Prostate Exams: 5 Types of Tests & How They Work

Prostate cancer is one of the most common cancers in men, second only to skin cancer.¹ In fact, prostate cancer will affect around 1 in 8 men during their lifetime.² Fortunately, with early detection through cancer screenings, doctors can cure prostate cancer in 90% of cases.¹

While a prostate exam might seem intimidating, the tests involved can save your life. Here, we look at the different types of tests your doctor might recommend during a prostate exam, what to expect and what types of prostate cancer treatments are available.

What Is the Prostate?

The prostate is a small gland below the bladder and in front of the rectum. Its purpose is to produce fluid that is part of semen in men.¹

This walnut-sized gland gradually grows larger with age. However, if the prostate begins to grow uncontrollably large, it could indicate the presence of cancer.¹

Why Is It Important to Maintain Prostate Health?

Maintaining your prostate health is important because prostate cancer is so common, especially in those with a family history of cancer. Keep in mind that with early detection, the five-year survival rate of prostate cancer cases is around 99%.³

Do You Need a Prostate Exam?

Only males require a prostate exam as part of their health screening tests. Women don't have a prostate, so prostate exams aren't part of their regular health screenings.

Your doctor may recommend a prostate exam and other exams like a colonoscopy if you are over 50 years old. For those aged 40 to 50, your doctor may recommend earlier screenings if you:¹

• Are of African American descent
• Have a close male relative, such as a parent, uncle or sibling who was diagnosed with prostate cancer before they were 65
• Have a close female relative who was diagnosed with breast cancer⁴

How often should I get my prostate checked?

Starting at age 40 or 50, depending on your family history,² you'll need to get checked every one to two years.⁵ Those with a family or personal history of cancer might want to opt for yearly screenings.

5 Types of Tests to Expect During a Prostate Exam

Depending on your age and family history of cancer, your doctor may want to perform a prostate exam, which may consist of various tests and screenings, including:

• A Digital Rectal Exam (DRE)³
• A Prostate-Specific Antigen (PSA) test⁶
• A Prostate Health Index (PHI) test⁷
• A transrectal ultrasound (TRUS) or MRI if cancer is suspected⁸
• A prostate biopsy if cancer is suspected⁹

1. Digital Rectal Exam (DRE)

A doctor performs your digital rectal exam (DRE) usually during your annual physical exam. During this exam, the doctor will place their gloved, lubricated finger in your rectum and physically examine the prostate gland itself. The doctor will look for irregularities in:³

• Size
• Shape
• Texture

A DRE isn't painful, but you may feel uncomfortable for a few seconds. However, if you suffer from hemorrhoids, anal tears or anal fissures, the exam could cause pain, so let your doctor know before your exam.⁶

How effective is the DRE?

The DRE alone can't determine whether you are suffering from cancer or a less serious condition such as benign prostatic hyperplasia (BPH) or a urinary tract infection.⁶ BPH can cause swelling and inflammation of the prostate gland but is noncancerous.¹⁰ A blood test can help determine whether or not your enlarged prostate is cancerous.⁶

2. Prostate-Specific Antigen (PSA) Test

As part of your prostate exam, after the DRE, your doctor may order a Prostate-Specific Antigen (PSA) test:⁶

• This test measures the amount of PSA in the blood.
• PSA is a substance produced by your prostate, and higher levels of it in the blood are typically associated with prostate cancer.
• This test is more accurate than a digital rectal exam.

How do I prepare for my PSA test?

Prior to your PSA test, your doctor may recommend that you abstain from sexual activity for 48 hours. Ejaculating can elevate your PSA levels temporarily and skew your test results.⁶

Does an elevated PSA result indicate prostate cancer?

Several factors other than prostate cancer can affect the PSA level in your blood. Your doctor will take these into account when evaluating your test results. These factors include:⁵

• Older age
• Being of African American descent
• Having a prostate infection or swollen prostate, also known as prostatitis
• Being on certain medications such as finasteride or dutasteride, which can lower your PSA
• Past medical procedures in the area of the urinary tract
• Having had recurrent urinary tract infections

What do my PSA levels mean?

