Prostate Exam: How It’s Done and Who Needs One

Few topics make grown men squirm in their chairs like the words
“prostate exam.” But here’s the truth: the exam is usually quick,
not nearly as awkward as you imagine, and it can help detect problems early,
including prostate cancer.

Instead of picturing something out of a horror movie, think of a prostate exam as
another routine checkup more like a slightly weird handshake between you and
your doctor’s gloved finger. In this guide, we’ll break down exactly
how a prostate exam is done, who should get one,
what the different tests are, and how to approach screening decisions with confidence.

What is the prostate and why does it matter?

The prostate is a small, walnut-sized gland that sits just below
the bladder and in front of the rectum. It wraps around the urethra the tube
that carries urine out of the body and its main job is to help make seminal
fluid, the liquid that transports sperm.

Because of where it sits, anything that affects the prostate can also affect
how you pee and sometimes how you have sex. Conditions that can involve the
prostate include:

Prostate cancer – one of the most common cancers in men.
Benign prostatic hyperplasia (BPH) – a noncancerous enlargement of the prostate that can cause urinary symptoms.
Prostatitis – inflammation or infection of the prostate, often painful.

A prostate exam is mainly used to screen for signs of cancer,
but it can also pick up other prostate-related problems.

What is a prostate exam?

When doctors talk about a “prostate exam,” they usually mean a combination of:

A PSA blood test (prostate-specific antigen), and
A digital rectal exam (DRE), where your provider gently feels
the prostate through the rectum.

You might have one, or both, depending on your age, risk factors, and what you
and your doctor decide together. Let’s look at each part in detail so you know
exactly what to expect.

PSA blood test: the lab side of a prostate exam

What is the PSA test?

The PSA test measures the level of prostate-specific antigen,
a protein made by both normal and cancerous prostate cells, in your blood. A
higher PSA level can mean:

Prostate cancer
Benign enlargement of the prostate (BPH)
Prostatitis (inflammation or infection)
Recent ejaculation, bike riding, or even certain medical procedures

In other words, an elevated PSA does not automatically mean cancer,
but it’s a signal that your provider might want to investigate further.

How is the PSA test done?

The PSA test process is straightforward:

You roll up your sleeve in a lab or clinic.
A healthcare professional cleans the skin and inserts a small needle into a vein in your arm.
A small tube of blood is collected and sent to the lab.
You go about your day. The actual draw usually takes less than five minutes.

Results come back as a number (PSA level, measured in ng/mL). What is considered
“normal” can vary by age, lab, and individual risk factors. Your doctor will look
at trends over time, not just a single number.

Do you need to prepare for a PSA test?

Your provider may suggest a few simple preparations, such as:

Avoiding ejaculation for 24–48 hours before the test.
Skipping intense cycling or long bike rides before the test.
Reviewing medications that might affect PSA levels (like certain prostate drugs).

Always follow the specific instructions your provider gives, but don’t stress
this is not an exam you “fail.” It’s just information to help guide your care.

Digital rectal exam (DRE): the hands-on part

What is a digital rectal exam?

A digital rectal exam is a quick physical exam where your
clinician feels the back surface of your prostate through the rectal wall. They
check for:

Size (is it enlarged?)
Texture (smooth, firm, rubbery?)
Any hard areas, nodules, or lumps
Areas that feel tender or irregular

This exam can sometimes pick up suspicious changes even when PSA levels are
normal, which is why many providers still consider it a useful part of
prostate cancer screening.

What actually happens during a DRE?

Here’s the play-by-play so it feels less mysterious:

You’ll be asked to stand and bend forward at the waist, or lie on your side with your knees drawn up (both positions are common).
Your provider puts on a glove and applies a lubricant.
They gently insert one finger into your rectum.
They press lightly in different directions to feel the prostate.
The exam usually takes less than a minute.

Most people describe it as “weird” more than painful. You may feel some pressure,
and yes, it can be a bit embarrassing but your provider does this all the time.
For them, this is Tuesday at 10:15 a.m., not a major life event.

