Prostate exams are an essential basic health screening test that everyone at risk of prostate cancer should consider. Current American Cancer Society (ACS) guidelines suggest that men over the age of 50 should speak with their primary care physician about getting screened routinely for prostate cancer. This guideline may change depending on your risk for prostate cancer.
When To Get a Prostate Exam
Prostate cancer is a very common cancer in men who are 50 years of age or older. If detected early, the 10-year survival rate of prostate cancer is 98%. As a result, it is absolutely essential that you get a prostate exam at the correct time.
As previously mentioned, the ACS guidelines suggest that men who are 50 years or older should get screened for prostate cancer. However, for men who are at high risk of getting prostate cancer, this exam should be considered at age 45. Major risk factors for getting prostate cancer that might put an individual at high risk include:
- African American ethnicity
- A first-degree relative (brother or father) who was diagnosed with prostate cancer at an early age (under 65 years old)
If you have more than one first-degree relative that was diagnosed with prostate cancer at an early age, you should consider speaking with your healthcare provider even earlier, at age 40.
What Happens During a Prostate Exam
Prostate exams might be uncomfortable. Here is what to expect when you receive your first prostate exam. Prostate exams can include two major tests: the PSA blood test and a digital rectal exam (DRE).
PSA Blood Test
The PSA test measures the amount of prostate-specific antigen in your blood. PSA is a protein that is produced by your prostate. Normally, your prostate produces only small amounts of PSA. However, if you have prostate cancer or diseases such as benign prostate hyperplasia (BPH), your prostate might release more amount of PSA. As such, high levels of PSA can indicate disease.
Digital Rectal Exam
The DRE exam is used to physically examine the size, shape, and texture of your prostate. In order to examine your prostate, your doctor will insert a lubricated, gloved, finger into your rectum to inspect your prostate. This exam should not be painful and will only last 1-2 minutes. Your doctor will be feeling for hard, lumpy, or other abnormalities of the prostate. Although slightly uncomfortable, this test can be extremely helpful for detecting prostate cancer at an early age.
During the exam, you will be asked to remove your clothing and put on a hospital gown. There are a number of possible positions to stay in but will completely depend on your physician and your own preference. For instance, you can lie on your side, bend over the table, or squat on the exam table. These options will be disclosed to you by your doctor.
According to the ACS, if no prostate cancer is found based on the DRE exam, your PSA value will determine the time frame of your next prostate exam.
- A PSA of less than 2.5 ng/mL indicates a retest in 2 years
- A PSA of greater than 2.5 ng/mL indicates annual retesting
These guidelines might change based on your patient history and your doctor will ultimately decide what your next steps are.
How to Prepare for a Prostate Exam
Before your prostate exam make sure to tell your doctor about any other conditions that you have. Especially be sure to mention if you have any problems with your rectum or your anus. This includes hemorrhoids, anal fissures, or if you have any rectal bleeding. Additionally, make sure to tell your doctor about any prescription medication or over-the-counter medications/supplements that you are currently taking.
It is important to note that you should abstain from sexual activity before taking a PSA blood test. This is because medications and ejaculation can temporarily cause PSA to rise during the test and raise false alarms about prostate cancer.
Why Prostate Exams are Important
Prostate cancer is one of the most common cancers in men. A prostate exam can reveal very valuable information about your overall health and also detect cancer as early as possible. Additionally, prostate cancer is very slow-growing and asymptomatic until very advanced stages. If not detected early enough, treatment will be a lot more difficult and chances of survival will decrease drastically.
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What Can Prostate Exams Detect
Besides prostate cancer, prostate exams (PSA blood tests and DREs) can also detect a variety of other diseases. These include:
- Rectal tumors: cancer of the rectum
- BPH: benign prostate hyperplasia. An enlargement of the prostate gland can cause symptoms of urinary incontinence and kidney issues.
- Anal fissures: small, thin, tear in the lining of the anus
- Hemorrhoids: swollen veins in your lower rectum.
- Rectal prolapse: large intestine gets unattached and slips outside the anus
- Prostatitis: prostate inflammation and enlargement
The Cost of Prostate Exams
Typically, prostate exams are considered a basic health screening test and tend to not be a large expense. However, your insurance status can greatly influence how much you end up paying for this procedure. To outline your possible expenses, the price ranges of prostate exams for both insured and uninsured are discussed below.
