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More about Enlarged Prostate:
Definition Causes and symptoms Diagnosis Treatment Alternative treatment Prognosis Prevention Resources |
When a man's symptoms point to BPH, the first thing the physician will want to do is a digital rectal examination, inserting a finger into the anus to feel whether—and how much—the prostate is enlarged. A smooth prostate surface suggests BPH, whereas a distinct lump in the gland might mean prostate cancer. The next step is a blood test for a substance called prostate-specific antigen or PSA. Between 30–50% of men with BPH have an elevated PSA level. This does not mean cancer by any means, but other measures are needed to make sure that the prostate enlargement is in fact benign. An ultrasound exam of the prostate, which is entirely safe and delivers no radiation, can show whether it is enlarged and may show that cancer is present.
If digital or ultrasound examination of the prostate raises the suspicion of cancer, most urologists will recommend that a prostatic tissue biopsy be performed. This is usually done using a lance-like instrument that is inserted into the rectum. It pierces the rectal wall and, guided by the physcian's finger, obtains six to eight pieces of prostatic tissue that are sent to the laboratory for microscopic examination. If cancer is present, the prognosis and treatment are changed accordingly.
A catheter placed through the urethra and into the bladder can show how much urine remains in the bladder after the patient urinates—a measure of how severe the obstruction is. Another and very simple test for obstruction is to have the man urinate into a uroflowmeter, which measures the rate of urine flow. A very certain—though invasive—way of confirming obstruction from an enlarged prostate is to pass a special viewing instrument called a cystoscope into the bladder, but this is not often necessary.
It is routine to check a urine sample for an increased number of white blood cells, which may mean there is infection of the bladder or kidneys. The same sample may be cultured to show what type of bacterium is causing the infection, and which antibiotics will work best. The state of the kidneys may be checked in two ways: imaging by either ultrasound or injecting a dye (the intravenous venous urogram, or pyelogram); or a blood test for creatinine, which collects in the blood when the kidneys cannot eliminate it.
— David A. Cramer, MD
