Check Your Prostate

A digital rectal exam (DRE) is one of the primary methods a doctor uses to check your prostate. It involves the doctor briefly inserting a finger into your rectum to feel for potential abnormalities. The abnormalities may include symptoms associated with prostate cancer, benign prostate hyperplasia (an enlarged prostate), and prostatitis (an inflamed prostate usually from infection). Medical professionals do not recommend trying to perform a self exam do to the training required to reach accurate conclusions based on the exam. However, if you wish to administer your own exam, you should be familiar with the techniques used by an examining physician.

Steps

Deciding If You Need a Prostate Screening

1. Determine the necessity of a screening based on your age. The American Cancer Society suggests a yearly prostate screening for all men age 50 and over. However, select circumstances may warrant screenings beginning at an earlier age. These include:
   • Age 40 for men with more than one first-degree relative (son, brother, or father) who had prostate cancer before age 65.
   • Age 45 for men with a single first-degree relative who had prostate cancer before age 65.
   • Age 45 for African American men due to carrying a higher risk of prostate cancer.
2. Note any symptoms associated with your urinary system. Problems associated with your bladder, urethra, and penis can all potentially have ties to prostate problems. Due to the proximity of the prostate to these systems it can grow and press against them causing dysfunction. With prostate issues you may experience the following:
   • Slow or weak urine streams
   • Difficulty urinating
   • Frequent urination at night
   • Burning urination
   • Blood in your urine
   • Difficulty getting an erection
   • Painful ejaculation
   • Lower back pain
3. See your doctor. If you have any urinary symptoms, a variety of ailments may be responsible that a DRE alone cannot diagnose. Also, a DRE is just one of several tests your doctor may use to determine the health of your prostate.
   • Your doctor may order a trans rectal ultrasound (TRUS) to check for suspicious tissues inside of your rectum.
   • A biopsy may also be necessary to confirm or rule out cancer.
4. Request a prostate-specific antigen (PSA) test. Your doctor can order a laboratory test to check your PSA levels (a specific protein found in your prostate) in the event of prostate abnormalities. Most doctors conclude a PSA level of 4ng/ml or lower is considered normal.
   • PSA levels can cause false positive or false negative results. The Unites States Preventive Task Force advises against prostate screening with PSA levels due to these risks.
   • Ejaculation (recent sexual activity), prostate infection, digital rectal examination, and bike riding (due to pressure on the prostate) can cause elevations of PSA. Those without prostate symptoms and elevated PSA may require repeat testing after two days.
   • Repeat elevated PSA levels may warrant a DRE and/or biopsy of the prostate (needle inserted to take a piece of the prostate tissue for analysis) if symptoms are present.
   • Men with a PSA of less than 2.5 ng/mL may only need to be retested every two years whereas screening should be done yearly if your PSA level is 2.5 ng/mL or higher.

Checking Your Prostate

1. Consider having your doctor perform the exam. Though it may seem relatively simple to perform, prostate exams require proper technique and the ability to understand what you are feeling for.
   • Possible complications include bleeding due to nail punctures of cysts or other masses. This can lead to infection or other complications, which you cannot handle at home and would require a trip to your doctor regardless.
   • In addition, if your self exam is abnormal and you seek advice from your doctor, he will most likely repeat the exam to confirm the results anyway.
2. Assume the correct position. Performed at your doctor’s office, your doctor would position you either lying down on your side with your knees up or standing leaning forward with your hips flexed. This gives the doctor easier access to your rectum and prostate.
3. Inspect the area for any skin conditions. This will either require some handy work with a hand mirror or the assistance of a spouse or partner. Inspect your rectal area visually for any skin conditions, such as cysts, warts, or hemorrhoids.
4. Put on a sterile glove. You or your partner should put on a sterile latex glove to perform the DRE. Ensure that you wash your hands before touching the glove to put it on. You will only use your index finger for the exam, but you should still wear gloves.
   • Ensure you have closely trimmed fingernails before washing your hands and putting on the glove. Even through the latex, you can accidentally scrape the area or puncture a cyst or other mass.
5. Lubricate the glove. A lubricant such as Vaseline or KY Jelly will allow easier, less stressful penetration into the rectum. Apply a liberal amount of the lubricant to the index finger of the glove.
6. Feel the walls of your rectum. You or your partner will insert the index finger into your rectum. Turn the finger in a circular motion to feel for any bumps or lumps that could indicate cancer, tumors, or cysts along the walls of your rectum. If no abnormalities are present, the walls should be smooth with a consistent shape.
   • Use gentle pressure.
7. Feel the wall of your rectum toward your belly button. Your prostate lies above/in front of this portion of your rectal wall. Abnormal findings as you feel toward your prostate include firm, bumpy, non-smooth, enlarged, and/or tender areas.
8. Remove your finger. In a professional setting, the entire exam will take approximately ten seconds, so don’t spend too much time feeling around as it will only increase your discomfort with the exam. Dispose of the glove and remember to wash your hands again immediately.
9. Contact your doctor. Make sure that you follow-up with your doctor for further tests and discussion. If you feel like your exam showed abnormalities, then you should make an appointment with your doctor right away. Remember to tell the physician that you administered a self exam if it’s been less than two days since this can result in an elevated PSA level on other tests.

Warnings

• Note that cancer can occur even with normal results from both the PSA test and a DRE.
• Closely trim your fingernails first.
• Consensus regarding the reliability of screening is mixed with some foundations and physicians recommending it whereas others do not. Discuss your family history, age, and symptoms with your healthcare provider to make an informed decision.

Things You'll Need

• Surgical gloves
• Lubrication

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