Medical Tests for Prostate Problems

The prostate is a walnut-sized gland in men that produces fluid that is a component of semen. The gland has two or more lobes—or sections—enclosed by an outer layer of tissue. Located in front of the rectum and just below the bladder, where urine is stored, the prostate surrounds the urethra, which is the canal through which urine passes out of the body.

The most common prostate problem in men under 50 is inflammation or infection, which is called prostatitis. Prostate enlargement is another common problem. Because the prostate normally continues to grow as a man matures, prostate enlargement, also called benign prostatic hyperplasia or BPH, is the most common prostate problem for men over 50. Older men are at risk for prostate cancer as well, but it is much less common than BPH.

Sometimes, different prostate problems have similar symptoms. For example, one man with prostatitis and another with BPH may both have a frequent, urgent need to urinate. Other men with BPH may have different symptoms. For example, one man may have trouble beginning a stream of urine, while another may have to get up to go to the bathroom frequently at night. A man in the early stages of prostate cancer may have no symptoms at all. This confusing array of symptoms makes a thorough medical examination and testing very important. Diagnosing the problem may require a series of tests.

Male urinary tract, front and side views.

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Talking With Your Doctor or Nurse

Letting your doctor or nurse know you have a problem is the first step. Try to give as many details about the problem as you can, including when it began and how often it occurs. Tell the doctor or nurse whether you have had recurrent urinary tract infections or symptoms such as pain after ejaculation or during urination, sudden strong urges to urinate, or hesitancy and a weak urine stream. You should talk about the medicines you take, both prescription medicines and those you can buy over the counter, because they might be part of the problem. You should also talk about how much fluid you typically drink each day, whether you use caffeine or alcohol, and whether your urine has an unusual color or odor. In turn, the doctor or nurse will ask you about your general medical history, including any major illnesses or surgeries.

Other typical questions are as follows:

• Over the past month or so, how often have you had to urinate again in less than 2 hours?

• Over the past month, from the time you went to bed at night until the time you got up in the morning, how many times a night did you typically get up to urinate?

• Over the past month or so, how often have you had a sensation of not emptying your bladder completely after you finished urinating?

• Over the past month or so, how often have you had a weak urinary stream?

• Over the past month or so, how often have you had to push or strain to begin urinating?

Your answers to these questions may help your doctor or nurse identify the problem or determine what tests are needed. You may also receive a symptom score evaluation that can be used as a baseline to see how effective later treatments are at relieving those symptoms.

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Preparing for the Exam

The common tests your doctor or nurse will perform first require no special preparation. Digital rectal exams (DRE) and blood tests for prostate-specific antigen (PSA) are often included in routine physical examinations for men over 50. For African-American men and men with a family history of prostate cancer, it is recommended that tests be given starting at age 40. Some organizations even recommend that these tests be given to all men starting at age 40.

If you have urination problems or if the DRE or PSA test indicates that you might have a problem, you will probably be given additional tests that may require some preparation. Ask your doctor or nurse whether you should change your diet or fluid intake or stop taking any medications. If the tests involve inserting instruments into the urethra or rectum, you may be given antibiotics before and after the test to prevent infection.

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Procedures

DRE

This exam is usually done first. Many doctors perform a DRE as part of a routine physical exam for any man over 50, some even at 40, whether the man has urinary problems or not. You may be asked to bend over a table or to lie on your side holding your knees close to your chest. The doctor slides a gloved, lubricated finger into the rectum and feels the part of the prostate that lies next to it. You may find the DRE slightly uncomfortable, but it is very brief. This exam tells the doctor whether the gland has any bumps, irregularities, soft spots, or hard spots that require additional tests. If a prostate infection is suspected, the doctor might massage the prostate during the DRE to obtain fluid for examination with a microscope.

Digital rectal exam (DRE).

PSA Blood Test

To rule out cancer, your doctor may recommend a PSA blood test. The amount of PSA, a protein produced by prostate cells, is often higher in the blood of men who have prostate cancer. However, an elevated level of PSA does not necessarily mean you have cancer. The Food and Drug Administration has approved a PSA test for use in conjunction with a DRE to help detect prostate cancer in men age 50 or older and for monitoring men with prostate cancer after treatment. However, much remains unknown about how to interpret the PSA test, its ability to discriminate between cancer and benign prostate conditions, and the best course of action if the PSA is high.