Prostate Problems - Diagnosis

Prostatitis

Doctors develop a ‘differential diagnosis’ by weighing the results of a patient’s history (symptoms such as painful urination), physical exam (signs such as a tender prostate examination), and diagnostic tests (for instance, the presence or absence of bacteria and inflammatory cells in prostatic secretions), against their own experience, and their awareness of known diseases. By a process of elimination, doctors arrive at a ‘working diagnosis’ (educated guess) they use to name a patient’s complaints. In conventional medicine, subsequent treatments are based on the disease’s name. Although this “naming ceremony” makes the doctor and patient feel better, it doesn’t necessarily correlate with the true cause of the illness, or mean that the symptoms will disappear after treatment (particularly if the wrong name is given). Prostatitis is notorious in this regard. Men are often told they have prostatitis and are prescribed antibiotics (usually without further testing) if they simply complain of prostate pain during a digital rectal examination, even though muscle spasms or a rough exam, not infection, is to blame (only 5% of prostatitis is caused by a bacterial infection). Nevertheless, doctors routinely treat every type of prostatitis with antibiotics. Not surprisingly, two-thirds of these men fail to improve. Although frustrating for the physician, the consequences of assigning a wrong diagnosis can be devastating for the patient who is subjected to months (even years) of unrewarding doctor visits, expensive and invasive tests (which are usually normal), and a grocery list of medications – all to no avail. That’s why it’s crucial for doctors to make an accurate diagnosis.

Prostate Enlargement

There are many ways to evaluate whether a patient has an enlarged prostate, some of the most common ways follow:

Your doctor will ask you detailed questions about your symptoms. You will most likely be asked about other health problems, medications (including over-the-counter, OTC, drugs, such as ibuprofen or antacids) you're taking and whether there's a history of prostate problems in your family.
Your doctor may perform a digital rectal exam. Due to the proximity of the prostate to the rectum, your doctor can determine whether your prostate is enlarged and also check for signs of prostate cancer.
A urine test may help rule out an infection or other conditions that cause prostate enlargement-like symptoms, such as prostatitis, bladder infection or kidney disease.

Answers to a standardized questionnaire about your urinary symptoms can help your doctor determine whether you have mild (score of 7 or less), moderate (score of 8-19), or severe urinary symptoms (score of 18-35). Click here to download a PDF with a urinary symptom questionnaire, new window will open.

Bladder Outlet Obstruction

Your doctor will ask detailed questions about your symptoms and medical history. A physical exam will be performed to help determine if a bladder outlet obstruction exists.

One of the most common causes of this condition is an enlarged prostate or BPH. A thorough history and physical examination evaluating other potential sources of lower urinary tract obstructive symptoms should be undertaken before empiric treatment for BPH is begun.

Prostate Cancer

The importance of screening and early detection is key for long-term survival. Prostate cancer diagnosed early, while still restricted to the prostate gland, has a much better chance of successful treatment. Screening for prostate cancer consists of a prostate-specific antigen (PSA) blood test and a digital rectal examination. Men should start being screened for prostate cancer at the age of 50. Screening should start earlier, at age 40, for men with the following predisposing factors:

African-American ethnicity
All men with a family history of prostate cancer in either the mother or father's side

An elevated prostate-specific antigen and/or an irregular feeling prostate or nodule in the prostate found on digital rectal examination may be an indication of prostate cancer. The diagnosis of prostate cancer is made on the basis of a prostate biopsy performed under ultrasound guidance generally in the physician's office.

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