What Should I Know About the Digital Rectal Exam?

3 min read

A digital rectal exam (DRE) is a test to identify changes in the prostate. It is an exam that can help with early detection of prostate cancer. A doctor can also observe any changes to the end of the large intestine (rectum or anus) with a DRE.^1,2

How is a DRE done?

During a DRE, a doctor will insert a gloved and lubricated finger into the rectum through the anus. The doctor will then assess the size of the prostate and check for any changes or unusual bumps on the prostate.^1,2

The exam can be done in 2 possible positions. You can stand and bend at the waist. You can also lie on the exam table with your knees to your chest.^1,2

When do I need a DRE?

Unless you have other risk factors, DRE exams begin around age 50. Typically, a DRE occurs as part of an annual wellness check. If you have a family history of prostate cancer, your doctor may recommend a DRE starting at age 40. You may also receive a DRE if you have:^1,2

Blood or discharge in your urine or stool
Accidental leakage of urine (urinary incontinence)
Bleeding from the rectum
A change in bowel habits

Community shares

We asked the ProstateCancer.net community: "Have you gone through a digital rectal exam?" Many shared their experiences with the DRE procedure for early detection of prostate problems.

Frequent exams

Every responder had experienced a DRE at some point. Most have DREs regularly to monitor prostate health.

"Several times! No big deal!!"

"Every year since I was 40. Not now, though. Prostate is gone. No more of those finger waves!"

"Yearly from primary care, plus one today as part of my colonoscopy."

"I was very nervous the first time, but now a few times in, while not pleasant, it does not concern me unduly. It’s good to have the OK verdict. Has been done by both doctor and nurse practitioner."

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DRE as a lifesaver

Many respondents shared that a DRE started their prostate cancer journey. The DRE led to diagnosis and treatment.

"It was a DRE that combined with a slight rise in my PSA that started me on my prostate cancer journey."

"My last DRE was last June. I had gone to a urologist for symptoms of BPH (benign prostatic hyperplasia). He said the prostate felt abnormal. I had a biopsy, 10/12 positive samples. Had robotic prostatectomy and just finished 25 days of radiation."

"While my PSA went up a little, the digital exam saved my life."

"It is 20 seconds of discomfort that might save your life."

"It wasn't pleasant, but it saved my life (prostatectomy)."

DRE as part of prostate cancer diagnosis

The DRE is often a first step to detecting prostate cancer. When a doctor feels abnormalities during a DRE, further testing is done. Sometimes, even when the DRE results seem okay, further testing can reveal a problem. Always push for additional testing if something feels off.

"I had a DRE just prior to my biopsy, which revealed advanced aggressive prostate cancer."

"I had a gastroenterologist, urologist, and a radiation oncologist all perform a DRE on me. Not one ever felt any abnormalities. A 12-needle prostate biopsy confirmed that I had stage llC prostate cancer."

Continuing with DRE after prostatectomy

The community had mixed responses about continuing the DRE after a prostatectomy. Some responders continue receiving a DRE yearly, while others do not.

“Not needing 'the finger wave' is one of the silver linings after a radical prostatectomy!"

"No DRE since my proton radiation treatments."

“Yearly DRE by my primary care doctor since age 50. PSA trended on the chart until robotic prostatectomy. No DRE since."

"Yes, but I don't understand why they are doing the DRE after my prostatectomy."

"Yep, I had a DRE last Tuesday. My GP said all felt good. I'm a 6-year prostate cancer survivor/thriver."

