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These days, prostate examinations are usually done in one of two main ways—depending on why you’re being checked, what equipment is available, and your doctor’s approach.
1. Digital Rectal Examination (DRE) – the traditional method
This is still the quickest and most accessible way to check the prostate’s size, texture, and for obvious abnormalities.
How it’s done:
You’ll usually stand and bend forward at the waist, or lie on your side with knees drawn up.
The doctor puts on a glove, applies lubricant, and gently inserts a lubricated, gloved finger into the rectum.
The prostate can be felt through the rectal wall—its size, shape, and firmness are assessed.
The exam usually lasts less than 10 seconds of actual contact.
Purpose:
Quick screening for obvious enlargement, asymmetry, nodules, or unusual firmness.
Often done alongside a PSA blood test for prostate cancer risk assessment.
2. PSA Blood Test – now often the first step
Many guidelines suggest combining or even replacing routine DRE with a prostate-specific antigen (PSA) test:
Requires only a small blood sample.
Measures PSA levels—elevated values can indicate inflammation, enlargement, or cancer.
Not perfect—false positives/negatives happen—so abnormal PSA often leads to further checks.
3. Imaging & Biopsy if Needed
If something unusual is found:
Multiparametric MRI is increasingly used before a biopsy to target suspicious areas and reduce unnecessary procedures.
Targeted prostate biopsy can be done via transrectal or transperineal routes, often with ultrasound or MRI guidance.
Recent Trends
Some countries now recommend PSA-first approaches, with DRE reserved for follow-up, to reduce discomfort and because PSA + imaging can detect more clinically relevant cancers.
Self-referral PSA testing is becoming more common in private clinics.
AI-assisted MRI interpretation is emerging to better distinguish aggressive from harmless cancers.
