Prostate Health Check-Up: Complete Guide for Men in 2025

Digital rectal examinations (DRE) are typically uncomfortable rather than painful. Most men experience a feeling of pressure and a brief urge to urinate during the exam, which usually lasts less than a minute. Relaxing during the exam can help reduce discomfort. If you experience actual pain during a DRE, be sure to tell your doctor immediately, as this could indicate inflammation or other issues that need attention. Blood tests for PSA involve a standard blood draw, which causes only momentary discomfort for most people.

While some guidelines now place less emphasis on the DRE as a routine screening tool, many healthcare providers still recommend both tests for a more comprehensive assessment. PSA and DRE provide different types of information and can complement each other. Some prostate abnormalities may be detected by DRE even when PSA is normal. However, if you have significant anxiety about the DRE, discuss this with your healthcare provider. In some cases, especially for men at average risk with normal PSA levels, your doctor might agree to monitor with PSA alone and reserve DRE for specific situations.

Primary care physicians (PCPs) can perform standard prostate screenings including PSA tests and DREs, and they typically manage initial evaluations and routine monitoring. Urologists are specialists with additional training in urinary tract and male reproductive system conditions. You might see a urologist if you have abnormal screening results, specific prostate symptoms, elevated risk factors, or a history of prostate conditions. Many men start with their PCP for basic screening and are referred to a urologist if concerns arise. However, men with significant risk factors might choose to establish care directly with a urologist for specialized monitoring.

Most health insurance plans, including Medicare, cover prostate cancer screening for men over 50. Under the Affordable Care Act, many preventive services, including prostate cancer screening, must be covered without cost-sharing (copayments, coinsurance, or deductibles) when delivered by in-network providers. However, coverage details vary by plan, particularly for men under 50 or for advanced screening methods. Additionally, if a screening test leads to further diagnostic testing or treatment, those services may involve cost-sharing. Check with your insurance provider about specific coverage details, and consider asking your healthcare provider about coding the visit appropriately as preventive care when applicable.

No screening test is perfect, and prostate check-ups can miss some cancers. Standard PSA testing may miss about 15% of prostate cancers, and DRE can only assess the posterior portion of the prostate. Some aggressive cancers may develop and spread quickly between screenings. Additionally, some cancers may not elevate PSA significantly or may be located in areas not easily felt during a DRE. This is why newer screening approaches like multiparametric MRI and advanced biomarkers are being developed and increasingly used. Regular screening according to guidelines, rather than one-time testing, improves detection rates over time. If you have persistent symptoms despite normal screening results, additional evaluation may be warranted.

The controversy centers on balancing benefits against potential harms. The benefits include early detection and treatment of potentially life-threatening cancers. The potential harms include false positives leading to unnecessary anxiety and procedures, overdiagnosis of slow-growing cancers that would never cause symptoms, and complications from subsequent treatment (including incontinence and erectile dysfunction). Different medical organizations have varying guidelines because studies show mixed results regarding whether screening reduces overall mortality. The current consensus is moving toward more personalized, risk-adapted screening approaches and shared decision-making between patients and providers. This allows each man to weigh the potential benefits and harms based on his values, preferences, and risk factors.