate for a few seconds to check for any abnormalities, such as lumps, swelling, tenderness or increased size.

5. You will be given tissue to clean yourself and instructed to get dressed.

The exam should only take a few minutes from beginning to end and should not be painful.

“There may be some physical discomfort,” Dr. Weinstein says. “But it is uncommon that an anesthetic is needed or used. Overall, discomfort, including a bit of soreness or an urge to pass urine or gas, usually resolves with the end of the exam.”

If screening results are abnormal

According to Dr. Weinstein, not all abnormal findings detected during a digital exam or PSA are due to cancer. “A biopsy is usually needed to make the diagnosis of cancer, but not all patients who are referred for prostate biopsies end up being diagnosed with cancer,” he says.

Additionally, if cancer is diagnosed, and the cancer is at an early stage, Dr. Weinstein says treatment has a high probability of curing the cancer. “And not all cancers require treatment,” he says. “Some cancers are not aggressive and can be monitored.”

Talk with your doctor if you are concerned about your personal risk of developing prostate cancer. Together, you can make an informed decision about whether — and when — to be screened.

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