Most Medicare or employer-sponsored plans will cover PSA tests. As such, you likely will only be responsible for a low out-of-pocket cost that can be anywhere from $0-30. This cost usually consists of the co-pay for a doctor’s visit and laboratory costs. Some private insurance plans can fully cover all health screenings after you reach a certain age. Make sure you check with your insurance provider before receiving a prostate exam to avoid any surprise costs.
If you are covered by Medicare, Medicare Part B will cover your PSA laboratory test and your DRE. Under Medicare, you will have to meet your deductible and then pay 20% of the original costs. For 2022, the deductible is $233.
If you are uninsured, the price range for a PSA test can range from $100-$300, depending on the clinic you go to. Additionally, your costs might be even greater if your provider decides that you are at risk for prostate cancer and require that you receive a prostate biopsy. These procedures are more invasive and can cost up to $6,000 per procedure.
However, a few options exist for uninsured individuals to receive free or low-cost prostate exams. There are both local and federal programs that can help uninsured individuals receive access to prostate examinations. Listed below are community health centers nationwide offering free prostate cancer screenings to individuals without health coverage.
Free or Low-Cost Prostate Screening Locations
|Washington, DC||GW Cancer Center|
|Santa Maria, CA||Marian Cancer Center|
|Cleveland, OH||Cleveland Clinic Martin Health|
|New Brunswick, NJ||The Cancer Institute of New Jersey|
|New York City, NY||Mount Sinai Health System|
Prostate Exam Frequently Asked Questions (FAQs)
Prostate exams can be a mildly uncomfortable and even embarrassing experience for a lot of individuals. Listed below are some frequently asked questions that can help increase understanding and alleviate some anxiety about these screenings.
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How do prostate exams feel?
Although prostate exams are not painful, you might experience some slight discomfort. There will be some pressure in the area and might make you feel like you have to urinate. If you do experience any pain, make sure to tell your physician as this is not normal. Make sure to keep in mind that your doctor is a professional and has likely performed this exam numerous times before. Additionally, these exams are very short and will only take 1-2 minutes.
What are alternatives to prostate exams?
Besides PSA blood tests and DREs, there are a few other ways to screen and/or diagnose prostate cancer. For instance, you can opt for a prostate biopsy. This is the only way to definitively confirm prostate cancer in a patient. A prostate biopsy is when your doctor removes several small samples of your prostate and sends them to the laboratory to test for cancer cells. This procedure is often ordered after an initial prostate exam if your physician finds that you are at risk for prostate cancer. You can also opt for a transrectal ultrasound (TRUS). A TRUS is a procedure where a physician inserts a small probe into your rectum which then translates into a video image of your prostate exam.
What are signs that there is something wrong with my prostate?
There are many signs and symptoms of prostate issues. If your prostate is significantly enlarged, you might experience:
- Weak or slow urine stream
- Difficulty starting urination
- Urinary urgency
- Urinary frequency
- Nocturia (waking up in the middle of the night to pee)
- The feeling of incomplete bladder emptying
Other more non-specific signs of general prostate issues or even prostate cancer include:
- Blood in urine
- Blood in semen
- Erectile dysfunction
- Complete loss of bladder control
- Burning or pain during urination
How can I keep my prostate healthy?
Besides getting consistent preventative care, there are numerous ways to keep your prostate healthy and your chances of getting prostate cancer down.
- Eat a healthy diet
- Avoid excess alcohol consumption
- Avoid eating processed foods
- Exercise consistently
- Keep your hormones level in check. Testosterone levels are important to your prostate health, however, levels will decrease with age. Talk to your physician about considering testosterone replacement therapy)
Prostate cancer and other conditions can be very difficult to detect without a proper prostate exam. It is fundamental that you follow current guidelines and your primary care provider’s direction and guidance in terms of routine prostate checks. Although these exams might be uncomfortable to speak about, make sure you discuss with your doctor the appropriate steps based on your previous medical history and patient-specific characteristics.
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Sophie is a 2024 Pharm D. candidate studying pharmacy at Rutgers University, New Brunswick. She has a passion for healthcare and writing and hopes to make meaningful contributions to healthcare transparency and accessibility. In her free time, she likes to take care of her houseplants, cook, and hang out with her cat.