When I meet a man to check his prostate, the first thing I do is shake his hand. That's the point when many of them realise I have big hands - and big fingers. It can add trepidation to a situation already fraught with insecurity and embarrassment. But I'm quick to reassure them that this gives us an advantage: I can examine more of their prostate and it won't be any less comfortable. Here are a few truths about the exam.
It'll just take a minute
There's no shying away from the fact that this exam involves inserting a gloved and lubricated digit into the rectum. While that may not sound pleasant, it's over very quickly. The whole appointment might take just few minutes and the part you're dreading - probably less than 20 seconds.
You'll be granted some privacy to take off your lower clothing before being asked to lie on your side and draw your knees up to your chest. While it's natural to tense up in these situations, you be surprised at how easily a lubricated finger slips in. Once it's in there it usually takes just a few seconds for the anal sphincter to relax around it.
You'll be aware of some pressing - this shouldn't be painful but it may make you feel a brief urge to urinate. If you do experience any pain you should tell the examiner straight away. If the exam is physically intolerable for you but deemed necessary it can be performed under general anaesthetic. Once the surface of the prostate has been inspected, the digit is removed and the area around the anus cleaned of any residual lubricant.
What are we looking for?
Many men experience issues with their prostate gland as they age. The symptoms for benign prostate enlargement and prostate cancer are very similar - most men present first with urinary issues. When your prostate has simply enlarged the surface is usually smooth. We begin to suspect prostate cancer when the surface is hard and lumpy. It's a key difference and the best way to find out is via a rectal exam.
What will I know afterwards?
A rectal exam can't definitively diagnose prostate cancer. Only a biopsy can do that and you wont be offered one if you don't need it. Rectal exams are part of a suite of diagnostic tests, including PSA blood tests and MRI scans, that help to either build or break the case for further investigation.
Can't I just get a blood test?
If you have concerns about prostate cancer you certainly should have a Prostate Specific Antigen (PSA) blood test. Knowing your PSA level can help to establish what's normal for you so that a spike (which could indicate the presence of cancer) is more easily identified. But a blood test alone is not enough. The test has been known to deliver 'false-positive' results in some cases - leading men into have invasive biopsies for no reason. Up to 20% of men with prostate cancer show no increase in PSA levels*. So it's best used to check against the result of a rectal exam but can't be relied upon in isolation.
What if we find something?
A rectal exam can give us an indication that cancer may be present but discovering a lump is not a cancer diagnosis. If the examiner finds the surface of your prostate to be hard and lumpy or your PSA levels are higher than expected you may be referred for additional tests. If you haven't already seen a Consultant Urologist they may conduct another rectal exam to check the GP's initial assessment.
The next step is usually to have an MRI scan so an image of your prostate can be examined. If necessary, you may then be referred for a biopsy to take a sample from your prostate. Even then, finding cancer cells in your prostate doesn't necessarily mean you'll need cancer treatment. Find out more on the truth about prostate cancer diagnosis here.
*Reference: NHS England
Last updated Friday 20 November 2020
First published on Monday 23 November 2015