Skill Checkup: Digital Rectal Examination

Adam Warren Ylitalo, DO, FACOS, FACS; Bradley Schwartz, DO

Disclosures

September 23, 2019

If a patient with neutropenia or acute prostatitis needs to be examined for a fluctuant prostate signifying abscess, antibiotic therapy should be started before DRE and after all cultures are obtained. The examination in a patient with prostatic abscess or acute bacterial prostatitis should be gentle and may consist of nothing more than feeling a hot, boggy prostate with a fingertip, then stopping the examination. Prostatic massage is only rarely indicated in patients without suspected chronic bacterial prostatitis.

The examination should be performed with the patient in a safe position in case vasovagal syncope should occur; this is not uncommon, particularly in younger men.

Prostate cancer typically feels like a harder nodule, and an abscess is typically fluctuant. In acute prostatitis, the gland can be quite tender, which can be a diagnostic finding; however, care should be taken not to manipulate the prostate vigorously because of the risk for bloodstream infection.

Read more about DRE.

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