Investigating the Prostate

Prostate problems are often picked up as part of a routine examination.  Doctors usually screen elderly males for symptoms which would suggest a problem with the prostate gland.  Occasionally, patients see their doctor when there are bothersome symptoms related to the gland as we have discussed above.

Before you see your doctor, it would be a good idea to think carefully about your symptoms to assess their severity and how they are affecting you.  Some men who may have symptoms, simply want the reassurance that the condition is not something life-threatening, and are otherwise happy to live with it.  Others are significantly troubled by their symptoms and are desperate for treatment.

Prostate Self-Assessment Questionaire:

1. Do you have difficulty initiating urination? i.e. do you have to wait a while before urine starts to flow?
2. Do you pass urine in fits and starts i.e. is your urine flow very weak?
3. Does it take you long to pass urine?
4. Do you continue to dribble urine after you have finished passing urine?
5. Are you woken up from your sleep at least twice a night by the need to pass urine?
6. Do you sometimes have the need to rush to the toilet to pass urine?

If you answer "yes" to any of these questions, you may have a prostate problem and should consult your doctor.

The Physical Examination:

Other than a general examination, to ascertain your general state of health, your doctor will examine your abdomen to feel if your bladder is enlarged (a sign of retention of urine).
The final part of the examination will be a digital rectal examination, in which you will be asked to lie to your side and bend at the knees.  This will make your prostate easier to feel.  Your doctor will then insert a gloved finger into your rectum in order to assess the size and other characteristics of your prostate.  Normally, the prostate gland is not tender, but in prostatitis, tenderness may be felt.  Occasionally, during the examination, your doctor may massage your prostate in order to obtain a specimen of fluid from it for laboratory testing.

Investigations:

The following investigations may be performed
• Blood test: to assess kidney function.  PSA (prostate-specific antigen) levels are often tested.

• Urine flow measurement: an enlarged prostate may cause obstruction of normal urine flow.  Devices are able to test this flow to ascertain if there is an obstruction, and to determine its severity.  This test is very simply done.  You will basically be made to pass urine into a funnel-shaped container, and all the measurements are obtained automatically.

• Measurement of Residual Urine: a device placed over the lower abdomen allows doctors to determine the volume of urine retained in the bladder after passing urine.

• Imaging: x-rays and ultrasound examinations may be done to assess for ureteric or kidney stones, or hydronephrosis (swelling of kidney).

• Transrectal ultrasound: a transrectal ultrasound scan is done by passing a small probe into the rectum.  This allows for visualization of the prostate gland.  If necessary, a sample of prostate tissue may biopsied for testing.

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