Medically Reviewed by Jennifer Robinson, MD on November 18, 2020 Doctors use the digital rectal exam (DRE) as a relatively simple test to check the
prostate. Because the prostate is an internal organ, your doctor cannot look at it directly. But because the prostate lies in front of the rectum, they can feel it by inserting a gloved, lubricated finger into the rectum. It may be performed in the screening of
prostate cancer. Not all medical institutions agree on when men should begin screening (routine testing) for prostate
cancer or even if a DRE should be part of the screening. To help detect prostate cancer in its early
stages, the American Cancer Society recommends that men talk to their doctors about the benefits, risks, and limitations of prostate cancer screening before deciding whether to be tested. For most men at average risk, discussions about screening begin at age 50. However, some doctors recommend that men at higher risk of prostate cancer -- African-American men or men with a family history of prostate cancer -- start screening earlier. What Happens During a Digital Rectal Exam?Your health care provider will insert a gloved finger into the rectum and feel the prostate for hard, lumpy, or abnormal areas. The test takes only a few minutes to complete. You may feel slight, momentary discomfort during the test. The procedure does not cause significant pain or any damage to the prostate. What Happens After the Digital Rectal Exam?You may go on with your normal activities. Your doctor will discuss the test results with you. If they detect a suspicious lump or area during the exam, further testing will be the next step. DefinitionThe normal adult prostate gland is heart shaped with a weight of approximately 20 to 25 g. Abnormal findings on rectal examination include areas of firmness, either localized (nodules) or generalized. Bogginess and asymmetry may also be noted. TechniqueThe reader should review the techniques described in Chapter 97, Rectal Examination. The prostate gland is located anteriorly, and the examiner should be able to palpate two relatively firm lobes with a distinct furrow (sulcus) between and lateral to each lobe. During the rectal examination in men, the index finger should be extended superiorly across the top of the prostate, sweeping laterally across each lobe to check for palpable nodule(s) or localized areas of softness, induration, or tenderness. The seminal vesicles may be felt as V-shaped extensions in the superolateral area, but usually they are palpable only if inflamed or containing a neoplasm. Basic ScienceThe normal prostate gland has five lobes: anterior, posterior, lateral (two), and medial. The medial and two lateral lobes are most prominent. The three major conditions that affect the prostate gland are benign prostatic hypertrophy, prostatitis, and prostatic cancer. Hypertrophy of the prostate occurs primarily in the medial and lateral lobes. It involves smooth muscle, connective tissue, and glandular elements of the normal gland. It often begins in the periurethral glands where the urethra traverses the prostate. Accordingly, symptoms of lower urinary tract obstruction may occur relatively early in the clinical course of prostatic enlargement. Prostatic nodules may be palpated in any portion of the prostate. True nodules must be distinguished from rectal mucosal lesions and may be due to benign prostatic hypertrophy (BPH), palpable prostatic calculi, or adenocarcinoma of the prostate. With few exceptions, it is mandatory to biopsy all prostatic nodules because the etiology of a nodule cannot otherwise be determined. Prostatitis may be acute or chronic, bacterial or abacterial. Abacterial prostatitis is sometimes referred to as prostatosis. Acute bacterial prostatitis is accompanied by irritative urinary symptoms such as dysuria, frequency, and urgency. Fever may be significant. Prostatic examination should be limited to making the diagnosis since, in this setting, prostatic massage may lead to considerable morbidity, including septicemia. Prostatitis may be evaluated by the three-glass test as described in Chapter 184, Hematuria. Urine cultures will be positive in acute bacterial prostatitis. Chronic prostatitis may be associated with a mild urethritis causing early morning secretions in the urethra. Glass 1 of the three-glass test may be cloudy and contain mucous threads. Glass 3 (collected after prostatic massage) may contain clear evidence of white blood cells not present in the previous samples. Massage should be gentle from the lateral toward the medial lobe, and down the middle from base to apex. Adenocarcinoma of the prostate typically begins in the posterior lobe. The gland may be large, asymmetrical, or hard; or the cancer may be too small to palpate. Occasionally, there will be induration of a lateral lobe with obliteration of the lateral sulcus. The location of most malignancies of the prostate is such that urethral compression and symptoms of lower tract obstruction may appear relatively late in the clinical course. Obstructive symptoms, however, can occur in a short time, whereas the symptoms of BPH are usually noted to be insidious when a careful history is taken. Moreover, serum acid phosphatase usually remains within normal limits in the absence of extension or metastasis of the malignancy. Careful rectal examination of the prostate is mandatory for early detection of prostate cancer. Clinical SignificanceThe clinical significance of careful examination of the prostate gland is highlighted by the observation that approximately one-third of men above age 60 will have some symptoms or findings referable to the prostate. Prostatic carcinoma represents 10% of all noncutaneous malignancies in men, occurring in 10% of those above the age of 60. Prostatic carcinoma is found in up to 50% of autopsy specimens in men above the age of 80 who died of other causes. Sixty to 70% of cases show local extension or distinct metastases. Hence, early diagnosis and treatment are imperative and are best facilitated by obtaining a biopsy early in the course of suspected abnormalities of the prostate. References
What is the physical exam for prostate?A digital rectal examination (or exam) is used to see if you might have a prostate problem or prostate cancer. It involves your doctor or nurse feeling your prostate through the wall of the back passage (rectum).
Can prostate cancer be detected in physical examination?How is prostate cancer diagnosed? The usual ways to check for prostate cancer are a physical exam of the rectum (the area where the prostate can best be felt) and a blood test. In the rectal exam, your doctor puts a gloved, lubricated finger a few inches into your rectum to feel your prostate gland.
What is the most common physical finding associated with prostate cancer?Signs and Symptoms of Prostate Cancer
Problems urinating, including a slow or weak urinary stream or the need to urinate more often, especially at night. Blood in the urine or semen. Trouble getting an erection (erectile dysfunction or ED)
How is a prostate examination performed?Your health care provider will insert a gloved finger into the rectum and feel the prostate for hard, lumpy, or abnormal areas. The test takes only a few minutes to complete. You may feel slight, momentary discomfort during the test. The procedure does not cause significant pain or any damage to the prostate.
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