Diagnosis of Prostatic Adenoma

A medical history and examination should always be performed first before any other intervention. Blood and a urine sample, ultrasound, biopsy, cystoscopy and flow studies all form part of the diagnoses and evaluation of the patient. According to the patient’s presentation the medical professional will determine what investigations need to be performed. It is also important to make sure that the symptoms are not as a result of another ailment like prostate cancer.

  1. Medical History
  2. The doctor should perform a complete and through medical history. This will help to assess and identify symptoms and their effect on the patient’s quality of life. The history will also guide the doctor on what further investigations need to be performed as well as help guide possible treatment.
     

  3. Medical Examination
  4. rectal exam

    Rectal exam

    A full medical exam should be done with emphasis on the rectal exam. Prostate size and abnormalities can be estimated by an experienced medical professional while performing a rectal examination.

    The medical professional should explain the procedure of the rectal examination and why it needs to be done to the patient. A rectal examination can be uncomfortable but should not cause any pain. There may be a chaperone, usually another medical professional, watching the rectal being performed to protect the patient from any potential abuse and to protect the doctor from any wrongful accusations. The patient lies on his left side with his knees pulled towards his chest. The buttocks are carefully separated while the medical professional uses a well-lubricated, gloved finger to examine the rectum.
     

  5. Transrectal Ultrasound
  6. transrectal ultrasound

    Transrectal ultrasound device

    A more accurate way to determine the size of the prostate is by doing a transrectal ultrasound. Transrectal ultrasound is a short (about 5-15 minute) procedure. It uses sound waves to create an image of the prostate gland. A well-lubricated, small probe is placed into the rectum. The probe releases sound waves, which send back echoes which can be viewed as an image on the screen. The patient also lies on his left side with his knees pulled towards his chest. This procedure can cause an uncomfortable sensation of rectal fullness but should not be painful. This procedure is usually done if abnormalities are felt or suspected on medical history and examination.
     

  7. Ultrasound-guided prostate biopsy
  8. prostate biopsy device

    Prostate biopsy device

    A prostate biopsy will be performed to differentiate benign prostatic adenoma from prostate cancer. If the patient is a definite candidate for surgical removal of the prostate, a biopsy is not always done because the prostate or pieces of it will be sent for histological analysis after removal. The urologist takes a sample of suspicious prostatic tissue using an ultrasound-guided approach while doing a transrectal ultrasound. The area is injected with a local anaesthetic before the procedure is performed. The patient might also be given an enema before the biopsy.
     
     
     

  9. Blood Tests
  10. blood tests

    Blood tests

    PSA (Prostate Specific Antigen) is taken as a way of screening which men need further investigations. PSA levels are elevated in men with prostate cancer and prostatic adenoma. If the PSA is within normal range the patient is considered unlikely to have prostate pathology. This blood should not be taken on the same day after a rectal examination has been performed because a rectal exam could cause PSA levels to rise.

    Bloods to check kidney function like creatine is taken to determine if any kidney damage or impairment is present.
     

  11. Urine Analysis
  12. urine test

    Urine test

    The doctor may request a urine sample to exclude a urinary tract infection that can present with similar symptoms as prostatic adenoma. A urinary tract infection is also more common in men with prostate pathology.
     
     
     
     
     
     
     
     

  13. Urine Flow Rate
  14. Urinary flow rates can be measured with a flow meter. This can be used to monitor improvement after treatment. It can also be used to determine the severity of the patient’s symptoms.
     

  15. Cystoscopy
  16. cystoscop

    Cystoscope

    If indicated, the urologist might do a cystoscopy to view the patient’s bladder. During a cystoscopy other bladder pathology causing obstruction can be excluded. This is usually performed by inserting a lubricated catheter with a small camera into the urethra.