According to the American Cancer Society, 1 in 7 men will have a diagnosis of prostate cancer in their lifetime. While researchers continue to work out whether or not prostate cancer can be prevented, prostate exams are performed to reduce the high numbers of deaths from the disease.
What is a prostate exam?
Screening means looking for early signs of a disease in healthy people who do not have any symptoms. The aim of screening is to diagnose disease at an early stage as it is easier to treat and more likely to be cured.
Who should get a test done?
The prostate is part of the male reproductive system.
Men worldwide over the age of 50 are strongly advised to have at least an informed discussion with their healthcare provider about screening for prostate cancer.
The American Cancer Society recommend that the discussion about screening should take place for men at the following ages:
- 50 years of age for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
- 45 years of age for men at high risk of developing prostate cancer. This includes African-Americans and men who have a father, brother, or son diagnosed with prostate cancer at a younger than age 65.
- 40 years of age for men with more than one first-degree relative who had prostate cancer at an early age.
Some groups do not recommend routine screening. The U.S. Preventive Services Task Force changed their recommendations in 2012 to recommend that men are not screened for prostate cancer.
What tests are available?
There are two main tests commonly used to screen for prostate cancer. These are the digital rectal exam (DRE) and the prostate-specific antigen test (PSA).
Neither test can confirm prostate cancer. However, they can reveal strong signs that a man has a prostate problem and requires further testing such as a prostate biopsy.
Men who want to be screened should be tested with the PSA blood test. If a man gives his consent, the DRE is usually conducted as an early part of the screening.
In the DRE, a doctor or nurse inserts a gloved, lubricated finger into the rectum. They do this to check the size of the prostate and feel for abnormalities.
In the PSA test, a blood sample is taken so that the level of PSA in the blood can be measured. PSA is a protein made by the prostate.
Any concerns about a DRE should be discussed with a healthcare professional.
Before having a DRE, a man should consider the following questions:
- What will happen during the DRE?
- How long will the procedure take?
- Will it be painful?
- How accurate is a DRE at finding cancer?
- When will the results of DRE be available?
- How will the results be given?
- Who will explain the results?
- What further tests will be necessary if the results suggest cancer?
Men are also advised to:
- Inform their healthcare team if they have hemorrhoids or anal fissures, as the DRE may make them worse
- Find out from their insurance provider what costs will be covered and if there are any additional costs
In the U.S., men are asked to give consent before the test. Their consent states that they understand the benefits and risks of the DRE and agree to have the test.
During the DRE
A DRE is generally not painful and only takes a few minutes to complete.
To start the exam, the specialist will gently insert a lubricated, gloved finger into the rectum. The specialist will determine the size of the prostate and feel for bumps, soft or hard spots, and other abnormalities.
Prostate cancers often begin in the back of the gland, which may be felt during a rectal exam. If the prostate is enlarged, the patient may feel discomfort or mild pain during the exam.
After the DRE
Most men go back to their regular activities immediately after a DRE. There may be some bleeding from the rectum afterward, particularly if there are hemorrhoids or anal fissures.
If bleeding persists or is significant, the man is advised to contact his healthcare provider.
If the doctor finds any areas of concern during the DRE, additional tests may be needed to examine them more closely.
Several factors can affect PSA levels in a blood test.
To guarantee an accurate test, a patient must not have:
- a urine infection
- ejaculated for 48 hours before
- exercised heavily in the previous 48 hours
- had a prostate biopsy within the last 6 weeks
These factors may raise the PSA level. Sometimes, a high PSA level may simply be due to increased activity or tension. Intense exercise, work, or a period of travel can lead to a rise in PSA.
What is involved in the PSA test?
The PSA test is a blood test for prostate problems. It measures the amount of PSA that is made by the prostate gland. Some of this protein leaks into the blood and can be measured by doctors.
The higher the PSA level in the blood, the more likely it is that a prostate problem is present. However, many factors can affect PSA levels, such as age and ethnicity. Some prostate glands produce higher levels of PSA than others.
PSA levels also can be affected by:
- some medical procedures
- some types of medication
- an enlarged prostate
- prostate infection
What happens after a PSA test?
A PSA test usually takes 14 days to complete.
If the PSA level is normal, the healthcare specialist may leave further tests to the choice of the individual. They may decide to do the test every 1-2 years.
If the PSA level is high, the specialist is likely to refer the man for more tests. These tests might include an examination of the prostate gland and possibly a prostate biopsy.
The specialist will consider a number of factors such as:
- family history - especially any cases of prostate cancer
- body weight
- previous medical history
What is the prostate gland?
Men have a small gland below the bladder that is about the size of a walnut. This is the prostate gland.
The prostate surrounds the first part of the tube that carries urine from the bladder to the penis. This tube is called the urethra and also carries semen. The prostate gland is divided into two lobes, to the left and the right of a central groove.
What is the function of the prostate?
The most important function of the prostate gland is to produce a fluid that together with sperm cells from the testicles makes up the semen.
The muscles of the prostate ensure that the semen is pressed into the urethra and expelled out during ejaculation.