Digital Rectal Exam
What is a Digital Rectal Exam?
A digital rectal exam (DRE) is a fundamental routine test to assess the state of your prostate. It consists of massaging the lining of the rectum and surrounding organs – such as the prostate – to detect any abnormality.
The assessment provides unique and crucial information about the state of the prostate which neither a PSA test or an ultrasound scan can, such as:
- Prostate size and volume;
- Type and evenness of the surface;
- Presence of painful or suspicious areas (harder, irregular and heterogeneous areas, nodules, etc.).
These aspects are key to defining accurate therapeutic guidance and the stage of diagnosis for each patient.
The Importance of a DRE in Diagnosing Prostate Cancer
A DRE is advised when gastro-intestinal problems exist, such as abdominal or rectal pain, blood in the stool, haemorrhoids, perianal fistulas, etc., but also in men aged over 50 without any urinary symptoms or – a little earlier – with a family history of prostate cancer.
It is the first exam performed in diagnosing and screening this type of cancer, among other pathologies affecting the prostate, such as benign prostate hyperplasia (BPH).
The aim is to identify the presence of cancer at a very early stage – when the treatment is more effective and potentially curative.
But performing the exam depends always and foremost on the patient’s will and motivation. It should be remembered that the success rate of any therapy depends on early and timely detection of the disease.
A DRE is so important that even after surgery or another treatment associated with prostate cancer, it is an essential exam for checking normality and the success of the therapy.
What is the DRE Procedure?
A DRE is a straightforward and painless clinical exam. There may be some natural discomfort, but it is temporary.
No preparation is required, there is no need for anaesthetic and there is no risk to the patient. However, it is advisable to evacuate the intestines before the exam so that they are empty.
So, what should I expect on the day of the exam?
The patient lies on their back (stomach facing upwards) with their legs bent.
The stages of the exam are as follows:
The doctor begins by lubricating his finger well after putting on a glove.
Next, he carefully and slowly inserts the end of his index finger into the anus.
The finger must follow the natural curvature of the anus.
The top, bottom and sides of the prostate, as well as the surface, are massaged by the end of the finger.
In this way, the size of the prostate, presence of nodules and hard areas and/or other abnormalities can be assessed easily and immediately.
A normal DRE does not show any evidence of masses, changes in consistency or irregularities in the surface of the prostate.
DREs can identify palpable prostate tumours, i.e., those at the back of the organ – and the most common.
If the doctor suspects a tumour, this exam can precisely identify its location, size and volume.
If an abnormality is identified, complementary exams are prescribed and a prostatic biopsy. Only a biopsy can clarify whether a tumour is malignant or not.
Dr. José Santos Dias
Clinical Director of the Instituto da Próstata
- Bacherlor's Degree from the Faculty of Medicine at the University of Lisbon
- Specialist in Urology
- Fellow of the European Board of Urology
- Autor dos livros "Tudo o que sempre quis saber Sobre Próstata", "Urologia fundamental na Prática Clínica", "Urologia em 10 minutos","Casos Clínicos de Urologia" e "Protocolos de Urgência em Urologia"
FAQs about DREs
If I don’t have any symptoms, why does my asdoctor want me to do a DRE?
How long does the procedure take?
What does the DRE detect?
What other tests may I have to take after the DRE?
- Toucher rectal
- Comparison of Digital Rectal Examination and Serum Prostate Specific Antigen in the Early Detection of Prostate Cancer: Results of a Multicenter Clinical Trial of 6,630 Men
- Digital Rectal Exam for Prostate Problems
- Digital Rectal Examination for Prostate Cancer Screening in Primary Care: A Systematic Review and Meta-Analysis
- Digital Rectal Exam (DRE)
- How prostate cancer is diagnosed
- Urologia em 10 minutos