Your annual checkup invariably involves getting some orifices probed. An otoscope gets shoved in your ear, a wooden depressor flattens your tongue. But the internal invasion most middle-aged men dread most is preceded by the snapping of the doctor’s latex gloves: A prostate exam.
Don’t worry—It’s normal to stress a little about the test. So here’s what to expect, when you should get one, and how prepare for a prostate exam. Plus, answers to the questions you’re too embarrassed to ask your friends (like, Should I poop before a prostate exam?)
What Happens During a Prostate Exam?
Getting the walnut-sized gland probed—technically called a digital rectal exam or DRE— is one of two screenings doctors use to detect prostate cancer, the most common cancer in men after skin cancer, says urologist Wagner Baptiste, M.D.
DREs are typically done in tandem with a prostate specific antigen (PSA) test, a blood test that measures how much PSA is in your blood.
The DRE is less effective at finding cancer than the PSA, according to the American Cancer Society. That’s largely because cancer can arise in parts of the prostate where your doctor’s finger can’t reach due to tissue interference, says Baptiste. But it can help detect tumors in men with a normal PSA level.
What Age Should I Get My Prostate Checked?
There’s some debate among experts when it comes to screening age, says Baptiste.
The National Comprehensive Cancer Network (NCCN) recommends that average-risk men start at 45. But the American Urological Association (AUA) advises starting at 55. This recommendation appears to be based on the youngest age in two large trials that were first to report results.
The caveats: If you have a family history of prostate cancer or if you’re African-American—both of which increase your risk of prostate cancer—you should talk with your doctor about starting a prostate exam at age 40. You should also ask about beginning testing at 40 if you have a family history of breast (male or female) cancer or ovarian cancer. In many cases that’s due to inheriting a BRCA1 or BRCA2 gene mutation (you can get a blood test to see if you have these genes).
A BRCA1 mutation may increase your risk of prostate cancer by seven to 25 percent, and BRCA2 mutation may raise your risk by 20 to 60 percent, according to some sources.
The Digital Rectal Exam (DRE)
Digital rectal exams are literally the butt of all prostate exam jokes. During the test, your doctor will digitally probe your prostate to search for abnormalities.
“You’ll drop your pants and slightly bend your knees to start,” Baptiste says. “Your doctor will put their hands on your belly and insert a lubricated, gloved index finger into your rectum. They’ll swipe their finger from left to right and move from bottom to top on your prostate looking for any lumps that may indicate prostate cancer.”
The exam isn’t painful, but you’ll feel some pressure when your doctor pushes on your prostate, Baptiste says. There are no risks to the procedure, which only takes around a minute.
Should I poop before a prostate exam?
You can, but don’t force it if you don’t need to move your bowels, Baptiste says.
“There’s no specific bowel prep necessary,” says Baptiste. “It’s common for poop to appear during the exam, but your doctor is used to it and knows what they’re doing and knows where your rectal wall lies to move feces out of the way.”
Other things to do before a prostate exam
Let your doctor know if you have existing conditions including hemorrhoids or anal fissures or tears before your exam.
Can’t I just check my prostate at home?
This is a test best left to the experts, says Baptiste.
The Prostate Specific Antigen (PSA) test
This blood test measures the amount of prostate specific antigen—a protein that is produced by both normal and malignant prostate gland cells—in your blood.
Higher PSA levels may indicate prostate cancer, but a PSA test is used to determine if further testing, including a biopsy, is needed.
How should I prepare for a PSA?
Avoid sex and masturbation, and don’t cycle, horseback ride, or perform strenuous exercise three days before the test, Baptiste says. “These activities can elevate your PSA levels and make it difficult to interpret your results,” he says.
What happens if my PSA levels are high?
Your doctor will likely order a second test to confirm the findings, says Baptiste.
“There are a lot of pre-test conditions to consider that can influence a high PSA test including sex and masturbation or intense exercise, so you want to rule those out,” says Baptiste.
What Happens After a Prostate Screening?
Your doctor will review your results and determine if further testing is needed.
“Your physician may request an MRI to get a more detailed picture of your prostate,” says Baptiste. “The scan can reveal suspicious area(s) that can be targeted during your biopsy, which is required to diagnose prostate cancer.”
How Often Should I Get My Prostate Checked?
After your first exam, make an appointment every other year, Baptiste says.
“If you’re someone at higher risk, including a family history of prostate cancer, your doctor may suggest getting checked yearly,” he says.
The Bottom Line
Prostate cancer is the most common cancer in men, after skin cancer. A prostate exam is an important screening to start at 55—or earlier if you have a family history or other at-risk factors—to potentially catch and treat prostate cancer early.