Referral To A Urologist
The GP may refer you to a urologist or other appropriate specialist if:
- previous treatments have not helped your urinary problems
- a urinary infection does not go away or comes back regularly
- you cannot fully empty your bladder
- you have kidney problems
- you have stress incontinence, which is when urine leaks out at times when your bladder is under pressure for example, when you cough or laugh
You should also see a specialist if the GP is concerned that your symptoms could be caused by cancer, although for most men this is not the cause.
To help find out what might be causing your symptoms and decide how to manage them, you should be offered extra tests to measure:
- how fast your urine flows
- how much urine is left in your bladder after you have peed
You may also be offered other tests, depending on your symptoms or the treatment you and your doctor are considering.
Page last reviewed: 10 February 2020 Next review due: 10 February 2023
How Soon Will Prostate Test Results Be Available
Results for simple medical tests such as some urodynamic tests, cystoscopy, and abdominal ultrasound are often available soon after the test. The results of other medical tests such as PSA blood test and prostate tissue biopsy may take several days to come back. A health care provider will talk with the patient about the results and possible treatments for the problem.
What Is Prostatic Fluid
Prostatic fluid is secreted by the prostate gland in males. During ejaculation, some amount of prostatic fluid is ejected along with sperm and semen into the male urethra.
- The prostatic fluid provides nourishment to the sperm.
- The proteins in prostatic fluid when combined with fluids derived from seminal vesicles will promote activation and functionality of the sperm.
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Further Tests For An Enlarged Prostate
Depending on your test results, you may have further tests to find out what is causing your symptoms.
Bladder pressure test
This shows how well your bladder is working. The doctor passes thin tubes up your penis and fills your bladder with a clear liquid. Thin tubes are also placed in your back passage . The tubes measure the pressure in your bladder, back passage and urethra. You will then be asked to empty your bladder, and the pressures will be measured again while you urinate. You may have this test if youre thinking about having surgery to treat an enlarged prostate, or if youve had surgery but your symptoms havent improved or are getting worse.
This shows whether you have a blockage or any abnormal tissue in your urethra or bladder. A doctor or specialist nurse will pass a thin tube up your penis into your bladder. Youll be able to feel the tube moving, but anaesthetic gel will be used to make the test more comfortable. The tube has a light and camera on the end so the doctor or nurse can see the inside of your urethra and bladder on a screen. You may have this test if you have severe urinary symptoms, blood in your urine or pain, or if you often get urine infections. You may also have this test if your doctor thinks your urethra or the opening of your bladder may be too narrow this is called a stricture.
Prostate And Urethra Problems
In this series
Prostate and urethral problems can affect the smooth flow of urine in men. This leaflet will give you a brief explanation of the different prostate and urethral conditions and how the urine system can be affected.
In this article
In the UK, prostate cancer is the most common cancer in men and is responsible for 12,000 deaths…
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Prostate Cancer: Advancements In Screenings
You may know thatprostate canceris one of the most common cancer types in men. The good news is that thereare many treatment and management options, even if the cancer is caught ata later stage.
What you may not know: There are several options when it comes toprostate cancer screening. After considering multiple factors, your doctor may recommend theprostate-specific antigen test, and/or one of the newer screeningtests that are now available.
Johns Hopkins urologistChristian Pavlovich, M.D., explains what you should know.
Other Causes Of Urethral Pain
Urinary tract infectionOne of the most common causes of urethral pain is urinary tract infection. It is usually accompanied by other symptoms such as a frequent and urgent need to pass urine.
UrethritisThis is inflammation of the urethra. It’s usually due to an infection which has been acquired sexually, most commonly gonococcus. Again, other symptoms often accompany urethral pain, such as a discharge from the penis or pain passing urine.
See the separate leaflet called Urethritis and Urethral Discharge in Men for more details.
TraumaThe most common type of injury to the urethra is by the insertion of a tube to drain the bladder . You may require this procedure if you develop urinary retention, usually as a result of swelling of the prostate.
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Why Is A Prostate
A PSA blood test is performed to detect or rule out prostate cancer. The amount of PSA in the blood is often higher in men who have prostate cancer. However, an elevated PSA level does not necessarily indicate prostate cancer. The U.S. Food and Drug Administration has approved the PSA blood test for use in conjunction with a DRE to help detect prostate cancer in men age 50 or older and for monitoring men with prostate cancer after treatment. However, much remains unknown about how to interpret a PSA blood test, its ability to discriminate between cancer and problems such as BPH and prostatitis, and the best course of action if the PSA level is high.
When done in addition to a DRE, a PSA blood test enhances detection of prostate cancer. However, the test is known to have relatively high false-positive rates. A PSA blood test also may identify a greater number of medically insignificant lumps or growths, called tumors, in the prostate. Health care providers and patients should weigh the benefits of PSA blood testing against the risks of follow-up diagnostic tests. The procedures used to diagnose prostate cancer may cause significant side effects, including bleeding and infection.
