How Do Physicians Examine a Man's Prostate Gland? Guide

The prostate gland is an important part of the male reproductive system, and examining it can help physicians identify prostate enlargement, inflammation, infections, and possible signs of prostate cancer.

Physicians use several examination methods, including a digital rectal examination (DRE), prostate-specific antigen (PSA) blood testing, urine analysis, imaging scans, and, when necessary, a prostate biopsy.

Understanding how physicians examine a man’s prostate gland can help men feel more comfortable before an appointment and recognize why particular tests may be recommended.

A physician considers age, urinary symptoms, family history, medical background, and individual risk factors before deciding which tests are appropriate.

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This guide explores how physicians examine a man’s prostate gland, including digital rectal examinations, PSA blood tests, ultrasound, MRI scans, biopsy procedures, possible findings, and important screening recommendations.

What Is the Prostate Gland and Why Do Physicians Examine It?

The prostate is a small gland located below the bladder and in front of the rectum. It surrounds part of the urethra, the tube that carries urine from the bladder through the penis.

In younger adults, the prostate is approximately the size of a walnut, although its size can increase naturally with age. Its primary reproductive function is to produce fluid that contributes to semen and supports sperm movement.

Common reasons for a prostate examination include:

Frequent urination, particularly during nighttime.
Difficulty starting or maintaining urine flow.
Weak or interrupted urine streams.
A sensation that the bladder has not emptied.
Pain or discomfort in the pelvic region.
Blood in the urine or semen.
Repeated urinary tract infections.
Elevated PSA levels or a family history of prostate cancer.

Three common prostate conditions physicians investigate are benign prostatic hyperplasia (BPH), prostatitis, and prostate cancer.

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How Do Physicians Examine a Man’s Prostate Gland?

Physicians use different methods to evaluate the prostate, depending on the reason for the examination. The process usually begins with a medical history and physical assessment before moving to laboratory tests or specialized procedures.

The following are the most common examination methods.

1. Digital Rectal Examination (DRE)

A digital rectal examination (DRE) is a physical procedure that allows a physician to feel the prostate through the wall of the rectum.

Because the prostate sits directly in front of the rectum, a healthcare professional can assess part of its surface using a lubricated, gloved finger.

How Is a Digital Rectal Examination Performed?

The physician generally explains the procedure before beginning. The patient may be asked to lie on their side with their knees slightly bent or stand while leaning forward over an examination table.

The physician then:

Puts on a disposable medical glove.
Applies lubricant to the gloved finger.
Gently inserts one finger into the rectum.
Feels the accessible surface of the prostate through the rectal wall.
Evaluates the gland’s size, shape, texture, and tenderness.
Removes the finger and completes the examination.

The examination generally takes only a short time.

What Does the Physician Look For?

During a DRE, the physician evaluates several physical characteristics, including:

Prostate size: Whether the gland appears enlarged.
Texture: Whether the tissue feels smooth, firm, or unusually hard.
Shape: Whether the prostate has a regular or irregular outline.
Lumps or nodules: Whether any unusual areas can be felt.
Tenderness: Whether touching the prostate causes discomfort.

A smooth, enlarged prostate may suggest benign prostatic hyperplasia. Tenderness can sometimes occur with inflammation or infection, while hard areas or nodules may require further investigation.

2. Prostate-Specific Antigen (PSA) Blood Test

A prostate-specific antigen (PSA) test is a blood examination that measures the amount of PSA circulating in the bloodstream.

Physicians use PSA testing to help assess prostate health, investigate urinary symptoms, evaluate cancer risk, and monitor certain prostate conditions.

How Is the PSA Test Performed?

The procedure is straightforward and usually takes only a few minutes. A healthcare professional cleans the skin, inserts a small needle into a vein, and collects a blood sample. The sample is sent to a laboratory for analysis.

What Do PSA Results Mean?

A higher PSA result does not automatically indicate prostate cancer. Several noncancerous conditions can increase PSA levels, including:

Benign prostate enlargement.
Prostatitis or prostate inflammation.
Urinary tract infections.
Recent urinary procedures.
Certain activities or circumstances that temporarily affect PSA levels.

Physicians interpret PSA results alongside age, previous measurements, prostate symptoms, family history, and other clinical findings.

3. Urine Examination

A urine test may be recommended when a man experiences urinary discomfort, frequent urination, painful urination, or difficulty emptying his bladder.

Although urine testing does not directly examine the prostate, it helps physicians identify urinary conditions that may cause similar symptoms.

How Does Urine Testing Work?

The patient provides a urine sample in a sterile collection container. A laboratory examines the sample for abnormalities.

Depending on the suspected condition, testing may include:

Urinalysis: Checks for blood, white blood cells, protein, and other substances.
Urine culture: Identifies bacteria that may cause urinary tract infections.
Additional laboratory testing: May be recommended when specific urinary abnormalities require investigation.

If a physician suspects bacterial prostatitis, urine culture results can help identify the responsible bacteria and guide treatment decisions.

