What is considered normal or abnormal on a digital rectal exam?

One of the most feared yet also one of the most quick, easy, and painless exams a man can undergo is a digital rectal exam.  A digital rectal exam (DRE) is a very simple procedure in which a doctor will examine the lower rectum and other internal organs such as the prostate gland. 

A DRE is primarily done to check the health of a man’s prostate gland giving a doctor valuable information on its condition.  By inserting a lubricated, gloved finger into the rectum, a doctor will be able to feel the prostate right away and can assess for detection of conditions such as an enlarged prostate (benign prostatic hyperplasia or BPH) and prostate cancer.

Even though many men would rather skip this exam, it is a necessary and vital part of a man’s routine physical, especially after the age of 50, when men are more likely to begin experiencing issues with their prostate.  The DRE is an important part of the early detection and diagnosis of prostate conditions and is a safe exam where no equipment is needed and that can be done in a very short amount of time – less than a minute.

Assessing what is normal or abnormal on a digital rectal exam

Once a doctor is done conducting a DRE, they will be able to tell a man right away the results of what he felt.  If the prostate is found to be “normal,” that means it felt smooth and the doctor did not feel any areas of increased hardness or bumpiness.  It also means the prostate felt normal sized and not enlarged.

If however, the doctor finds an “abnormality,” when conducting a DRE, it could be for several reasons:

·      There was felt a presence of an area of increased hardness

·      There was felt the presence of a nodule or bump

·      The prostate was felt to have an overall increase in size

·      When the DRE was performed, the patient felt the prostate to be tender to the touch.


The DRE was considered to be abnormal – now what?

If the DRE exam is found to be abnormal, then the next step is to also conduct a PSA test. The PSA test is blood test used primarily to screen for prostate cancer.  The test measures the amount of prostate-specific antigen (PSA) in a man’s blood.  PSA is a protein produced by both cancerous and noncancerous tissue in the prostate.

A high PSA reading can lead to more testing to rule out the possibility of prostate cancer.  However if the PSA is normal, but the doctor felt an area of hardness or a nodule, then he may choose to do a biopsy to determine whether or not the area is the result of prostate cancer.                                                              

If the DRE detects an enlarged prostate but with no hardness or a nodule and the PSA is normal, then usually the doctor will attribute this to BPH.  However, depending on the doctor, they may still want to do a biopsy to rule out cancer. 

Another condition that can cause the prostate gland to enlarge or become tender on examination is prostatitis, a temporary inflammation of the prostate that is not cancerous. 

When a DRE and a PSA test are combined along with other information about a man’s overall health, this can guide a doctor to develop a better plan of whether to recommend additional testing for the prostate gland so that any issues such as prostate cancer can be diagnosed and treated early.