Granted, I've never been through an exam, but my husband just recently had the prostate issue come up. The PSA is just bloodwork, so no problem there. GP sent DH to local urologist after psa level up, and this Dr. would not do exam--sent him back to major hospital where JPouch surgeon is. They did do a digital exam (with some discomfort). A biopsy is different with a jpouch, so when it comes to that the Urologist at MUSC will do it. Very conservative approach to prostate cancer these days as reflected in the medical research literature and my husband's experience. The PSA is watched, wait & see--no rush to do biopsy or remove prostate.