Digital Rectal Exam (DRE)

Often included in a man’s annual physical or wellness checkup, a digital rectal examination (DRE) is an important screening tool for prostate cancer, which is the second most common cancer in men worldwide. A part of the male reproductive system, the prostate is a walnut-sized gland that adds lubricating fluid to semen and helps propel the semen through the urethra during ejaculation.

The important role of the DRE in prostate cancer screening

Located just below the bladder in front of the rectum, the prostate cannot be felt from the outside of the body. When performing a DRE, a physician can feel and detect lumps, hardened areas and other abnormalities in the back wall of the prostate gland. Because any abnormalities in the middle or front part of the prostate cannot be felt during a DRE, prostate cancer screening usually includes a prostate-specific antigen (PSA) test as well. 

A PSA test is a relatively simple blood test that can detect elevated levels of a certain protein (PSA) in the bloodstream, which can be a sign of prostate cancer. Because many factors can affect PSA levels, the results of a PSA test should be interpreted by an experienced physician. If a prostate tumor is suspected, the physician will usually order a biopsy, which is the only way to conclusively diagnose or rule out prostate cancer.

Most early-stage prostate tumors do not cause symptoms. Even so, many can be detected in a DRE or PSA test. A DRE can detect some tumors that are not associated with an elevated level of PSA in the bloodstream, while a PSA test can detect tumors that cannot be felt during a DRE. Recent studies confirm that the combined approach of DRE and PSA testing is more effective for the early detection of prostate cancer than either procedure is on its own.

What does a DRE involve?

When performing a DRE, a physician inserts a gloved, lubricated finger into the rectum to feel for lumps and hardened areas, which could indicate prostate cancer. This simple in-office procedure takes only a few minutes to complete and typically involves only mild discomfort, if any. If pain occurs during a DRE, it is usually not a sign of cancer. However, it could indicate a benign condition, such as inflammation of the prostate (prostatitis), and therefore warrants follow-up testing.

How often should a DRE be performed?

For the purpose of routine prostate cancer screening, the American Cancer Society recommends a DRE and PSA test for:

• Men 50 and older with a life expectancy of at least 10 years
• Men 45 and older who have an elevated risk of developing prostate cancer, such as those who have a first-degree relative (father or brother) who was diagnosed with prostate cancer at an early age (younger than 65)
• Men 40 and older who are at high risk of developing prostate cancer, such as those who have more than one first-degree relative who was diagnosed with prostate cancer at an early age

A man who meets any of these criteria should make an informed decision—with the help of his healthcare provider—on whether to be screened for prostate cancer. Many men opt to include prostate cancer screening in their annual physicals.

Benefit from world-class care at Moffitt Cancer Center

If you have a high PSA level and require further testing, you can be screened for prostate cancer at Moffitt. Request an appointment by calling 1-888-663-3488 or submitting a new patient registration form online.