At what age are doctors doing prostate exams nowadays?

Having gone through the entire drill for years regarding high PSA and ultimately prostate cancer, I can only tell you it is a personal thing pending on family history, your urinary health, and your own piece of mind. If you are excited about the thought of the doctor sticking his finger up your butt, go for it. The PSA is altogether different. Some doctors don't even recommend a PSA. Here are a few referrals from the most respoected institutions in the US.

Cleveland Clinic First prostate exam by age 50. If you have a family history of prostate cancer, you should consider having your first prostate exam at age 45.

The U.S. Preventive Services Task Force (USPSTF) now recommends that men ages 55 to 69 decide for themselves whether to undergo a prostate-specific antigen (PSA) screening test.

johns Hopkins While the general guidelines recommend starting at age 55, you may need PSA screening between the ages of 40 and 54 if you:

Have at least one first-degree relative (such as your father or brother) who has had prostate cancer

Have at least two extended family members who have had prostate cancer

Are African-American, an ethnicity that has a higher risk of developing more aggressive cancers

First one at 40.

Last one at 43.

Annual PSA tests for the last 9 years.

I just read about a study performed in the UK that indicated that a 10 minute MRI of the prostate was superior at finding prostate cancer and even determining if it is likely to require treatment. I don’t believe it was a large population of men but at least it demonstrates an area of study that shows real promise for finally developing a reliable method for accurately finding prostate cancer.

@Srgfgahs But MRI is very expensive isn't it?

@Pecan_nutjob it’s certainly more expensive than a blood test. However, in the study, it identified cancer in men who had PSA scores in the normal range. A DRE misses the third lobe of the prostate. If larger studies confirm the results, aggregate treatment costs will decline as only aggressive tumors need be treated. Anxiety levels in men with prostate cancer will go down. Right now we just have to live with watchful waiting to see if larger studies achieve the same results as this small study. I’m pretty sure if you Bing or Google it you will find it online.

My father died a horrible agonizing death from prostate cancer. I will willingly pay $150 for an MRI just for the peace of mind. That’s the cost of an MRI using my Medicare Advantage Plan.

I will willingly pay $150 for an MRI just for the peace of mind. That’s the cost of an MRI using my Medicare Advantage Plan.

Damn that's cheap. I got billed over a thousand for one last year on my insurance. Mind you if the study was in the UK they have state funded healthcare so the patients don't worry about cost, so they'll be happy to have the scan. I'll take the risk of the doc missing something to avoid bankruptcy.

French here, early 50s of age, never had one done. And no doctor never asked me if I wanted this to be tested.

Not sure I'm gonna be asked one day. Iguess if I want one, I'll have to ask myself.

It's hard for me to imagine MRIs would be suited for mass screening for prostate cancer due to the expense and general lack of availability. The incidence of prostate cancer in men over 65 isn't all that different from that of women with breast cancer, tho breast cancer is the more lethal one. But breast cancer screening is widely available with mammograms while MRIs for prostate cancer would be way more difficult to schedule. However, for men who are at high risk due to, say, family history, MRI screening could make sense. That would just focus on a limited population tho.

My GP does not do DREs says PSA is sufficient. It wasn't until I was referred to a Urologist for a epididymal cyst that I received a DRE, now yearly. @Pollux I agree too expensive for a MRI screening, at least with the insurance I have now. Plus scheduling is a PITA.

In Germany the health insurance pays starting at age of 45 for prostate cancer check-up.

My father died a horrible agonizing death from prostate cancer. I will willingly pay $150 for an MRI just for the peace of mind. That’s the cost of an MRI using my Medicare Advantage Plan.

@Srgfgahs Sorry about your dad, and I understand your personal concern about your family risk. Not a doctor, but it seems reasonable that high risk candidates may warrant an MRI if the studies support it. Out of pocket co-pays are a small fraction of the cost of an MRI which is picked up by the insurance companies, which pass that cost onto all their policy holders, even Medicare (that’s all of us).

I had my only rectal prostate exam when I was 40.

Furthermore I can only confirm what a compatriot wrote.

In Belgium the prostate examination has been replaced by a blood test. And if the test is positive,an MRI scan is planned.

We can regret this, but medical science is not standing still.

I wonder in which countries the prostate examination is still done in the good old way .

@Rigel I doubt it would ever be done on an annual basis. However, the cost of treating aggressive prostate cancer as well as the cost of active surveillance to make sure it is an indolent cancer are also passed on. In the US, the higher cost passed on to all of us is the profit insurance companies charge us, businesses and the government for healthcare. Preventing disastrous expensive outcomes makes sense.

What you have to ask yourself is if healthcare is a luxury reserved for only those who can pay or is it a right that all should have.

I remember all my dad’s hospital stays, surgeries and procedures. Their cost was passed on too. Outcomes and costs are lower if diagnosis and treatment are started early.

Don’t even get me started on the waste in our patchwork healthcare system. At one point, where I live there were 5 MRI machines operating within a 10 mile radius because different medical groups each had their own.

