Digital Rectal Exam
The first part of a thorough prostate exam is also known as the digital rectal exam. With this exam, the physician puts on latex gloves and lubricates one finger. The doctor then inserts this lubricated finger into the rectum to feel for the prostate, which is located slightly below the rectum and can be felt through its walls. A digital rectal exam is used to assess two features of the prostate: size and shape. A normal prostate is approximately the size of a walnut. It should also feel smooth to the touch. During the rectal exam the physician will be looking for a prostate that is larger than normal and for any surface irregularities. Unusual bumps or lumps on the prostate could signal an abnormal growth that is potentially cancerous.
Blood Tests
The next step of a prostate exam is to measure levels of a protein called prostate specific antigen (PSA) in the blood. Blood PSA levels are an important indicator of prostate health because they will be elevated if the prostate is larger than normal. Causes of elevated PSA include prostate cancer as well as an enlarged but otherwise healthy prostate (a condition known as benign prostatic hyperplasia). Because inflammation of the prostate (due to a bacterial infection) can also elevate PSA levels, the doctor may also perform a urinalysis to look for any bacteria that could be in the urinary tract. Doctors also may test the blood for creatinine and blood urea nitrogen levels, because these can be used to diagnose kidney problems, which can also cause an enlarged prostate.
Additional Tests
If the digital rectal exam reveals any abnormalities or if the PSA levels are high, the physician may perform other tests to further examine the health of the prostate. An ultrasound can be used to image the prostate to see if it has any unusual masses or lumps of tissue. In addition, the physician may obtain a tissue biopsy, in which a small needle is used to take a small amount of prostatic tissue, which is then examined under a microscope. This part of the exam can be used to determine if the cells in the prostate are normal healthy cells or if they are cancerous.
