What happens during a prostate exam

A prostate exam usually involves two parts: a blood test and a digital rectal exam (DRE). The blood test measures PSA (prostate-specific antigen), a protein your prostate makes. The DRE is a physical exam where your doctor inserts a gloved, lubricated finger into your rectum to feel the size and texture of your prostate gland, which sits just below the bladder.

The entire exam takes about five to ten minutes. You will be asked to remove your pants and underwear, then bend forward or lie on your side. The DRE itself lasts only a few seconds, though some men feel pressure or mild discomfort. You may feel the urge to urinate, which is normal and passes quickly.

Some doctors perform only the blood test, some only the DRE, and some do both. Ask your doctor ahead of time which test or tests you will have so you know what to expect.

Key Takeaways

  • A prostate exam usually combines a PSA blood test with a digital rectal exam, though your doctor may do one or both.
  • The digital rectal exam takes a few seconds and involves your doctor inserting a gloved finger to feel the prostate gland.
  • Mild discomfort and the urge to urinate are normal during the exam and pass quickly.
  • Talk with your doctor about whether screening is right for you, since prostate cancer screening has both benefits and risks.
  • Bring a list of any medications you take, as some can affect PSA levels.

Why doctors recommend prostate screening at different ages

Prostate cancer is common in older men but often grows slowly. The American Cancer Society recommends that men have a conversation with their doctor about screening starting at age 50, or at age 40 to 45 if they are Black or have a family history of prostate cancer. Men at very high risk may start the conversation even earlier.

The goal of this conversation is to weigh the benefits and risks. Finding cancer early can save lives, but PSA tests can also produce false positives—results that suggest cancer when none is present—leading to unnecessary biopsies and worry. Your doctor can help you decide whether screening makes sense for your health and your values.

If you decide not to be screened, you can change your mind later. Screening is not a one-time decision.

What PSA numbers mean and when they warrant follow-up

PSA is measured in nanograms per milliliter (ng/mL). A PSA below 4.0 ng/mL is generally considered normal, though some doctors use different cutoffs. A single high PSA does not mean you have cancer—PSA can rise from infection, recent ejaculation, or vigorous exercise. Your doctor may ask you to wait a few days and retest before taking action.

If your PSA is elevated or rising over time, your doctor may recommend a repeat test, an ultrasound, or a biopsy. A biopsy involves taking small tissue samples from the prostate to look for cancer cells under a microscope. Not all elevated PSA results lead to biopsy, and not all biopsies find cancer.

PSA levels also vary by age. A 70-year-old man with a PSA of 5.0 may have a different risk profile than a 55-year-old with the same number. Your doctor will interpret your results in the context of your age, family history, and previous PSA trends.

How to prepare for your prostate exam

There is no special preparation needed for a prostate exam. You can eat and drink normally. If you are having a PSA blood test, fasting is not required, though some doctors prefer it—ask when you schedule.

Avoid ejaculation for 24 to 48 hours before the exam, as this can temporarily raise PSA levels and skew your results. If you have had a urinary tract infection or prostatitis (prostate inflammation) recently, tell your doctor, as these can also elevate PSA. Vigorous exercise, especially cycling, can raise PSA as well.

Bring a list of all medications and supplements you take. Some drugs, including certain blood pressure medicines and finasteride (used for enlarged prostate), can affect PSA levels. Your doctor needs to know what you are taking to interpret your results correctly.

What to expect if your results are abnormal

An abnormal PSA result does not mean you have prostate cancer. Your doctor's next step depends on how high your PSA is, how fast it has risen, your age, and your symptoms. Many men with elevated PSA have benign prostate enlargement or infection, not cancer.

If your doctor recommends a biopsy, you will be referred to a urologist. The biopsy is usually done in an office setting using ultrasound guidance. You will receive local anesthesia, and the procedure takes about 10 to 15 minutes. Afterward, you may see blood in your urine or stool for a few days, which is normal. You can return to normal activities the next day, though you should avoid strenuous exercise for a week.

If a biopsy finds cancer, your doctor will discuss treatment options with you. Early-stage prostate cancer often grows slowly, and treatment choices include active surveillance (monitoring without when ready treatment), surgery, radiation, or hormone therapy. Your age, overall health, and the aggressiveness of the cancer all factor into the decision.

Risks and limitations of prostate screening

Prostate screening can detect cancer early, but it also has downsides. False positives can lead to anxiety and unnecessary biopsies. Overdiagnosis—finding cancers that would never have caused harm—is a real concern, especially in older men. Some men are treated for slow-growing cancers that would not have affected their lifespan or quality of life.

Biopsies carry small risks of infection and bleeding. Some men experience erectile dysfunction or urinary problems after biopsy or treatment. These risks are usually temporary but can be permanent in a small number of cases.

For these reasons, the decision to screen should be made together with your doctor, not as a routine test everyone should have. A conversation about your personal risk, your family history, and what you value most—early detection or avoiding unnecessary testing—is the best starting point.

Questions to ask your doctor before screening

Before your prostate exam, consider asking your doctor these questions to make an informed decision about screening:

  • Do I have risk factors that make screening more important for me (age, family history, race)?
  • What are the benefits and risks of screening in my case?
  • Will you do a PSA blood test, a digital rectal exam, or both?
  • What PSA level would prompt you to recommend further testing?
  • If my PSA is elevated, what would the next steps be?
  • How often should I be screened if I decide to go ahead?

Frequently Asked Questions

Does a prostate exam hurt?

The digital rectal exam is usually not painful, though some men feel pressure or mild discomfort. It lasts only a few seconds. If you are very anxious, tell your doctor beforehand—they can go slowly or use extra lubricant. The PSA blood test is a standard needle stick and causes no more discomfort than any other blood draw.

Can I get a prostate exam without the digital rectal exam?

Yes. Some doctors now offer PSA blood tests alone. Talk with your doctor about which tests they recommend and why. Both tests together give more information than either one alone, but a PSA test by itself is an option if you strongly prefer to avoid the DRE.

How often should I be screened?

This depends on your age, risk factors, and your PSA results. Men with normal PSA levels may be screened every one to two years or every few years. Men with elevated PSA may need more frequent testing. Your doctor will recommend a schedule based on your individual situation.

What if I have symptoms like trouble urinating or pain?

Urinary symptoms and pain are not screening issues—they are reasons to see your doctor right away, regardless of your age or screening status. These symptoms may point to infection, enlargement, or other conditions that need evaluation. Do not wait for a routine screening appointment if you have symptoms.

Can I refuse the digital rectal exam and just get the PSA blood test?

Yes. Screening is your choice, and you can decide which parts of an exam you want. Some men prefer the blood test alone. Keep in mind that the DRE provides information the PSA test does not, so your doctor may recommend both, but the final decision is yours.