Prostate Exam

A prostate exam is a screening test to look for early signs of prostate cancer. The doctor will assess your risk of having prostate cancer based on several factors, including your prostate-specific antigen (PSA) levels and the results of your digital rectal exam, as well as your age, family history and ethnic group.

Cancer of the prostate is one of the most common types of cancer. I affects about 1 in 8 men worldwide. Many prostate cancers are not aggressive and remain contained in the gland, but some are aggressive and can spread throughout the body quickly. It is, therefore, important to diagnose and treat prostate cancer as soon as possible to ensure a good outcome.

The average prostate exam age is 50, but based on family history and symptoms, can be as early as age 45. A prostate exam cannot provide a definitive cancer diagnosis, but an abnormal result should be followed up with further investigations such as a prostate biopsy.

Depending on where you live, there are two types of screenings your doctor may use to detect prostate cancer, namely a PSA blood test and a digital rectal exam (DRE). Neither test, however, can confirm that you have prostate cancer, which is why they are called screening assessments rather than diagnostic tests.

Digital Rectal Exam

During a DRE, a doctor physically examines your prostate by inserting a lubricated, gloved finger into your rectum, which is next to the prostate. Any abnormalities felt in the gland, such as an odd shape, texture or size, may need additional testing.

While a DRE may feel uncomfortable, it only takes a few seconds and should not be painful. You should let your doctor know if you have any sores in or around your anus, such as piles or anal fissures, which could cause discomfort.

You do not need to prepare for a digital rectal exam. You also do not need to feel embarrassed as your doctor will be very experienced in performing this exam. Your doctor, however, may ask you to abstain from sex for 2 days (48 hours) before the exam as ejaculation can cause your PSA levels to temporarily rise, which can skew the test results.

PSA Blood Tests

PSA is a molecule that occurs naturally in the prostate gland, and there is always a small amount in your blood. Blood tests that show higher than normal levels of PSA, may indicate a prostate issue, such as enlargement, inflammation, infection or possibly cancer.

Routinely screening all men to check their prostate-specific antigen (PSA) levels is a controversial subject in the medical community. This is largely due to the unreliability of PSA tests which are known to produce both false-positive and false-negative results. For example, around 1 in 7 men with normal PSA levels may have prostate cancer.

Although PSA blood tests cannot accurately determine whether you have prostate cancer they can be used as a gauge to determine if more testing is needed. If you have a raised PSA level, your doctor may refer you for an MRI scan of your prostate. If the scan shows a problem, it can be targeted later with a biopsy.

In the UK there is no routine screening programme for prostate cancer through the NHS. Men with symptoms are now offered an MRI scan before a biopsy. Men over 50 can still, however have a free PSA test if requested.

Due to the limitations of PSA blood tests, most men are now offered a MRI scan before further tests and treatment.

Biopsies To Diagnose Prostate Cancer

Tissue taken from a prostate biopsy are studied in a laboratory. If cancerous cells are detected, they can be studied further to determine how quickly the cancer will spread. Biopsy results will indicate the staging and grading of the cancer and help doctors to decide which treatment is the most appropriate.

There are different types of biopsies, including the following:

• A transperineal biopsy: During this procedure, which is done under general anaesthetic, a needle is inserted into the prostate through the skin behind the scrotum. It has the advantage of a reduced risk of infection.
• A transrectal biopsy: During this biopsy, an ultrasound probe is inserted into your rectum. This allows the doctor to see where to insert the needle to take small samples of tissue from your prostate. This procedure is normally done using a local anaesthetic.

Although a biopsy is more reliable than a PSA test, it can carry risks, such as:

• Taking a sample from a place where the cancer is not located and missing it.
• Needing another biopsy if your symptoms persist or your PSA level continues to rise.
• Undergoing unnecessary surgery or radiotherapy based on finding small, low-risk cancers that do not need treatment.
• Incontinence.
• Erectile dysfunction (impotence).

Frequently Asked Questions