Your PSA levels can vary:³

• A result below 4 nanograms per milliliter (ng/ml) indicates that 85% of the time, you won't have cancer.
• A result between 4 and 10 ng/ml indicates a 1 in 4 chance of developing cancer.
• A result greater than 10 ng/ml means you have a 1 in 2 chance of developing cancer.

How often you get tested also depends on your PSA test results. If your PSA is:¹¹

• Under 2.5 ng/mL, your doctor may recommend screening every two years
• Over 2.5 ng/mL, your doctor may recommend screening every year

How accurate is my PSA test?

While an elevated PSA test result can indicate cancer, this is not always the case.¹ For those with an elevated PSA, your doctor might recommend a Prostate Health Index (PHI) test for a more accurate result.⁷

3. Prostate Health Index (PHI)

The Prostate Health Index (PHI) is a type of blood test that more accurately lets your doctor know if you need a prostate biopsy based on the results of your PSA test and DRE. The PHI tests your blood for levels of:⁷

• PSA
• free PSA
• p2PSA

This test is typically given to individuals with a PSA between 4 and 10 ng/mL who are over 50 years old and whose DRE was normal. Your doctor can use this test to prevent unnecessary biopsies.⁷

4. Transrectal Ultrasound (TRUS)

Prior to recommending a prostate biopsy, your doctor might recommend a transrectal ultrasound (TRUS). This allows the doctor to look at an image of your prostate using an ultrasound probe inserted through your rectum. If the doctor sees any abnormalities, they may recommend a prostate biopsy, which also utilizes TRUS technology.¹²

5. Prostate Biopsy

Should your doctor feel there is a chance you have prostate cancer, they will order a prostate biopsy. This test is typically done in the doctor's office. During this test:⁹

• You lay on your side with your knees bent.
• The doctor inserts a small ultrasound probe into your rectum.
• Using ultrasound images of the prostate, the doctor will inject the prostate with a local anesthetic.
• With the assistance of the ultrasound, the doctor will use a needle to take 10 to 18 tissue samples from various areas of the prostate.
• The doctor will then send the samples to a pathology lab to determine if cancer cells are present.¹

Less commonly, your doctor could take the samples from your prostate through your urethra or the skin of the perineum.⁹

How long does a prostate biopsy take?

The test only takes about 10 minutes.³

Are there side effects from a prostate biopsy?

You may experience the following symptoms or complications after the biopsy, which are typically temporary, lasting several days to several weeks:³

• Soreness in the rectum
• Blood in your stool, urine or semen
• A urinary tract infection
• Acute urinary retention
• Erectile dysfunction

Note that your doctor may prescribe an antibiotic to prevent an infection after your procedure.

Preparing for a prostate biopsy

Prior to your prostate biopsy, your doctor may recommend that you:³

• Stop taking some medications, such as blood thinners, nonsteroidal anti-inflammatory drugs (NSAIDs), vitamins and supplements a few days before the procedure.
• Do an enema the day before the procedure.
• Eat light meals the day before the procedure.
• Take an antibiotic to prevent infections.

Treatment Options for Prostate Cancer

Those diagnosed with prostate cancer have several options for treatment, including active surveillance.¹³

Prostate removal surgery

Surgery to remove the prostate is the most serious option you can choose, but it will eliminate cancer contained in the prostate and prevent it from spreading.¹⁴

Surgery will either be done:¹⁴

• Traditionally, through an incision made between the anus and scrotum
• Laparoscopically, using smaller incisions to remove the prostate
• Robotically, which involves laparoscopic surgery with the assistance of a robot

During recovery, you will likely be hospitalized for one to two days. Expect temporary side effects such as pain and swelling. Side effects such as erectile dysfunction and urinary incontinence may be permanent in some cases.¹⁴

Targeted radiation of the prostate

Targeted radiation kills the cancer cells within your prostate. Your doctor will do this if the cancer is in an early stage, or use it in conjunction with other treatments, such as hormone medications or prostate surgery.

