The first rectal exam,
usually by the local GP, is by inserting a finger in the rectum and feel the prostate. The patient may then be referred to a urologist.
The next exam, done by the urologist, is typically done by inserting an ultrasound instrument in the rectum. This produces a very good cross-section image of the prostate, and is the base for referring the patient for operation of benign prostate enlargement if needed.
If cancer is suspected, a biopsy of the prostate is made, blood tests, and MRI to see all details.