@Srgfgahs Preventative surveillance makes sense where warranted and where there is a payoff…be it cost or better health. I’m sure colonoscopies cost a lot more than an MRI, but they justifiably lower risk and are cheaper than treating advanced stages of colon cancer that could be prevented. If effective, prostate MRIs could provide the same benefit.

The UK study on prostate screening by MRI was much in the news this week (last week in August 2023). Here's a report by the BBC https://www.bbc.co.uk/news/health-66507893 (Link may fail after a few days).

The professor in charge said in one interview she hoped the expense of providing a national screening programme with MRI scans would be justified by the reduced costs of more effective treatment of prostate problems. She thinks it could be done in 15 - 20 minute long per person scans in mobile units available across the country. She also said this could be done in the hubs being set up now in many towns which just concentrate on diagnostic scans (ultrasound, CT, MRI) or routine day surgery like cataract operations. These are outside hospitals to make the procedures cheaper and easier.

There's a lot of work to do, however. This first project was a small number of patients. And with a state funded health service like in the UK, there are so many things for limited money to be spent on.

@Cefn that’s the study I was referring to. It is definitely worth a read.

In terms of specifically a prostate exam, not just a rectal exam that includes a finger, at my last physical my PA said she starts giving them at age 50 (I’m a few years shy.) She offered me one, but she had just examined my penis and testicles and given me a hernia exam and I didn’t want to seem overeager so I said I’d wait another two years

Just had a physical at 51. No prostate exam.

Mine started regularly at my yearly exam in my late 40s. I think there is now less emphasis on the rectal exam and more on psa and other testing if psa rises or you have symptoms.

My doctor did my first prostate exam when I was 35, and every year after that. I think it's usually after age 40.

Not soon enough here in the UK due, as has already been mentioned, to the fact that the PSA test is seen as being unreliable which I can say, from personal experience, is just a fob off presumably due to the cost.

My older brother was diagnosed, and treated for, prostate cancer when he was in his late 60s. Luckily he’s all clear and subject to monitoring going forward.

I had a PSA test last December and have been diagnosed as having an enlarged prostate and am also subject to further annual testing to see how things develop. Whilst it’s a serious silent killer, it does develop very slowly so a watch and see approach is fine.

After the high PSA result had happened I was hoping to have a DRE but my Doctor wouldn’t do one because she was of the opinion that any abnormalities might be on the side of the prostate that can’t be reached during the examination.

As I’ve said before, if you have a prostate get your PSA level checked immediately if you’re 50 plus.

Man, that "deer in the headlights" bit really got me-having a prostate exam sprung on you right when you thought the physical was basically done would throw me over....

On the age thing — you're not wrong that 50-ish is the number people usually throw around, but it's a little more nuanced than that. Official guidance still says 55-69 is when men should be having the "should I get PSA tested" conversation with their doctor, and after 70 they actually recommend against routine screening. But that's really about the PSA blood test specifically, for guys at average risk. If you're higher risk that conversation gets pulled way earlier, like mid-40s or even 40.

So I don't know if 46 isn't some wild outlier, it really just depends..

Also kind of interesting — the actual finger exam (DRE) on its own has fallen out of favor as a real "screening tool" these days. PSA is considered the main thing now, and DRE is more of an extra some doctors still do out of habit and others have just dropped. So yeah, wildly different experiences from doctor to doctor, and neither approach is really "the standard" anymore. Anyone else not getting the DRE anymore?

The blood/PSA test has pretty much replaced the traditional DRE, at least here in the U.S. I have heard mixed reports of the age ranges when it's done nowadays but age 40-50-something seems to be the norm. I haven't had one in years (a DRE). The first one I had was when I was 17 and it was my first visit to a non-pediatrician. I totally wasn't expecting that to happen and thought I was going to involuntarily urinate when the doctor started to press around in there. Thankfully, that didn't happen.

Yes, it's partially true, transrectal ultrasound (TRUS) and MRI give more information. However traditional DRE is still performed by urologists.

Digital rectal exams are no longer commonly performed as a routine part of a standard annual physical for healthy adults.

@buttdial I gonna have urological check-up next Tuesday, I will see what happens. I was submitted to TURP surgery few months ago and still I am under surveillance.

Had my first one at 31 after finding some blood in my sperm, was not expecting that before being at least 40.

As others have replied, a prostate exam is not routine anymore. I had always heard that after age 40ish it would be routinely performed and I should expect it during a physical exam, but that was not my experience. In my case (I am in my mid 70's) the ONLY time I have had a rectal exam was when I was in my 20's and I had prostatitis. I have changed doctors many times over the years....always male doctors, and none have included a DRE as part of my physicals.

Indeed it doesn't seems to be "the norm" anymore. I had to do some blood test that included a PSA screening before seeing the urologist and thought it meant there won't be a prostate exam.

He even told me that he usually do a PSA screening first now and only perform rectal exam if it's above 10. Also that I will get another one next time I see him (in two months) if the antibiotics weren't working and I still had some issue.

My sub's doctor, at our recent yearly exam, said that she doesn't do digital exams. As they are not always precise. In that if the same person does not do it year after year...differences may or may not be detected. One could say errors can be made either way. So a PSA gets done to watch the numbers.