Examination Of An Enlarged Prostate 

At our 3D Prostate Clinic, we use a full set of laboratory tests for the diagnosis of an enlarged prostate.

1) Ultrasound: We use ultrasound to check the shape, structure, and size of the prostate arriving at volume and weight values using the formulas described early in this article. TransRectal Ultrasound (TRUS) is not only used to diagnose whether the prostate is enlarged or not, but also to observe intuitional pathological changes in the prostate, such as infection, hyperplasia, nodules, cysts, calcification, stones, etc.

2) Digital Rectal Examination (DRE): DRE will be done after the bladder is emptied. The aim is to check the tension of the anal sphincter (which is different with a neurogenic bladder) and the condition of the prostate, including shape, size, and texture, also to see if there are nodules or tenderness/pain from the massage. When the prostate is enlarged, the gland can increase in length and/or width attaining a smooth surface, distinct edge, medium hardness and elasticity, the central sulcus lessening or disappearing entirely. The size of a normal prostate is similar to a chestnut. A Degree I enlarged prostate is like an egg, and a Degree II enlarged prostate is like a duck egg, and a Degree III enlarged prostate is like a goose egg.

3) Laboratory testing: The high white blood cell urine count in a routine test shows urinary tract infection. High white blood cell counts in prostate fluid and semen routine examinations indicates prostatitis and spermatocystitis. High urea nitrogen and creatinine levels indicate impaired renal function.

4) A full set of lab. testing to identify causative pathogens:

The doctors at our Clinic take a number of samples for causative pathogen testing, which includes urethral secretions, prostate fluid, semen, and blood, etc. This sampling process combined with our extensive testing allows us to accurately identify the causative pathogens. The most common urogenital infections include: Staphylococcus aureus, Hemolytic streptococcus, Gonococcus, Bacterium aeruginosum, Corynebacterium, Escherichia coli, Proteus, Enterococcus, Klebsiella, Tubercle Bacillus, Chlamydia, Mycoplasma, Virus, Fungus, and Trichomonas, etc.

5) Determination of residual urine: The normal bladder volume is 350 to 500 ml. Residual urine after urination should be less than 10ml. When the residual urine is over 30ml, this indicates a pathological condition. The simplest and most atraumatic testing method is abdominal ultrasound.

6) Urodynamics: Urodynamics can be utilized to objectively evaluate urinary function. During the examination, 250 to 400 ml is the optimal urine volume, 150 to 200 ml is the minimum urine volume. The fastest uroflow rate is 15ml/s.

7) Cystoscopy: The normal distance from the seminal hillock to the bladder neck is 2cm. When the prostate is enlarged, the posterior urethra will be extended, the urethra will be compressed and cracks will form. The bottom of the bladder will sink and trabecula, cella or diverticulum abnormalities will form in the bladder wall.

8) Prostate Specific Antogen (PSA): Prostatitis, prostate enlargement and prostate cancer can all make the PSA value increase. Normally a PSA>4 ug/L result is the critical value that is used to screen prostate cancer. When the PSA result is between 4 to 10ug/L, it is called the grey area, it can indicate prostate cancer or prostate enlargement. When the PSA result is over 10ug/L, the possibility of prostate cancer is almost certain. When checked by digital rectal examination (DRE) and transrectal ultrasound, and prostate nodules are detected, and PSA is over 10ug/L, a prostate biopsy is required to diagnose or exclude prostate cancer.