Men don’t usually bring up prostate exams in casual conversation, and that silence is part of the problem.

Across clinics and exam rooms, we see it all the time: men who delay checkups until urinary symptoms become disruptive, or worse, when routine blood work turns into a cause for concern. The truth is, prostate screening isn’t about embarrassment or fear, it’s about staying one step ahead of issues that are common, manageable, and potentially serious if ignored.

Let’s break down what a prostate exam really involves, when you should consider one, and why it may be one of the most important steps you take for your long-term health.

Why prostate health matters

The prostate is a small gland, roughly the size of a walnut, sitting just below the bladder. As men age, the prostate naturally enlarges, a condition known as benign prostatic hyperplasia (BPH). It’s not cancer, but it can affect daily life in frustrating ways: a weak stream, frequent nighttime urination, urgency, or difficulty starting and stopping flow.

Even more concerning is prostate cancer, which can develop silently and is the second most common cancer in men worldwide. In its early stages, it often causes no symptoms at all, and by the time signs do appear, treatment options may be more limited.

That’s where regular exams come in, not to cause anxiety, but to provide clarity.

What happens during a prostate exam?

For many men, the idea of a prostate exam conjures more dread than necessary. In reality, the process is brief, respectful, and informative.

There are two main components: the digital rectal exam (DRE) and the prostate-specific antigen (PSA) blood test.

During the DRE, your doctor gently inserts a gloved, lubricated finger into the rectum to feel the size, shape, and texture of the prostate. It takes less than 30 seconds and may feel a bit awkward, but it’s not painful.

The PSA test, meanwhile, is a simple blood draw that measures a protein made by prostate tissue. Elevated levels don’t always mean cancer; BPH and inflammation can also raise PSA, but tracking changes over time gives valuable insight.

Used together, these tools help identify concerns early and guide next steps.

Why do men avoid it?

Many men avoid prostate exams because they assume no symptoms means no problem. Others feel embarrassed or worry about what the results might reveal.

But avoidance has consequences.

Prostate cancer caught early is often highly treatable. BPH, when managed promptly, may not require surgery or even medication. Waiting until symptoms are severe limits treatment choices and can lead to unnecessary discomfort, anxiety, or more invasive interventions down the line.

You don’t have to wait until something feels wrong to take control.

What happens if something looks abnormal?

If your PSA level is elevated or your DRE feels suspicious, your doctor may recommend additional evaluation. This doesn’t necessarily mean something serious, it just means more information is needed.

Follow-up may include repeating the PSA after a few weeks, ordering a specialized urine or blood test, or referring you to a urologist. Depending on your risk profile, imaging such as multiparametric MRI may be suggested to visualize the prostate in greater detail. If needed, a targeted biopsy, often guided by MRI, is performed to collect tissue samples for analysis.

In selected cases, newer genomic tests can help determine how aggressive a detected cancer might be, supporting more tailored decision-making.

It’s important to know: most abnormal findings are not cancer. But you can’t know that without checking.

When should you talk to your doctor?

You don’t need symptoms to start the conversation.

Most major guidelines, including those from the American Urological Association (AUA) and European Association of Urology (EAU), recommend that men of average risk begin discussing prostate screening at age 50.

If you’re African American or have a first-degree relative (father or brother) diagnosed with prostate cancer, it’s worth having that conversation by age 45, or even earlier in high-risk families.

A simple discussion with your primary care doctor or urologist can help determine if and when screening makes sense for you.

Screening has evolved and so have the options.

What’s important to understand is that screening doesn’t automatically lead to aggressive treatment. In fact, many early-stage or slow-growing prostate cancers are now managed with active surveillance, meaning regular monitoring rather than immediate surgery or radiation.

This strategy helps avoid overtreatment while still keeping you safe.

For BPH and other non-cancerous conditions, treatment options have expanded dramatically over the last decade. From medications to minimally invasive therapies like UroLift, Rezūm, or HoLEP, the goal is always to improve quality of life while minimizing side effects and downtime.

Final thoughts: Take the first step

Getting a prostate exam isn’t about giving up control, it’s about taking it back.

Whether you’re symptom-free or starting to notice changes, checking in on your prostate health is a smart, simple step toward staying ahead. The process is quick. The discomfort is minimal. The potential benefit is enormous.

So don’t avoid it. Don’t delay it. Start the conversation. You might be surprised at how much peace of mind it brings.

Martina Ambardjieva is a dedicated urologist and medical educator with extensive experience in both clinical practice and academic instruction. She earned her MD from the University “Sv. Kiril i Metódij” in Skopje and is a PhD candidate in urological oncology, with a focus on bladder carcinoma. Her scholarly work includes numerous publications in oncologic urology, urinary calculosis, and men’s health.

Dr. Ambardjieva currently serves as a urologist at the PHI University Surgical Clinic “Naum Ohridski” and completed her residency training at the University Urology Clinic in Skopje. Earlier in her career, she practiced as a general medical doctor at Sante Plus General Hospital and completed a medical internship at the University of Ljubljana.

In addition to her clinical responsibilities, Dr. Ambardjieva is a teaching assistant at the Medical Faculty in Skopje. She works additionally as a collaborator for Dr. Telx. She has held leadership positions in the European Medical Students’ Association and actively participates in international medical education and policy. She has attended numerous congresses and workshops in France, Italy, Canada, and Turkey, and serves as a delegate for the European Association of Urology (EAU), contributing to cross-border initiatives in urology. Certified in laparoscopic surgery, she continues to integrate patient care, research, and education in her professional work.