It's natural to have questions about a prostate exam. Here, a Tufts University chair of urology gently walks you through the experience.
Prostate Exams: A Chief Urology Doctor Explains How To Prepare and What To Expect
Published on Jul. 14, 2025
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“A prostate exam sounds scary and can make people feel nervous, but it’s not as bad as most people think,” says Jairam Eswara, MD, FACS, Chair of the Department of Urology at Tufts Medical Center. “It’s not particularly painful, it’s fast, and most importantly, it can save your life by detecting cancer at an early stage.”
This is because prostate cancer often has no symptoms in its early stages—and that’s when the disease is highly treatable. When caught early, the five-year relative survival rate for prostate cancer is more than 99%, according to the American Cancer Society (ACS). But this number drops significantly if the cancer spreads to other areas of the body, such as the bones, liver, or lungs. That’s why regular prostate cancer screenings can be genuinely life-saving.
Still, nerves are normal, especially if it’s your first time. Below, Dr. Eswara explains what to expect during a prostate exam and why they’re so important.
What is prostate cancer?
The prostate is a gland that’s part of the male reproductive system, responsible for producing fluid that helps nourish and carry sperm. Experts aren’t sure what causes cells in your prostate to become cancerous, though the ACS says that risk factors likely include:
- Age: About 6 in 10 prostate cancer cases occur in men over 65.
- Race: Prostate cancer develops more often in African American men and Caribbean men of African ancestry.
- Family history: You may be more likely to develop prostate cancer if you have one or more first-degree relatives (such as a parent or sibling) who were diagnosed with the cancer before they were 65 years old.
Once cancer cells are present in the prostate, they can multiply quickly and grow into a lump known as a tumor, explains the Cleveland Clinic. If left untreated, parts of the tumor can break off and spread to other parts of your body, making it much harder to treat.
While survival rates are near 100% for cases caught early, prostate cancer is still the second-leading cause of cancer death in American men, according to the ACS.
What is a prostate exam?
You won’t “feel” a lump forming in your prostate—a routine prostate screening is essential because it may be the first indication of cancer, Dr. Eswara explains.
This includes what’s called a digital rectal exam (DRE). “The exam involves inserting a finger [digit] into the rectum in order to feel for any masses that may indicate the presence of prostate cancer,” Dr. Eswara says.
The other screening test for prostate cancer is a PSA (prostate-specific antigen) blood test. However, Dr. Eswara notes, “Some men with prostate cancer will have a PSA in the normal range, making the rectal exam more important.”
Many individuals with prostate cancer will not have any symptoms, Dr. Eswara explains. “Conversely, urinary symptoms don’t typically mean one has prostate cancer,” he adds. “So it’s important to be vigilant. I’d encourage everyone to talk to their healthcare provider about whether screening for prostate cancer, including the prostate exam and PSA, is right for them,” Dr. Eswara says.
As a general guideline, the American Cancer Society says that men should start this discussion with their doctor at or before:
- Age 50 if you’re at average risk
- Age 45 if you’re at high risk, which includes African American men and men with a family history of prostate cancer
- Age 40 for men at very high risk, meaning you have multiple first-degree relatives with previous prostate cancer diagnoses
How to prepare for a prostate exam
“It can be scary when you find out you’re going to have a prostate exam, but the truth is that it’s not particularly uncomfortable and it’s quick,” Dr. Eswara says. “If patients are anxious, I remind them to take a deep breath and breathe easily. The exam is very fast!”
No major prep is required, but before your prostate exam, it’s recommended to:
- Wear loose, comfy clothes.
- Avoid ejaculating for 48 hours prior to your exam if you’re getting a PSA blood test (ejaculation can temporarily affect your PSA levels).
- Let your provider know if you have any concerns that might cause discomfort, such as hemorrhoids.
- Tell your doctor about any medications you’re taking.
“If known, patients should be familiar with any family history of cancer,” Dr. Eswara adds. “Some prostate cancers can run in families, and certain genes that confer a higher risk for prostate cancer will also confer a higher risk for other cancers such as breast, ovarian, and pancreatic.”
One thing you don’t have to worry about? There’s no need to change your bathroom habits ahead of a prostate exam, according to the Cleveland Clinic. If you have the urge to go, do so. But don’t be embarrassed about traces of a bowel movement during a rectal exam—it’s a routine, preventive exam that healthcare professionals are very familiar with.
What to expect during the exam
A PSA test is a standard blood draw—your provider orders a sample of your blood for laboratory analysis. A digital rectal exam (DRE) is more invasive in a way that might make you feel anxious, but Dr. Eswara assures that the process is quick, simple, and potentially life-saving.
He explains that a DRE works like this:
- “First, I ask people to pull their pants and underwear down to their knees.”
- “I then ask them to bend over and put their elbows down on the exam table with their knees straight.”
- “After warning my patient, I lubricate my gloved hand and insert my index finger into the rectum.”
He says that people will feel a sense of pressure in the pelvis, but it shouldn’t be overly painful. “I feel the surface of the prostate and the seminal vesicles, if possible,” he says. “I then remove my finger, and that’s it. It takes less than 10 seconds.”
He adds that sometimes, patients might experience an erection during a rectal exam, and that’s not something to stress over. “Getting an erection during a prostate exam is totally normal, and people shouldn’t feel embarrassed or worried,” he says. “Examining the prostate can be stimulating, and this is not uncommon.”
After the exam: what happens next?
“People will know the results of the [DRE] prostate exam instantaneously because your provider will be able to tell you what he or she feels,” Dr. Eswara explains. Most exams are routine and uneventful, and often, abnormal findings aren’t an immediate cause for concern.
“An abnormal digital rectal exam does not necessarily mean someone has cancer,” he says. In fact, the rates of prostate cancer in people who have an abnormal DRE range from just 15 to 30%. “Other non-cancerous entities can give an abnormal prostate exam, including prostatitis and benign prostatic hyperplasia (BPH, an enlarged prostate).” Still, if someone has an abnormal DRE, the next steps involve a prostate biopsy—with or without an MRI first, depending on the setting, Dr. Eswara explains.
It may take a few days to get the results of a PSA test. Typically, these results guide further screening recommendations for an individual, but non-cancerous factors can influence PSA levels. So if your results are higher than average, your provider may simply advise repeat testing.
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