PROSTATIC MASS OR ENLARGEMENT
PROSTATIC MASS OR ENLARGEMENT: Excerpt from Differential Diagnosis in Primary Care
Generally, when the physician examines the prostate in a routine
physical, there are only two conditions that he or she is looking
for—benign prostatic hypertrophy and prostate carcinoma. The former
presents a diffuse enlargement, soft in consistency, and the prostate varies
in size from a plum to an orange. Prostate carcinomas, in contrast, present
as a stony, hard nodule in the lateral superior or inferior areas in the
early stages or as a diffuse, hard, nodular enlargement in the more advanced
stages. The approach is different for the patient presenting with a urethral
discharge or difficulty voiding, because then one must include
acute and chronic prostatitis and prostatic
abscess in the differential.
In brief, that is the differential diagnosis of an enlarged prostate. The
only trick that might be useful in remembering it is to keep in mind the
ages 20, 40, 60, and 80. In general, 20-year-old men usually have acute
prostatitis from gonorrhea or other bacteria. The 40-year-old men usually
have chronic prostatitis from previous gonorrhea or from nonspecific
prostatitis. The 60-year-old men generally have prostatic hypertrophy, and
the 80-year-old men most likely have prostatic carcinoma. However, it is
important to remember that any one of these diseases may appear at the ages
of 40, 60, and 80.
Approach to the Diagnosis
The main consideration in diagnosing a prostatic mass is to rule out
carcinoma. It is therefore wise to draw blood for prostate-specific antigen
(PSA) before proceeding in anyone who is suspected of having prostate
cancer. If the mass is located in the posterior lobes, there is further
support for the diagnosis. Ultrasonography can be done for further
localization before proceeding with a biopsy. Obviously, if the PSA test is
positive, referral to a urologist is mandatory, although false-positives can
occur in this test. A large, boggy prostate suggests a prostatic abscess or
prostatitis. If there is no urethral discharge, one can elicit a discharge
by prostatic massage. However, this should not be done if the patient has
fever and significant tenderness of the prostate. It is better to proceed
with antibiotic therapy and reexamine the patient after the fever has
subsided. A smear and culture of the discharge is made. If upon examining
the discharge under high-power microscopy, four or more white blood cells
(WBCs) per high-power field are found, the diagnosis of prostatitis can be
made. If benign prostatic hypertrophy is suspected, cystoscopy and
retrograde pyelography can be done.
Other Useful Tests
-
CBC
-
Sedimentation rate (infection)
-
Chemistry panel (uremia)
-
Urinalysis (cystitis, UTI)
-
Cystogram (prostatic hypertrophy)
-
Skeletal survey (metastatic carcinoma)
-
Bone scan (metastatic carcinoma)
-
Acid phosphatase level (metastatic carcinoma)
-
CT scan of pelvic lymph nodes (metastasis)
-
Lymphoscintigraphy (node metastasis)
-
Cystoscopy (bladder neck obstruction)
Pictures
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
More About Prostatitis
More Medical Textbooks Online about Prostatitis
Review other book chapters online related to Prostatitis:
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- Prostatitis
- "Professional Guide to Diseases (Eighth Edition)" (2005)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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