Digital rectal examination

Because the prostate cannot be seen or felt externally, doctors perform a digital rectal exam (DRE) to assess its size, shape, and consistency. Along with prostate specific antigen (PSA) testing, a DRE is an essential screening tool for prostate cancer.

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The American Cancer Society and American Urological Association recommend that all men over age 50 have a DRE and a PSA test at least once a year. Men at high risk for prostate cancer—black men and any man with two or more first-degree relatives (father or brothers) with the disease—should begin annual DRE and PSA screening at age 40 or 45. Despite this recommendation, a study published in the Archives of Internal Medicine in 2004 found that only 47 percent of 588 men who underwent PSA testing had a DRE performed along with it. Skipping this exam means that many men with prostate cancer and a normal PSA result will go undiagnosed.

Some men avoid getting a DRE because they feel uncomfortable about the procedure, but it is not painful and lasts less than a minute. During a DRE, the patient either bends forward over the examination table, lies on his side, or kneels on the table. The doctor then inserts a gloved, lubricated finger a few inches into the rectum and gently palpates the prostate gland to feel for a nodule or lump, change in size, hard tissue, or any other abnormality that might indicate a tumor is present.

The frequent absence of a solid, palpable mass makes it difficult to detect early prostate cancer with a digital rectal exam. Used alone, a digital rectal exam misses 30 percent to 40 percent of prostate cancers, and most cancers found with the exam are detected when it is too late for treatment to be effective. The most reliable way to detect prostate cancer in its early stages is to combine digital rectal exams with measurements of PSA levels in the blood.