What Happens When You Get a Prostate Exam?

If you or your doctor suspect that you may have prostate cancer, or think you should be screened for prostate cancer, the first step in the diagnostic process is investigating your personal history and performing a physical exam. Even if your doctor does not mention prostate cancer or prostate cancer screening during an appointment, you can initiate the conversation yourself. Regardless of whether or not you’re examined at a regular well visit or if you make a separate appointment to address your concerns, the history and physical exam portion of the process will be the same. Your doctor will talk with you about any symptoms you might be experiencing, risk factors you may possess, and perform a digital rectal exam (DRE).

Prostate cancer symptoms

Early prostate cancer is often asymptomatic, meaning that it has no symptoms. This can make it challenging to make a very early diagnosis, and why many individuals will undergo regular screening if they are at high risk. The earliest signs of prostate cancer are typically related to a prostate cancer tumor pressing on the urethra (the tube that carries urine form the bladder through the penis and out of the body), and are therefore, usually related to urination. These include:

• Painful urination or a burning feeling while urinating or ejaculating
• Blood in the urine or semen
• An increased need to urinate (often during the night)
• Weak urine stream or interrupted urine stream
• Difficulty in starting or stopping urinating
• Leaking of urine or loss of bladder control

Many of these symptoms can be caused by a variety of different issues, including benign prostatic hyperplasia (BPH), which is the non-cancerous growth of the prostate gland as a man ages. These symptoms can also be caused by urinary tract infections, prostate gland infections, or trauma to the urinary or reproductive tract, all of which are treatable.^1,2 If you do have any of these symptoms, and if your doctor suspects that prostate cancer may be the cause, they will ask further information to determine your specific risk and decide if it’s appropriate to continue on with the examination.

Prostate cancer risk factors

The next step in your examination will be to gain a better picture of your medical history, and assess for any prostate cancer-related risk factors that you may possess. Risk factors can be classified as modifiable or non-modifiable, and contribute to an increased risk in developing a condition. Modifiable risk factors are things we can potentially control or change, such as diet, obesity, or smoking. Non-modifiable risk factors are things we cannot change or were born with like race, family history, or age. While risk factors increase a person’s risk of developing a condition, they are not the cause of the condition’s presence. For example, being exposed certain chemicals, including Agent Orange, could lead to genetic mutations which can then go on to contribute to prostate cancer.

Examples of common risk factors your doctor may take into consideration or ask you about further include the following:

• Race
• Ethnicity
• Family history
• Geography or places of residence
• Exposure to chemicals including Agent Orange (a chemical used in the Vietnam War)
• Smoking history
• Diet
• Obesity or history of obesity
• If you have any other medical conditions
• Medications or supplements you are taking^3-5

After your doctor collects this additional information, they can help paint a better picture of your prostate cancer risk, and if the symptoms you’re experiencing may be related to the condition. If you are asymptomatic, they will use this information to determine if it’s appropriate to still continue with screening.

Digital Rectal Exam (DRE)

The next step in the exam may be for you to have a digital rectal exam, also known as a DRE. A DRE involves your doctor sticking a gloved, lubricated finger into your rectum. During this exam, they will be checking for changes in size, texture, or shape of the prostate to determine if there are any potential cancerous masses. The DRE may also be used to screen for BPH (benign prostatic hyperplasia).⁶

Treatment options

Before moving forward with additional screening or diagnostic tests, your doctor may talk with you about your life expectancy. Although this may be a scary discussion to have at any stage in life, it’s an especially important one when it comes to prostate cancer. Prostate cancer is often diagnosed when it is still confined to the prostate, and is so slow growing that it may never cause any serious symptoms or be life-threatening. This is especially true for elderly men or men at any age who have other potentially life-threatening conditions.

Prostate cancer and life expectancy

Before further determining if you have prostate cancer and planning treatment, your doctor may look at your estimated life expectancy to see if it’s worth risking the chance of experiencing debilitating side-effects of treatment, such as erectile dysfunction and urinary or bowel incontinence. In some cases, treatment can lead to serious quality of life impairments for individuals that may impact their life more than the cancer would.

Your life expectancy is estimated using general population data to determine the average lifespan of an individual based on his age alone. For example, if the average age of an American male was 80 years old, and a man is currently 75, preliminary estimates would suggest his life expectancy is 5 more years. Of course, this is just an average, and many men will live much longer than this. This is why your doctor will also take into account your overall health to tailor the estimate specifically to you and your situation. For example, healthy behaviors such as a well-balanced diet or regular exercise may help increase a man’s projected life expectancy, while negative health behaviors such as smoking or excessive drinking may decrease the estimate. Further, certain medical conditions will be taken into account if they could potentially decrease a man’s life expectancy.⁷

It's important to keep in mind that your life expectancy is just an estimate used to predict if further screening or diagnostic procedures for prostate cancer, and potential treatment of the cancer, outweighs the physical, mental, and emotional impacts of receiving a diagnosis. If further diagnostic tests or screening measures are recommended, your doctor will provide you with information on what the next steps are, and what to expect.