Prostate Exams: Myths & Misconceptions

The prostate is the walnut-sized gland located below the bladder and above the rectum that is responsible for producing the seminal fluid that nourishes and transports sperm. The state of a man’s prostate can affect both his sex life and his overall health, and that’s why getting regular prostate exams is an important health screening tool for men.

Here, we’ll be looking at some of the most common myths about prostate exams, and the reality every man should know.

Myth: A prostate exam is used only as a cancer screening.

Reality: Cancer screening is an important function of a prostate exam, but that’s far from the whole story. The exam is also used as a tool to check for and diagnose an enlarged or inflamed prostate. These conditions, known as prostatitis and benign prostatic hyperplasia (BPH), can affect both sexual and overall health and can sometimes lead to serious complications when left untreated. 

In the United States, 1 man in 9 will be diagnosed with prostate cancer in his lifetime, making the disease the second most common cancer in men. So it’s definitely true that the prostate exam is used as a cancer screening tool for men, but that’s not its only purpose. 

Myth: The procedure includes only a rectal exam.

Reality:  When you hear the words “prostate exam,” the first thought that probably comes to mind is a rectal exam. A doctor performs this procedure—it is more accurately referred to as a digital rectal exam—by inserting a gloved, lubricated finger into the rectum to feel for any abnormalities in the prostate. However, this is not the only element of a prostate exam. Typically, a prostate exam also includes a prostate-specific antigen (PSA) blood test. PSA is a protein produced by tissue in the prostate and is mostly found in semen. This test is performed during a prostate exam because high PSA levels may be an indicator of prostate cancer or an enlarged or inflamed prostate.

Myth: I must get prostate exams once I reach a certain age.

Reality: Ultimately, the choice to begin getting regular prostate exams is up to each individual to make. In fact, the American Cancer Society recommends that men should not undergo this screening unless they’ve been informed about the uncertainties, risks and potential benefits of prostate exams.

The ACS recommends that if a man is at average risk for prostate cancer and expected to live at least 10 more years, he can start getting prostate exams regularly at age 50, if he decides to move forward with the screening. It’s recommended that men at high risk begin regular screening at age 45, while those at the highest risk (due to family history) can start as early as age 40.

The American Urological Association’s recommendations differ slightly. The AUA:

• Recommends against PSA screening in men under age 40 years. 
• Does not recommend routine screening in men between ages 40 to 54 years at average risk.
• Strongly recommends shared decision-making for men ages 55 to 69 years who are considering PSA screening, and proceeding based on a man’s values and preferences.
• Recommends that to reduce the harms of screening, a routine screening interval of two years or more may be preferred over annual screening in men who have participated in shared decision-making and decided on screening.
• Does not recommend routine PSA screening for men age 70 or older or any man with less than a 10- to 15-year life expectancy. 

Overall, when to start screening is based on an individual’s risk factors and a shared decision-making process with the physician.

Myth: A PSA test is always an accurate way to detect cancer.

Reality: Professional medical organizations remain split over who should get PSA tests and the actual health benefits such tests can provide. The main reason for this disagreement is that although high PSA levels can be an indicator of prostate cancer, they can also be a sign of other conditions, such as prostatitis, BPH or simply a natural increase due to age. As a result, PSA tests can be misleading. Some medical experts believe PSA tests result in false diagnoses of prostate cancer, which can cause potentially harmful psychological effects. And in some cases, these misleading results may lead patients to undergo additional testing and treatment for prostate cancer that is ultimately unnecessary and which could have long-lasting effects.

Myth: Prostate exams are painful.

Reality: The good news is you shouldn’t have to worry about any pain. Your doctor will perform the exam by inserting a gloved, lubricated finger into your rectum to feel the prostate for anything out of the ordinary. You may feel some pressure and discomfort during the exam, but it shouldn’t hurt. This portion of the exam typically takes only a few seconds to complete. It will be over before you know it! 

The condition of your prostate can affect your health in significant ways. Preventive health screenings such as prostate exams are a useful tool in detecting and treating health issues early. If you’re concerned about your prostate health, talk to your doctor to find out if you should move forward with regular prostate exams.