Prostate Exams: Do You Really Need One?

Prostate cancer, although the second most common cancer in men in the United States, is extremely treatable when it is detected in its early stages.

Recently, there has been debates in the medical community about whether or not the benefits of a prostate exam outweigh the risks. We asked Scott Stratton-Smith, MD, for his expert opinion on prostate exams and prostate cancer screenings.

Are prostate cancer screenings recommended?

Absolutely. Screening for prostate cancer is very important and recommended by the American Urology Association for men over 50 years old, or age 40 if they are at higher risk. African-American patients may begin screening at age 45. Prostate cancer is very treatable and early detection of prostate cancer is key to treatment and recovery.

Men should have a conversation with their primary care physician about their personal health to determine the best time for prostate cancer screening.

Who should get screened for prostate cancer?

Prostate cancer typically starts in men around 50 to 70 years old. For men who are not at a higher risk of developing the disease should begin a conversation with their doctor about getting screened in their fifties and repeat the screening about every two years.

Men who are at higher risk for developing prostate cancer should begin screenings at age 45. Those at higher risk for prostate cancer include:

• Black or African-American men
• Men with a family history of prostate cancer
• Men who have been diagnosed with prostate cancer before
• Men who have a family history of colon, breast, ovarian, or pancreatic cancer

What does prostate cancer screening entail?

There are two types of prostate cancer screening exams and both should be done in conjunction with the other: A digital rectal exam (DRE) and a prostate-specific antigen blood test (PSA).

A DRE is a physical exam in which the physician lubricates a gloved finger to gently examine the patient’s rectum. If it is enlarged or irregular in shape, the doctor will be able to easily detect it. While it may be uncomfortable, the test brief and can be life-saving.

A PSA test is a blood test that measures the level of prostate-specific antigens in the blood. Rising levels of PSA can be one of the first signs of prostate cancer, allowing for early detection and treatment. These are typically done annually or every other year.

Why should I get both prostate cancer screenings?

Both screenings provide valuable information about your health that can detect prostate cancer, even at an early stage. One result without the other may not provide enough indication of whether or not treatment is necessary.

There are many reasons why a man’s prostate may be enlarged, and prostate cancer is only one. When paired with a PSA blood test, results can better indicate whether further testing is needed to determine a diagnosis.

What are the risks of a prostate exam?

In the medical community, there is some controversy regarding the risks and benefits of a prostate exam. When a DRE is performed and irregularity is detected, 50% of the time there is prostate cancer and 50% of the time there isn’t. The risk, then, becomes over-treatment.

Although not a physical health risk, the possibility of further testing, such as a prostate biopsy or an MRI of the prostate, can be anxiety-provoking.

Overall, the benefits highly outweigh the risks. Patients should discuss the pros and cons of prostate cancer screening with their physician to make the best decision for their health.