A Tough Path To The Clinic
Implementing this pre-biopsy testing in clinical practice may not yet be practical because of the limited availability of the T2:ERG test, Dr. Srivastava said.
But Dr. Sanda is hopeful that, based on the studys findings, that may change. Nevertheless, the situation demonstrates that even well-conducted, definitive biomarker studies are really just one step on the pathway to in clinical practice, he added.
This type of work is a key next step to further enhance the utility of urinary markers to refine detection of aggressive prostate cancer, Dr. Srivastava said.
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New Prostate Cancer Blood Test
If you have an abnormal PSA score, your doctor may recommend another newertest that gives a better sense of yourprostate cancer risk. The prostate health index is one such test that is a more accurateblood test and measures your risk for having prostate cancer. Its approvedby the FDA for men who have PSA scores between 4 and 10.
What are the benefits of the PHI test?
- Fewer unnecessary biopsies: Some men who have elevated PSA scores are unsure about getting an invasive biopsy. This tool can be used to better determine whether your risk is high enough to warrant a biopsy.
- More accurate: This test is better at detecting prostate cancer. It can also detect whether you have a more aggressive type of cancer. This information can guide doctors to a more targeted treatment plan for you.
If you score low on the PHI test, your doctor may recommend monitoring youover time to see if your levels rise enough to cause concern.
Protein Urine Test May Signal Prostate Cancer
By Kate Kelland
4 Min Read
LONDON – A protein in urine could be a strong indicator of prostate cancer risk, according to British scientists who say their findings could one day be developed into a quick and simple test for the disease.
Medical equipment sits in labelled bins inside of a doctor’s office in New York in this March 17, 2010 file photo. REUTERS/Lucas Jackson
Scientists from the Cancer Research UK Cambridge Research Institute and the Institute of Cancer Research said the protein, called microseminoprotein-beta or MSMB, is found at reduced levels in men diagnosed with the disease and are also lower in men with more aggressive forms of the cancer.
The protein is easy to detect because it is found in urine and would potentially be a very simple test to carry out on men to identify those most at risk of developing the disease, said Hayley Whitaker of the Cambridge institute, who led the study.
Whitaker said that while it could be around five years before the results of this study are translated into a test for doctors to use in clinics, she hoped it would then also help them to determine which patients have aggressive tumors.
Prostate cancer killed an estimated 258,000 men around the world in 2008 and is the second most common cause of cancer death in men in the United States. In Britain, around 35,000 men are diagnosed with it and some 10,000 die from the disease.
The protein — which regulates prostate cell death — is produced by normal prostate cells.
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How Is A Digital Rectal Exam Performed
A DRE is a physical exam of the prostate. The health care provider will ask the patient to bend over a table or lie on his side while holding his knees close to his chest. The health care provider slides a gloved, lubricated finger into the rectum and feels the part of the prostate that lies next to it. The DRE may be slightly uncomfortable, but it is brief. This exam reveals whether the prostate has any abnormalities that require more testing. If an infection is suspected, the health care provider might massage the prostate during the DRE to obtain fluid to examine with a microscope. This exam is usually done first. Many health care providers perform a DRE as part of a routine physical exam for men age 50 or older, some even at age 40, whether or not the man has urinary problems.
What Is The Prostate
The prostate is a walnut-shaped gland that is part of the male reproductive system. It has two or more lobes, or sections, enclosed by an outer layer of tissue. The prostate is located in front of the rectum and just below the bladder, where urine is stored. It surrounds the urethra at the neck of the bladder and supplies fluid that goes into semen.
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Talking With Your Doctor Or Nurse
Letting your doctor or nurse know you have a problem is the first step. Try to give as many details about the problem as you can, including when it began and how often it occurs. Tell the doctor or nurse whether you have had recurrent urinary tract infections or symptoms such as pain after ejaculation or during urination, sudden strong urges to urinate, or hesitancy and a weak urine stream. You should talk about the medicines you take, both prescription medicines and those you can buy over the counter, because they might be part of the problem. You should also talk about how much fluid you typically drink each day, whether you use caffeine or alcohol, and whether your urine has an unusual color or odor. In turn, the doctor or nurse will ask you about your general medical history, including any major illnesses or surgeries.Other typical questions are as follows:
- Over the past month or so, how often have you had to urinate again in less than 2 hours?
- Over the past month, from the time you went to bed at night until the time you got up in the morning, how many times a night did you typically get up to urinate?
- Over the past month or so, how often have you had a sensation of not emptying your bladder completely after you finished urinating?
- Over the past month or so, how often have you had a weak urinary stream?
- Over the past month or so, how often have you had to push or strain to begin urinating?