Thank you

Thanks to those who shared their experiences with DREs. Have thoughts? Let us know in the comments below.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The ProstateCancer.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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JohnInTheMiddle Member
This article on DREs is not very helpful. A relative had his annual (what he called "perfunctory&quot😉 DRE - but it didn't catch his prostate cancer before it went to Stage 4 metastasis. Academic articles on DRE highlight the poor diagnostic value of the procedure. The authors could have highlighted the trend towards PSA plus MRI for catching prostate cancer. Presenting DRE without mentioning these things and even controversies is lazy and misleading too.
1. JillBrodie Community Admin
 <inline-mention username="JHMX" user-id="6612304"/> I am sorry to hear a relative of yours has stage 4 metastatic cancer. This article was only here to explain that the DRE is often a first step to detecting prostate cancer. If a doctor feels abnormalities during a DRE, further testing is done. And even when the DRE results seem okay, further testing can reveal a problem. I can understand your frustration based on the experience your relative has been through, I wish the doctors could have caught this earlier. Jill, <a href='https://prostatecancer.net' target='_blank'>prostatecancer.net</a> team
bvjarvis1 Member
Some men won’t get prostate cancer tests because of not wanting a DRE. I tell them that their health checkups are their choice; they should get the DRE; if not, at least get the PSA test. Something is better than nothing. Even though the benefit of DREs is mentioned often, so many men are forgoing any prostate checks, that I’m starting to read more and more that routine DREs are not necessary. At least get the PSA test.
BOOMERBOB46 Member
PSA of 10.98 sent me to a urologist who did a DRE on my first visit. The exam found nothing suspicious, but subsequent MRI found a Pirads V anomaly that the finger wag did not. My biopsy confirmed Gleason 4+3 prostate cancer. In my case at least, the PSA test was of more value than the DRE in signaling I was in trouble. I was poor surgical risk for a number of reasons, so underwent 28 hypo-fractionated radiation treatments over a five and one-half week period in conjunction with 4 months of ADT. PSA has remained low and stable since completion of treatments, so have had no further DRE's. My age is 78.
frankhighsmith Member
Can you self-DRE? I'm curious what they are feeling for. Men can feel for testicle nodules and women feel for lumps in breasts. I don't see anything written about self-tests.
1. JillBrodie Community Admin
 <inline-mention username="frankhighsmith" user-id="4148063"/> it is not recommended to do a self DRE test. Please take a look at this article for further information: <a href='https://www.medicinenet.com/how_do_you_check_for_prostate_cancer_at_home/article.htm' target='_blank' rel='noopener noreferrer ugc'>https://www.medicinenet.com/how_do_you_check_for_prostate_cancer_at_home/article.htm</a>. Jill, <a href='https://prostatecancer.net' target='_blank'>prostatecancer.net</a> team
frankhighsmith Member
Thanks Jill. I definitely wouldn't want to be the first diagnosis. I was thinking more as a farther-down-the-line status check after the "pros from Dover" do their diagnosis. 
1. JillBrodie Community Admin
 <inline-mention username="frankhighsmith" user-id="4148063"/> I think even then, doctors do not recommend it as you could end up hurting yourself. Jill, <a href='https://prostatecancer.net' target='_blank'>prostatecancer.net</a> team
Jim Early Moderator & Contributor
Regarding the DRE. As a physician I fully advocate for the DRE starting at 40 or even before with symptoms of any kind. First, a DRE can sometimes find a small cancer close to the surface before any significant rise in the PSA. Second, the cost effectiveness is obvious compared to blood tests and scans. With cancer occurring in an increasingly younger age group than ever before this inexpensive addition seems like a no brainer. Third, the DRE doesn't just detect prostate cancer. I have found a couple of carcinoid tumors and a couple of rectal carcinomas over the years which would have been found later without the routine DRE. DREs in women in conjunction with their pelvic exams have also been beneficial in finding other rectal pathology. Fourth, the DRE is part of a skill set that improves with practice. Learning how to present the importance of the test to patients and practicing the actual skill of a carefully performed DRE comes with frequent practice, just like any other medical procedure. Long live the DRE!!
1. Bobby Bofinger Moderator & Contributor
 <inline-mention username="Jim Early" user-id="4566171"/>, A light bulb went off... I have always thought of a DRE simply as a prostate exam. But if so, it would be called a DPE 😀 I am embarrassed to admit that your third point never really dawned on me -- the rectum was also getting examined. Of course! But sadly, plenty of men still forego prostate cancer screening simply because they do not wish to undergo a DRE. For these men, I would echo the earlier comment/sentiment of "at least get the PSA test". I would add to that, "and get it every year". That's how you develop a PSA trajectory. For me, even though my PSA was always under 4.0, and every DRE was negative, it was my PSA trajectory that indicated a potential issue, and that led to early cancer detection. So, long live the PSA test as well!
JohnInTheMiddle Member
 More and more research indicates the poor diagnostic power of the DRE. There are lots of false negatives. And the CDR, the cancer detection rate, especially missing any symptoms, is shockingly poor. This wouldn't be surprising if one considers that only one side of the prostate can be palpated. And as for the cost of the PSA, is not that expensive. It's disappointing that DRE is presented as uncontroversial. Or that it works. This is what journalism is for - to dig into concerns that lay people are likely not aware of. Not merely as advocates for the status quo.