Are there risks or side effects from a DRE?

Side effects are usually minimal:

A brief feeling of pressure or mild discomfort
Occasional small streaks of blood on toilet paper if you have hemorrhoids
Temporary embarrassment (completely normal)

Serious complications are extremely rare. If you have significant pain, bleeding,
or ongoing discomfort afterward, call your healthcare provider.

Who should have a prostate exam?

Here’s where things get a little more nuanced. Different organizations have
slightly different recommendations, and most now emphasize
shared decision-making meaning you and your doctor decide
together, based on your risk factors and preferences.

Average-risk men

For men at average risk (no strong family history, not Black,
no known genetic mutations), major U.S. organizations generally recommend:

Talk about screening starting around age 50. This conversation
usually focuses on PSA testing, with or without a DRE.
Men ages 55–69 are the main group where screening may offer
a small reduction in prostate cancer deaths. Whether that benefit outweighs
the risks depends on your values and health priorities.
Age 70 and older: Routine screening is usually not
recommended, especially if life expectancy is less than 10–15 years, because
the risks of overdiagnosis and overtreatment can outweigh benefits.

Higher-risk men

You may be considered higher risk if:

You are Black or of African descent.
You have a first-degree relative (father, brother, or son) diagnosed with prostate cancer, especially before age 65.
You have more than one close relative with prostate cancer.
You carry certain genetic mutations (like BRCA1 or BRCA2).

For higher-risk groups, many experts recommend starting the conversation
earlier, often around age 40–45, and considering screening
more seriously.

Who should definitely talk to a doctor?

You should definitely bring up prostate testing with your healthcare provider if:

You’re a man or person with a prostate aged 45–50 or older.
You’re younger but have a strong family history of prostate cancer.
You’re Black and in your mid-40s or older.
You have urinary symptoms like weak stream, frequent urination (especially at night), pain, or blood in urine or semen.

Symptoms don’t always mean cancer many are caused by benign conditions but
they do deserve attention.

Benefits and risks of prostate cancer screening

Potential benefits

The main goal of prostate screening is to find cancer early, when it may be:

Easier to treat
Less likely to have spread
Associated with more treatment options, including active surveillance

For some men, especially those at higher risk, screening could help prevent
death from prostate cancer or catch aggressive disease before it spreads.

Potential harms

Screening isn’t perfect. Downsides can include:

False positives: High PSA but no cancer. This can lead to anxiety
and invasive tests like biopsies.
False negatives: Cancer that isn’t picked up by PSA or DRE.
Overdiagnosis: Finding slow-growing cancers that might never
have caused problems during your lifetime.
Overtreatment: Treating those slow-growing cancers with surgery
or radiation, which can sometimes cause lasting side effects like urinary
leakage or erectile dysfunction.

This is why many guidelines now recommend that men weigh the pros and cons
and make an individual decision rather than automatically testing everyone.

How often should you get a prostate exam?

If you decide to be screened, your provider may suggest:

PSA testing every 2–4 years for most men in the screening age range.
More frequent testing if you’re at higher risk or if previous PSA levels were borderline.

Screening intervals can be personalized based on your PSA level trends, age,
overall health, and preferences.

How to prepare for your appointment

You don’t need to train like it’s a marathon, but a little prep helps:

Know your family history: Has anyone in your immediate family had prostate cancer? At what age?
List your medications and supplements: Some can affect PSA levels.
Write down urinary or sexual symptoms: When they started, how often they happen, and what makes them better or worse.
Bring your questions: This is a conversation, not a test you pass or fail.

If you feel anxious or embarrassed, tell your provider. You’re not the first
person to feel that way, and they can explain each step before they do it.

