When Should You Get Your First Prostate Exam?

Prostate Exam
Medically approved by
Dr Earim Chaudry
Last updated
11th August 2020

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In 30 seconds

The answer to when you should get your first prostate exam depends on your medical history and genetic predisposition.
Your prostate grows throughout your life, which means you’re more likely to experience problems as you age.
Prostate cancer is often symptomless, but if you feel unwell, consult a doctor: identifying what’s wrong will help you get the right treatment.

First off, what is a prostate? This is a walnut-sized gland located below the bladder, near your rectum. It secretes fluid that becomes part of semen, helping to carry sperm. has two main growth phases; first in puberty, and the second from around age 25, continuing at a rate of  14% increase each decade.

Sometimes the prostate can become enlarged enough to cause problems – or as a result of related health issues. The most common prostate problems are:

  • Prostatitis: when your prostate becomes inflamed as a result of an infection
  • Benign prostatic hyperplasia (BPH): an overly enlarged prostate
  • Prostate cancer

The recommended age for a prostate exam takes into account the fact the prostate grows throughout adulthood, but BPH, prostatitis and prostate cancer can affect you at any age. Below, we’ll outline what to look out for, when to get a prostate exam, and what that entails.

What’s the Recommended Age for Your First Prostate Exam?

Starting at age 50, all men should discuss getting a prostate exam with their doctor. 

The reason for this is prostate cancer. In the UK, about one in eight men will be diagnosed with this in their lifetime. It mainly affects men aged 50 plus, but your risk increases as you get older, and the most common age to be diagnosed is between 65 and 69 years. Most men with early prostate cancer don’t have any noticeable signs or symptoms

The exception to this rule is if you are experiencing symptoms, or if your genetics predispose you as higher risk. Doctors are increasingly finding the tendency towards some prostate cancers can be inherited from your father’s family. Additionally, black men are at a higher risk, with one in four getting prostate cancer in their lifetime. 

If you’re experiencing no symptoms, here’s the recommended age for prostate exam:

  • If you have a family history, first prostate exam at age 40
  • If you are black, first prostate exam at age 45
  • If you have no family history and you’re not black, first prostate exam at age 50

What Should I Look Out For?

The above recommendations apply to screening only – i.e. if you’re not experiencing symptoms. For many men, prostate cancer can be symptomless because of the way it grows: you’ll only notice changes if it grows too close to your urethra, disrupting the urinary process. The symptoms of this include:

  • Trouble starting a urine stream 
  • Having a weak urine stream
  • Dribbling at the end of urination
  • Urinary retention
  • Pain after urination or ejaculation. 

If you’re experiencing these, you should come in for a prostate exam. However, don’t panic: the most common cause of the above isn’t cancer – it’s benign prostatic hyperplasia (BPH). This is when your prostate naturally grows large enough to block your urinary tract. 50% of men aged 51 – 60 suffer from it, and the number rises as you age. There are a number of treatment options available, from lifestyle changes and medications to minimally invasive procedures (like ultrasound) and surgery. 

Another cause of these symptoms could be prostatitis, which is when your prostate becomes infected. This usually affects men aged 30 – 50. Additional symptoms include pain in and around your penis, testes, anus, abdomen or lower back, or erectile dysfunction. Usually, this will improve over time and with treatment. 

Sometimes, prostatitis hits harder. If you experience severe pain in the aforementioned regions, have extreme difficulty urinating, or experience these symptoms alongside a high temperature, you could have acute prostatitis and you should seek immediate medical attention. 

The other symptoms to look out for are signs that prostate cancer has spread. If the cancer breaks out of the prostate, symptoms could include back, hip or pelvis pain, erectile dysfunction, blood in urine or semen, and unexplained weight loss.

You’ll notice the same symptoms cropping up over and again here. This is why it’s important to inform your doctor to get you the right treatment. And the first step in many diagnoses is a prostate exam. 

What is a Prostate Exam?

The most common way your doctor will check your prostate is through a digital rectal exam (DRE), which indicates if your prostate is a normal size and shape. For this, you will bend at the waist while standing or lying on your side. Your doctor will insert a lubricated gloved finger in your rectum. They’ll then feel your prostate, and press a little bit on and around it. 

It takes just a few moments. The sensation may be slightly uncomfortable (it helps if you relax), and you might feel the urge to urinate. You should tell your doctor if you have hemorrhoids, anal tears or other problems with your anus.

In addition, your doctor may test your blood for prostate-specific antigen (PSA). PSA is produced in your prostate and it’s normal to have some in your bloodstream. A rise in PSA could indicate an infected or enlarged prostate, and a rise or fall in PSA could indicate prostate cancer. 

On the other hand, PSA levels are affected by ejaculation. You should tell your doctor about medications or supplements you’re taking and ask if you should abstain from sexual activity before the test.

When Should I Go Back?

The answer to how often you should get a prostate exam depends on your medical history, but if you’ve got the all-clear, when you return depends on your age. The recommendations are as follows:

Age 50 – 59:

  • If your PSA was between 1 and 3ng/mL: return every 2 to 4 years
  • If your PSA was under 1ng/mL: return aged 60

Age 60 – 70:

  • If your PSA was between 1 and 3ng/mL: return every 2 to 4 years
  • If your PSA was under 1ng/mL: No further screening required

Once you’re over 70, you should talk with your doctor about getting your PSA tested. There’s some debate about whether it’s a good idea after this age, because prostate cancer can be slow-moving, so it’s possible to live with it as an older man. However, some types of prostate cancer are a more immediate threat, so should be treated.

References

  1. Claus G Roehrborn, MD (2000). Prostate Size: Does It Matter?: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1476114/

  2. Prostate Cancer UK – Are you at risk?: https://prostatecanceruk.org/prostate-information/are-you-at-risk

  3. Prostate Cancer UK – What are the symptoms of prostate cancer?: https://prostatecanceruk.org/prostate-information/about-prostate-cancer/prostate-cancer-symptoms

  4. National Institute of Diabetes and Digestive and Kidney Diseases – Prostate Enlargement (Benign Prostatic Hyperplasia): https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostate-enlargement-benign-prostatic-hyperplasia

  5. NHS – Prostatitis: https://www.nhs.uk/conditions/prostatitis/

  6. NHS – Rectal examination: https://www.nhs.uk/conditions/rectal-examination/

  7. NHS – Should I have a PSA test?: https://www.nhs.uk/conditions/prostate-cancer/should-i-have-psa-test/

  8. Memorial Sloan Kettering Cancer Center  – Prostate Cancer Screening Guidelines: https://www.mskcc.org/cancer-care/types/prostate/screening/screening-guidelines-prostate

While we've ensured that everything you read on the Health Centre is medically reviewed and approved, information presented here is not intended to be a substitute for professional medical advice, diagnosis, or treatment. It should never be relied upon for specific medical advice. If you have any questions or concerns, please talk to your doctor.

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