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4. Prostate Ultrasound Examination

A prostate ultrasound uses high-frequency sound waves to create images of the prostate gland and surrounding structures.

Physicians may recommend ultrasound when they need additional information about prostate size, urinary problems, or findings from earlier examinations.

What Happens During a Prostate Ultrasound?

During transrectal ultrasound, the patient usually lies on their side with their knees bent.

A healthcare professional covers a narrow ultrasound probe with a protective covering and lubricant before gently inserting it into the rectum.

These images help physicians assess:

Prostate dimensions and volume.
General gland structure.
Certain abnormal areas.
Surrounding anatomical structures.
Areas that may need additional evaluation.

Ultrasound can also help guide a prostate biopsy by showing the location of the gland during tissue sampling.

5. Prostate MRI Scan

Magnetic resonance imaging (MRI) provides detailed images of the prostate using magnetic fields and radio waves.

Physicians may recommend a prostate MRI when PSA results are elevated, a DRE identifies an unusual area, or previous investigations suggest a possible abnormality.

How Is a Prostate MRI Performed?

The patient lies on a movable examination table that slides into the MRI scanner. The procedure is noninvasive and does not involve inserting a finger or needle into the prostate.

Why Is MRI Important?

Multiparametric MRI (mpMRI) combines different imaging techniques to provide information about prostate tissue.

It can help physicians:

Identify suspicious prostate lesions.
Evaluate prostate size and structure.
Determine whether a targeted biopsy may be appropriate.
Guide the location of tissue sampling.
Assess certain surrounding structures.

MRI findings are not a definitive diagnosis of cancer. A suspicious result may lead to a biopsy, while some patients may be monitored based on their overall risk.

6. Prostate Biopsy

A prostate biopsy is a procedure in which a physician collects small tissue samples from the prostate for laboratory examination.

It is generally considered when PSA results, MRI findings, DRE results, or other clinical information suggest a meaningful possibility of prostate cancer.

How Is a Prostate Biopsy Performed?

A urologist typically performs the procedure using imaging guidance. There are two commonly used approaches:

Transperineal biopsy: The physician inserts biopsy needles through the skin between the scrotum and anus to collect prostate tissue samples.

Transrectal biopsy: The physician guides biopsy needles through the rectal wall to reach the prostate.

Local anesthesia is commonly used, although the specific approach depends on the patient’s circumstances and the clinical setting.

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What Happens After a Biopsy?

A pathologist examines the samples to identify abnormal cells and determine whether cancer is present.

If cancer is detected, the pathology report may include a Gleason score or Grade Group. These classifications help describe how abnormal the cancer cells appear and support decisions about treatment or monitoring.

A biopsy may cause temporary soreness, blood in the urine or semen, or minor rectal bleeding, depending on the technique.

Fever, chills, or difficulty urinating after the procedure require prompt medical attention because they may indicate complications.

Common Myths About Prostate Examinations

Several misconceptions prevent men from discussing prostate health with their physicians.

Myth 1: Every prostate examination requires a rectal examination.

Not necessarily. Physicians may use PSA testing, urine analysis, and other assessments depending on the patient’s symptoms and risk factors.

Myth 2: An elevated PSA always means cancer.

False. Prostate enlargement, inflammation, infection, and other factors can increase PSA levels.

Myth 3: A normal DRE rules out prostate cancer.

False. A DRE assesses only the accessible surface of the prostate and may miss abnormalities elsewhere in the gland.

Myth 4: Prostate examinations are always painful.

A DRE may cause temporary pressure or discomfort, but it is generally brief. Other tests have different preparation and comfort requirements.

Myth 5: Men without urinary symptoms do not need to discuss screening.

Not necessarily. Early prostate cancer may not cause symptoms, so screening discussions can still be appropriate depending on age and individual risk.

Conclusion

Physicians examine a man’s prostate gland using several methods, including digital rectal examinations, PSA blood tests, urine analysis, ultrasound, MRI scans, and prostate biopsies.

Each procedure provides different information about prostate size, structure, inflammation, urinary health, and possible cancer.

A DRE helps physicians feel the accessible surface of the prostate, while PSA testing measures a prostate-related protein in the bloodstream.

Understanding these procedures can help men approach prostate health appointments with greater confidence, ask informed questions, and make decisions about screening and further evaluation in partnership with their healthcare professionals.

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References

https://en.wikipedia.org/wiki/Prostate

https://www.healthline.com/health/mens-health/how-is-a-prostate-exam-done

https://pubmed.ncbi.nlm.nih.gov/38182488/

About Us

Dr. Carlos Espiche, MD

Dr. Carlos Espiche, MD is a dedicated medical professional with a passion for providing personalized care. With years of experience in healthcare, she specializes in holistic treatment approaches, ensuring patients receive the best care possible. Dr. Carlos Espiche, MD is committed to improving patient outcomes through compassion and evidence-based practices.

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