How Often Should You Check Your Prostate (And What is the Exam Really Like)?

A doctor explains why the exam itself really isn’t all that bad (despite the finger in your butt).


Annoying as it is, there are parts of our bodies we should be getting checked out way more often than we do. Alongside our expert advisor Dr. Marc Leavey, primary care physician, we’re here to find out what we should be doing, why we should be doing it, and of course, how often. This edition: We’re taking a deep-dive into prostate exams.

First off, what could possibly be so wrong with my prostate that it requires a finger being inserted into my butt?
The number one thing doctors are looking for when they perform a prostate exam is prostate cancerthere are around 47,700 new prostate cancer cases in the UK every year, that’s around 130 every day. There are a few other things they check for while they’re down—er, up—there too, though.

“For one, we’re checking for benign prostatic hypertrophy (that is, an enlarged prostate), which can cause difficulty urinating and even erectile dysfunction,” says Leavey, noting that having an enlarged prostate is often a normal part of the ageing process in men. “We’re also looking for prostatitis [a bacterial infection caused by recurrent urinary tract infections], or inflamed prostate, which is not at all uncommon. We check for prostate stones, which are pretty rare, but they do happen.” Finally, they check your rectum for rectal tumours or cancer while they’re down there.

Okay, I guess it sounds important, but aren’t traditional rectal exams supposed to be a thing of the past?
There is certainly talk of the finger method being replaced with a simple blood test, although there’s no clear idea of when this might happen. “When I was growing up, we were told to have a rectal exam every year over 40,” Leavey says. These days, however, a healthy man may only need to have a rectal exam performed once every 10 years.

So come on, let’s get down to it. What’s the exam really like?
The rectal exam is just a small part of the whole prostate exam. First, the doctor will perform a PSA test (the part that may soon replace the rectal exam) which is a blood test designed to check the level of prostate-specific antigen in your blood. Generally speaking, a lower level means you’re less likely to have prostate cancer—most healthy men have levels under four nanograms per millilitre of blood.

“As far as the actual finger-in-butt part goes, it’s done either in a standing position, bent over the examination table, or lying down on the table with one leg curled up close to your chest,” Leavey says. “A gloved finger—that is well lubricated—is then inserted into the rectum, where the prostate is felt gently—not pushed, mashed or massaged—to check its size (a normal prostate is about the size of a walnut) and consistency.” Properly done, he adds that it shouldn’t take any more than 30 seconds and might be a little uncomfortable, but not painful.

When do I start needing to have this done to me?
“Almost universally, you don’t need to worry about prostate exams until you hit 40,” Leavey says. “If you have a first degree relative—like, a brother or a father—who developed prostate cancer at a young age, however, it’s a good idea to get screened younger.”

Once you’ve had your initial screening, the follow-ups really depend on what they find down there. If your PSA level is under one nanogram per millilitre of blood and the doctor doesn’t find anything wrong with your prostate, you may be able to go another 10 years without having another rectal exam. If your PSA is between one and two, however, Leavey recommends checking in every two years. And if you’re PSA is above three, you should go see a urologist.

“If you’re over 60 and your PSA is still under one, the odds of you getting prostate cancer are between slim and none, so you can quit having rectal exams,” Leavey says. “Most references also say you can stop if you’re over 70 years old.”

You should also check in with your doctor if you’re having symptoms like difficulty going to the bathroom, or sudden bathroom urges—like, you’ll pee in the sink if you don’t find a toilet quick enough. All that said, check with your doctor because the recommendations for prostate exams constantly change.

So is there a chance I may never actually have to go through with the rectal exam?
It’s possible! But if you’re pushing 40 now, chances are, you’re going to end up getting one. And it could well save your life.

UGH. Fine.
Have a nice day!