Questions to ask your doctor about prostate exams

Good questions might include:

Given my age and risk factors, do you recommend prostate cancer screening?
What are the possible benefits and harms of getting a PSA test?
How will we interpret my PSA result?
If my PSA is high, what’s the next step? Repeat test, MRI, biopsy?
How often would you recommend repeat screening for me?
If cancer is found, what are the treatment options and their side effects?

If your provider can’t answer these questions clearly, it’s okay to ask for a
second opinion, especially from a urologist.

Real-world experiences with prostate exams (500-word perspective section)

Hearing “you should get a prostate exam” is one thing. Hearing what it actually
feels like from real people is another. While everyone’s experience is unique,
there are some common themes that show up again and again.

Many men admit they delayed screening more because of embarrassment
than fear of cancer. One man in his early 50s joked that he spent more time
rehearsing one-liners in his head for the exam than the exam itself actually
took. When he finally went, he described the DRE as “a little pressure, a tiny
bit awkward, and then it was over before I finished my sentence.”

Another man in his 60s shared that he had checked his blood pressure, cholesterol,
and blood sugar regularly but avoided talking about his prostate. Eventually,
his wife encouraged him to bring it up at his physical. His PSA came back
slightly elevated, and his doctor repeated the test a few months later. The
number stayed high, so they proceeded with further evaluation. The outcome:
a small, early-stage prostate cancer that was monitored with active surveillance
rather than immediate surgery or radiation. His takeaway was simple:
“The scariest part was the waiting, not the exam itself.”

There are also stories from men who didn’t test until much later. Some were
feeling fine but finally mentioned mild urinary symptoms to their doctor
getting up more at night, weaker stream, or needing to rush to the bathroom.
Testing revealed more advanced disease than anyone expected. In those stories,
men often say they wish they had known how quick and manageable the exam really
was. For them, screening might not have been perfect, but earlier attention
could have meant easier treatment options.

Clinicians also share their perspective. Many primary care doctors and
urologists emphasize that the emotional barrier is often bigger than any physical
discomfort. They see patients crack jokes to cope, ask if there’s any other way
to check the prostate (right now, not really), and walk out surprised by how
fast it went. Providers repeatedly say their goal is not to scare anyone, but
to help people understand both the power and limits of screening.

In men who choose not to screen, the decision is usually thoughtful, not careless.
Some have other major health conditions and feel that the possible harms of
further tests and treatments would outweigh any benefit at their age. Others
prefer to focus on lifestyle changes healthy diet, exercise, and managing
blood pressure and heart health and accept the uncertainty that comes with
skipping PSA testing.

The common thread across these stories is this: the best decisions happen when
people feel informed, respected, and involved. Whether you
decide to test every few years, only once, or not at all, it’s important that
the choice is made with clear information not fear, shame, or guesswork.

If you’re nervous about scheduling your first prostate exam, you’re not alone.
But think of it like any other maintenance check for your body. You’d probably
rather catch a problem early on your car before the engine light starts flashing.
Your prostate deserves the same level of attention even if the “check engine”
light happens to involve a gloved finger and a brief, slightly awkward minute.

Takeaway: making the prostate exam decision that fits you

A prostate exam usually involves a PSA blood test, a quick
digital rectal exam, or both. For many men between ages 55 and 69 and some
at higher risk starting younger screening can modestly lower the chance of
dying from prostate cancer. At the same time, it can lead to extra testing,
anxiety, and possible treatment side effects for cancers that may never have
caused problems.

That’s why there’s no one-size-fits-all answer to the question,
“Should I get a prostate exam?” The best approach is to talk
honestly with your healthcare provider about:

Your age and life expectancy
Your race and family history
Any urinary or sexual symptoms you’re having
Your feelings about early detection versus the risks of overdiagnosis and overtreatment

If you’re in the recommended age range or have risk factors, consider putting
“prostate screening conversation” on your next physical’s agenda. It’s a short,
slightly awkward moment that might give you long-term peace of mind or even
save your life.

This article is for general information only and is not a substitute for professional medical advice. Always talk with a qualified healthcare provider about your specific situation.