What Tests Might I Have At The Gp Surgery
Your GP will ask about your symptoms, how long youve had them, whether they are getting worse over time, and how they are affecting your life.
Before you visit your GP, you might want to think about how often youve had symptoms over the last month. This may help you explain your symptoms to your GP. You might also want to keep a diary of how much you drink and how often you urinate.
Your GP will check whether your symptoms might be caused by another health problem, such as diabetes, or by any medicines you are taking, such as blood pressure medicines, anti-depressants or herbal medicines.
They will also check whether your symptoms could be caused by your lifestyle for example, if you often drink large amounts of fluid, alcohol, or drinks containing caffeine .
Your GP may ask you to keep a diary for a few days to check how much you are drinking, what type of drinks you have, how much urine you pass, and how often and at what times you urinate. A diary can help your doctor to work out what may be causing your symptoms and how to treat them.
Your GP may ask you for a urine sample to check for blood or any infection that could be causing your symptoms. You may need to give more than one sample. If you have an infection your GP will give you a course of antibiotics.
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What Happens After A Prostate Ultrasound
Once the test is done, you can take off the gown and put your clothes back on. Your rectum may feel tender for a few days, but you wont need to follow any specific aftercare instructions. Your doctor may prescribe an antibiotic to prevent infection.
In some cases, your doctor or technician may ask you to wait in the facility until your results are available. Youll usually need to wait a few days for a radiologist to look at the images and diagnose any conditions, however. Depending on where the test was done, you may wait up to two weeks for results.
Your doctor will schedule a follow-up appointment to discuss your test results. If you have any abnormalities or conditions that are visible on the images, your doctor will point out these areas. Excess tissue, prostate enlargement, or cancerous tumors will appear on the ultrasound images as bright white areas that represent the dense tissue.
How Is The Urine Test Working To Detect Prostate Cancer
The urine test, called Mi-Prostate Score , incorporates blood PSA level and two molecular RNA markers that are considered specific for prostate cancer. Cancer occurs when genes are combined in a different, abnormal way. This test looks for these combinations, that are considered risk signatures, or biomarkers, for prostate cancer.
One marker is a snippet of RNA made from a gene that is overactive in almost all prostate cancers. The second biomarker is considered to be an abnormal fusion between two genes: . The presence of these two biomarkers, or just one, in the urine, can accurately diagnose prostate cancer.
This revolutionary test is not only useful for prostate cancer screening, but also for prostate cancer prediction. It is surprising that this test can predict prostate cancer progression years before it can be detected using other diagnostic methods.
The purpose of developing new tests to detect and determine the location and treatment of prostate cancer is to provide doctors with better technology that makes them able to analyze the genetic makeup of tissue from a biopsy. When a man is told his PSA level is elevated, he wants to know exactly what needs to be done in order to prevent any spread of cancer and to reduce side effects as much as possible. These new tests, especially the urine test, represent medical advancements doctors will rely on when diagnosing and predicting prostate cancer progression.
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Imaging Tests For Prostate Cancer
Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. One or more imaging tests might be used:
- To look for cancer in the prostate
- To help the doctor see the prostate during certain procedures
- To look for spread of prostate cancer to other parts of the body
Which tests you might need will depend on the situation. For example, a prostate biopsy is typically done with transrectal ultrasound and/or MRI to help guide the biopsy. If you are found to have prostate cancer, you might need imaging tests of other parts of your body to look for possible cancer spread.
The imaging tests used most often to look for prostate cancer spread include:
Getting The Results Of The Biopsy
Your biopsy samples will be sent to a lab, where they will be looked at with a microscope to see if they contain cancer cells. Getting the results usually takes at least 1 to 3 days, but it can sometimes take longer. The results might be reported as:
- Positive for cancer: Cancer cells were seen in the biopsy samples.
- Negative for cancer: No cancer cells were seen in the biopsy samples.
- Suspicious: Something abnormal was seen, but it might not be cancer.
If the biopsy is negative
If the prostate biopsy results are negative , and the chance that you have prostate cancer isnt very high based on your PSA level and other tests, you might not need any more tests, other than repeat PSA tests sometime later.
But even if many samples are taken, biopsies can still sometimes miss a cancer if none of the biopsy needles pass through it. This is known as a false-negative result. If your doctor still strongly suspects you have prostate cancer , your doctor might suggest:
- Getting other lab tests to help get a better idea of whether or not you might have prostate cancer. Examples of such tests include the Prostate Health Index , 4Kscore test, PCA3 tests , and ConfirmMDx. These tests are discussed in Whats New in Prostate Cancer Research?
- Getting a repeat prostate biopsy. This might include getting additional samples of parts of the prostate not biopsied the first time, or using imaging tests such as MRI to look more closely for abnormal areas to target.
Prostate cancer grade
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