How does a prostate examination by an urologist work?

The doctor conducts a confidential anamnesis discussion with the patient. You will be asked whether you have any previous illnesses or complaints, which medications you are taking and the level of your libido.

If the findings are ambiguous, blood is taken to determine the prostate-specific antigen (PSA) in the blood. The external genital organs, the penis, the foreskin, the testicles as well as the epididymis and spermatic cord are examined in order to feel any changes and hardening.

Ultrasound is used to scan the kidneys to see changes in the kidneys. The aim is to find out whether kidney stones are present. Then the ultrasound follows the bladder, what it looks like, whether there are bladder stones and how much urine is present in the bladder.

TRUS

Then the "Transrectal Ultra-Sonic examination" (TRUS) of the prostate. This examination takes a few minutes. During the examination, the patient lies on his side on a couch while the doctor inserts a thin, finger-thick probe a few centimeters into the anus. This gives the doctor high-resolution images of the prostate and its surroundings on the monitor.

The images of the prostate are automatically measured and the size is determined and saved or printed out for later comparison. The doctor always has to feel the prostate with his finger. The reason is that the doctor has to feel the consistency of the prostate (soft or hard). In this way, together with the TRUS images, he can get a much better picture for the diagnosis. This examination also only takes a few seconds.

Uroflowmetry

The doctor may order a urine stream measurement to assess the ability to urinate.

Here you urinate through a funnel into a cup. At the top of the funnel there is a measuring unit (sensor) that determines the amount of urine released per unit of time and shows the doctor the result using a curve on the monitor. How long the emptying takes is also measured. The doctor can carry out further tests on the collected urine. If the values deviate from the norm, there are indications of possible underlying diseases.

Residual urine in the bladder

After the Uroflow measurement, ultrasound is used to check how much residual urine is still present in the bladder. A small amount of residual urine in the bladder is normal. However, from >70 ml, the underlying problem should be identified and treated.

PSA - prostate - specific - antigen

PSA is a (protein) protein that is produced by the glands of the prostate.

A PSA value of <4 is normal in healthy men.

If the PSA value in the blood is to be determined, you should not exercise or have sexual intercourse for two days before the blood test. Also, do not come to the examination on a bicycle. All of this puts pressure on the prostate and increases PSA levels, which can lead to an incorrect diagnosis. The blood sample should always be taken before the finger palpation examination. An increased concentration of the PSA value can be an indication of a possible malignant disease of the prostate.

Most common prostate disease

Benign prostate enlargement:

This is a benign tissue growth that causes frequent urge to urinate (pollakuria) and leads to urination disorders.

Prostatitis:

This is an inflammation of the prostate that is usually caused by bacteria. It is very painful and can even lead to urinary retention. In this case, you should see a doctor immediately. Urinary retention means the inability to empty the bladder.

If you have a prostate infection, you should consult a doctor

Source: Prof. Dr. med. Dietmar Molitor, Urologist