Can I Skip the DRE and Just Have a PSA?

PSA vs DRE: You Can't Skip The Digital Rectal Exam For The Blood Test

Close-up of a patient dreading an examination. Credit: rubberball / Getty Images

When it comes to prostate cancer screening, most men wonder if they can just take the prostate-specific antigen (PSA) blood test and skip the digital rectal exam (DRE) altogether. 

Since the prostate screening procedure entails two types of prostate screening exams (the PSA and the DRE), most people think that they can pick and choose between the two exams. Men usually prefer to avoid the digital rectal exam since it can be unpleasant and uncomfortable, but the DRE is a vital screening tool for prostate cancer that goes hand in hand with a PSA.

Your doctor uses both exams to get a complete picture of what exactly is going on down there. 

Purpose Of Screening

The purpose of the DRE and the PSA blood tests is to catch prostate cancer early, at its earliest stages and before the development of any symptoms. Prostate cancer is treated most effectively if detected in its very early states. 

The DRE vs. PSA

DRE (digital rectal exam)PSA (prostate-specific antigen) 
Doctor places a gloved finger (a digit) into the rectum to feel the prostate gland.A small amount of blood is drawn from the arm and tested.
The doctor checks for:
  • Lumps on or around the prostate
  • Swelling 
  • Tenderness
  • Hard spots or bumps (the gland should be smooth) 
  • Abnormalities in the prostate

Prostate cancer can be found early by testing the amount of PSA (a protein produced by the prostate) in the blood. Approximate levels of PSA are considered:

  • Normal: Levels under 4 ng/mL: 
  • High: Levels over 10 ng/mL
  • Intermediate: Levels between 4 and 10 ng/mL 

Problem With Just Testing PSA

The PSA test is not always reliable. PSA levels can be elevated if other prostate problems are present, and some men with prostate cancer may even have low levels of PSA.

Being overweight or obese can throw PSA levels off, as they may be diluted due to a larger blood volume.

 False positives and false negatives have happened with the PSA tests, which is why it's important that your doctor also performs a DRE.

Any abnormalities found during the DRE will prompt your doctor to order more tests. A prostate biopsy may be required to see if there are any signs of cancer present.

If screening does not point to any signs of prostate cancer, then the time between future prostate cancer screenings is determined by the results of the PSA blood test, where PSA levels under 2.5 ng/mL may mean you only need to be retested every 2 years and a PSA level of 2.5 ng/mL or higher may mean you should be screened every year.

At the end of the day, you and your doctor will decide on which exams are best for you and how often you should be screened for prostate cancer. Just remember that being afraid of the DRE should not be the reason behind putting off a thorough examination. Be sure to talk to your doctor if you are still feeling nervous about your next screening.

Still want to know more about Digital Rectal Exams and PSAs?


The Prostate Cancer Foundation. PSA and DRE Screening. Accessed Feb 1, 2016

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