If your doctor suspects that you have symptoms that point to a problem with your prostate gland then he may run a few checks for prostate cancer to rule it out.
These prostate cancer symptoms could include:
- Difficulty passing urine – slow stream, a stream of urine that takes a while to start
- Pain on passing urine
- Blood in the urine
- Being unable to empty the bladder (urinary retention)
- Needing to rush to the toilet (urinary frequency)
- Having urinary incontinence
- Bad smelling urine
- Pain when you pee
- Blood in semen
- Pain on ejaculation
- Pain in the lower abdomen
- Pain in/around the testicles
- Low back pain accompanying any of these symptoms.
Many prostate problems have very similar symptoms and often the only way to get a definite diagnosis is to run several tests. This may seem time consuming and frustrating.
When you see the doctor.
Before you go to see your health care provider you can think about the questions s/he will probably ask. Your consultation may be short so if you have the answers to possible questions in your mind you can make the most of your time.
- When did your symptoms start?
- Are they there all the time or do they come and go?
- If they come and go, what makes them come on?
- What sort of pain do you have? Is it dull, sharp, piercing, aching? On a scale of 1-10, with 10 the worst, how bad is it?
- Where is it? Does it move about?
- Which meds do you take? Your healthcare provider should have this information but have a list if you’re not seeing your usual doctor.
- Do you take any herbal remedies or use complementary medicine such as acupuncture etc?
- How is your general health?
- What health problems have you had/do you have? Think of things you haven’t discussed with your healthcare provider.
- Have you had this sort of problem before?
- What serious illnesses and surgeries have you had?
- How is your mental health – what stresses are you under?
- What is your diet, smoking history and alcohol intake like?
- How much exercise do you take?
- Do you have a family history or prostate problems?
- In all this, be honest with your doctor. He cannot help without your information – making a medical diagnosis is a bit like working as a CSI: you need all the facts and witness statements. You are that witness!
It will probably help the doctor if you wait until you’re asked the questions so he can follow his train of thought and your clues. If you think any questions or information have been missed then discuss it with him.
Which tests and exams with the doctor do?
Probably the first tests your doctor will do will be urine and blood tests.
- Urine tests will check for infection among other things, to see if that’s causing your symptoms. He will probably run a quick dip-stick test in the office to test for trace amounts of blood cells, sugar, protein etc.
- Blood tests may look at a number of things but one of the primary tests is the PSA test. PSA stands for prostate specific antigen and is a marker for prostate cancer.
However, it’s not 100% accurate and a low PSA may not detect cancer, especially early cancers and, some drugs can give a false low reading. A high PSA can be caused by a number of things and does not necessarily mean that you have cancer.
The PSA blood test result will take a few days to be sent back to your doctor, who will discuss the result with you. Suggested readings vary with your age and race.
The range is:
- Men below age 50: PSA less than 2.5
- Men 50 – 59 years: PSA level less than 3.5
- Men 60 – 69 years: PSA level less than 4.5
- Men over 70 years: PSA level less than 6.5
These will vary a little between labs and different countries may use different measurements (eg centilitres and decilitres) which moves the decimal point. This would make 2.5 into 2,500 – very different. So be guided by your healthcare provider.
NOTE: A one-off test may not tell the doctor what he needs to know and he may ask you to have the test repeated at intervals to establish a pattern.
- You will probably also have a digital rectal exam, or DRE. This helps the doctor establish what the prostate gland feels like.
The doctor will ask you to lie on your side with your knees hugged into your chest. He will put a gloved and well lubricated finger into the rectum to feel the prostate gland, as you can see from the picture here. It’s not too uncomfortable and doesn’t last long but most men dread it.
Unfortunately your doctor may have to repeat the DRE on other visits for the same or similar problems but don’t let this put you off getting a good diagnosis.
The DRE will always be done after the PSA blood test as it can make the PSA level falsely high if the 2 are done close together.
If your doctor thinks that a combination of your health history, symptoms and the findings on his examinations indicate a need for further tests, he may ask a specialist – a urologist – to see you. The urologist may order other tests and he may also ask you a lot of the questions your doctor asked you at first. Don’t be too surprised if this happens.
The National Institutes for Health have this article on PSA testing.
Other tests for looking at prostate problems:
Urodynamic testing looks at the mechanics of the urinary system. There are several tests that your doctor might order or perform.
For example, one test looks at the flow rate of urine by having you pee into a special cup that measures the rate and volume.
Another test looks at the amount of urine left in the bladder after you’ve passed urine.
Some tests need a local anaesthetic and all of them can be carried out in the outpatient setting.
The test can produce some blood in the urine and semen afterwards so don’t be alarmed if this happens. It can also leave you feeling a bit uncomfortable so take painkillers if you need to and wrapping a warm, damp washcloth over the end of the penis may help ease the discomfort.
Cystoscopy uses a thin, flexible telescope-like tube to look inside the bladder and the urethra. The urology specialist will use a fluid to numb the urethra and then insert the tube into the urethra via the tip of the penis.
This can also be done in the outpatient or day-case department.
The test can also produce some blood in the urine and semen afterwards so don’t be alarmed if this happens. It can also leave you feeling a bit uncomfortable so take painkillers if you need to and wrapping a warm, damp washcloth over the end of the penis may help ease the discomfort.
Ultrasound of the abdomen will look at the organs inside it. It’s painless, you’re conscious and just involves a specialist ultrasound technician applying some gel to the belly and putting a wand-like probe on top. The technician passes the wand backwards and forwards over the belly and the pictures show up on a screen. They are interpreted by a specialist in ultrasound imaging.
It’s the same procedure pregnant women have to look at the unborn baby.
Trans-rectal ultrasound with prostate biopsy involves using ultrasound again, but with a thin probe that’s put into the rectum. This way the specialist can see the prostate gland and any lumps, bumps and tumours there.
The ultrasound can then guide the specialist in taking a sample of the tissue through a needle into the prostate. This tissue sample is sent to the lab to see if it has any cancer cells or if the tumour is benign (non-cancerous).
The procedure is carried out in the outpatient department, usually with some light sedation and local anaesthetic.
It’s estimated that about 2 in 3 men who have biopsies do not have cancer.
You may feel a little tender after the test so a warm bath may help. Take paracetamol (but not aspirin/NSAID-based drugs unless your healthcare provider says it’s ok) regularly until you feel better. This test can also cause blood to appear in the urine and semen.
If you are given antibiotics after the test be sure to take them. If you feel feverish or have flu-like symptoms after the test then contact your healthcare provider urgently.
X-Rays, MRI and CT Scans also look at bones and soft tissues respectively. They add an extra layer of understanding to what’s going on in the body. Your urologist will order them if he feels they are needed.
The timing of the return of the test results can vary. Some are available almost straight away and others, like the biopsy may take a few days or a week. Ask your specialist how long they will take and what the next steps are so that you have all the information you need to reduce your anxiety.
If you’re worried about your symptoms or medical problem but don’t want to seek professional help because you feel embarrassed, silly or that it’s your fault, read this page now: How to talk to a doctor about an embarrassing problem.