After treatment, you may experience:¹⁵

• Frequent urination or difficulty urinating
• Blood in the urine
• Rectal bleeding
• Diarrhea and an upset stomach
• Cramping in the abdomen
• A skin rash in the treated area
• Erectile dysfunction
• A decrease in semen production
• Secondary cancer in the area treated

These side effects might be temporary or appear years later, while others can become permanent.

Ablation of the prostate

During ablation, your doctor uses heat, cold, chemicals or lasers to kill the cancer cells. Unfortunately, this treatment will also kill healthy prostate tissue. This can lead to:¹⁶

• Pain and swelling after the procedure
• Burning urine
• Changes in how much you urinate
• Blood in the urine and semen
• Changes in erectile function, which may be permanent
• A decrease in the amount you ejaculate, which is permanent

Hormone therapy

The main type of hormone therapy available to treat prostate cancer is androgen deprivation therapy (ADT) to reduce the amount of androgen your body produces. Other hormone-based drugs block androgens in other ways or decrease your testosterone levels. These drugs are typically used for prostate cancers that your doctor can't treat with surgery or radiation.¹⁷

The main side effects of hormones used to treat prostate cancer include:¹⁷

• A lack of sex drive
• Erectile dysfunction
• Nausea
• Diarrhea
• Vomiting
• Hot flashes

Active surveillance

For those with low-grade prostate cancer that is not considered aggressive, your doctor may recommend active surveillance. With this type of treatment, your doctor will simply monitor the cancer to see if it starts to grow.¹³

Physicians grade cancers on the Gleason scale, which predicts how quickly the cancer will grow. Slower-moving cancers have a lower Gleason score than more aggressive cancers.¹⁸

In the past, doctors used surgery or radiation to treat all grades of cancer, but the treatments sometimes had more serious side effects than the disease itself. That's because many low-grade cancers — with a Gleason score of less than 6 — are unlikely to spread to the rest of your body.¹³

When is active surveillance appropriate?

Doctors use active surveillance to monitor:

• Low-grade prostate cancers¹³
• Those who tested negative for cancer but have elevated PSA levels³
• Those with no symptoms and less than a 10-year life expectancy¹¹

When is active surveillance inappropriate?

If you are experiencing serious symptoms or your cancer is high-grade and fast-moving, active surveillance is not an appropriate option to treat your cancer.¹³

Does Insurance Cover Prostate Exams?

Yes, most insurance plans — including Medicare and Medicaid — cover prostate exams such as DREs and PSA tests.¹⁹

Most insurance companies cover the costs of these tests for men 50 years and older. If you have a family history of prostate cancer and are younger than 50, your doctor may deem your testing medically necessary, so your insurance should cover it.²⁰

Although most health insurance companies cover testing, you might be responsible for copays and coinsurance costs associated with these tests.¹⁹

How Much Do Prostate Exams Cost Without Insurance?

Without insurance, prostate exams can be pricey, depending on where you live and how the doctor performs them. The most expensive test for prostate cancer is the prostate biopsy.

• Your doctor will perform your DRE during your annual visit, or they might do it separately. The cost of this test ranges from $15 to $250, depending on whether your doctor performs it alone or as part of your general visit.²⁰
• A PSA test will cost between $100 and $300 out of pocket.¹⁹
• Note that some medical facilities and clinics will offer free PSA testing if you can't afford it.²¹
• Without insurance, a prostate biopsy may cost between $407 and $2,585. The average cost is around $877. Factors like anesthesia use and location will affect this amount.¹²

CareCredit Financing for Prostate Exams

If you are looking for an option to help manage your health and wellness finances, consider the CareCredit credit card. The CareCredit card can help you pay for the care you want and need and make payments easy to manage.* Apply today and use our Acceptance Locator to find a provider or retailer near you that accepts CareCredit. Continue your wellness journey by downloading the CareCredit Mobile App to manage your account, find a provider on the go, and easily access the Well U hub for more great articles, podcasts and videos.

Author Bio

Susan Paretts is a freelance writer with 19 years of experience covering health and wellness, pet care, and more. Her work has been published by the American Kennel Club, Bayer Animal Health, Elanco, LIVESTRONG.com, The San Francisco Chronicle, Chewy and more.