The prostate is a small gland below the bladder through which the first part of the urethra passes. With age it enlarges in most men, it can become inflamed, and prostate cancer is a common cancer that causes no symptoms for a long time. A prostate check helps to tell these three conditions apart and to detect them in time.
Many men put it off because they feel uneasy about it. At Dr Penev’s practice the examination is calm, every step is explained, and it takes less time than most patients expect.
When it is recommended
- as a preventive check – after the age of 50, or after 45 if your father or brother has had prostate cancer;
- with a weak or interrupted stream, straining and a feeling that the bladder has not emptied completely;
- with frequent urination, sudden urges and getting up at night more than once;
- with pain or heaviness in the perineum (between the scrotum and the anus), in the lower abdomen or during ejaculation;
- with a raised PSA from another test, or blood in the urine or semen;
- to monitor an already diagnosed enlarged prostate or chronic prostatitis.
Suddenly being unable to pass urine with a full, painful bladder is acute urinary retention – go to an emergency department or call 112 (the European emergency number). The same applies to a high temperature with shivering and pain in the prostate area, which may be acute bacterial prostatitis.
How it is done
The examination takes about 20–30 minutes.
- Conversation. Dr Penev asks about your symptoms, how long you have had them, the medicines you take and your family history. Sometimes you will fill in a short questionnaire about your urinary symptoms, which is later used to track the effect of treatment.
- Rectal examination. With a gloved finger and gel, Dr Penev feels the back surface of the prostate through the anus – its size, texture, tenderness and any lumps. It takes about a minute and feels like pressure and mild discomfort, but is usually not painful.
- Ultrasound. A transabdominal ultrasound scan of the prostate and bladder is done through the abdomen with a full bladder: the size of the prostate is measured, the bladder and kidneys are checked, and after you pass urine the residual urine is measured. It is painless and involves no radiation.
- PSA and other tests. Prostate-specific antigen (PSA) is a protein measured in the blood that rises with cancer but also with benign enlargement or inflammation. That is why the result is interpreted together with your age, the size of the gland, the change over time and the findings of the examination. If needed, a urine test, a culture or uroflowmetry is added.
Preparation
- Come with a full bladder – do not pass urine for about an hour before the examination and drink two or three glasses of water.
- Blood for PSA is best taken before the rectal examination or a few days after it; for 48 hours beforehand avoid ejaculation, cycling and intensive exercise.
- Do not have a PSA test during a urinary tract infection or for a few weeks after a catheter or a cystoscopy – the result may be temporarily raised.
- Bring your previous PSA results and ultrasound reports – comparing them over time is valuable.
Results
Dr Penev explains what the findings show while you are still at the examination.
- Prostate size – a guide to the degree of benign enlargement and to the choice between medication and surgery.
- Residual urine – a significant amount indicates difficulty emptying the bladder and a risk of infections and bladder stones.
- Texture and nodules – a lump or asymmetry on rectal examination is a reason for further investigation, whatever the PSA result.
- PSA – if it is raised or rising quickly, the next step is usually a repeat test after a few weeks and, if it is confirmed, an MRI scan and, if needed, a biopsy in hospital. You can read more about interpreting it in the article on the PSA test.
Based on all this you receive a plan: monitoring with a follow-up check, medication for the enlarged prostate or the prostatitis, or referral for surgery at the Department of Urology at Kaspela University Hospital (UMBAL Kaspela), Plovdiv.
Where it is done
The examination is carried out at Dr Penev’s urology practice in Plovdiv (5 Anri Barbyus St) and at Vita Med Medical Centre in Karlovo, by appointment; ultrasound is part of the examination in Plovdiv, and whether it is available in Karlovo is confirmed when you book. Further tests and surgical treatment are arranged through Kaspela University Hospital in Plovdiv.
Price
Initial consultation – €50, follow-up consultation – €30. The price of the ultrasound and laboratory tests is confirmed when you book.
One calm examination gives you more peace of mind than years of putting it off – book a prostate check with Dr Penev by phone or online.
Frequently asked questions
Do I need to stop my medicines before the examination?
Do not stop anything yourself, but bring a list. Some medicines for an enlarged prostate (5-alpha-reductase inhibitors) lower PSA by roughly half, and this is taken into account when interpreting the result.
Can ultrasound replace the rectal examination?
Not completely. Ultrasound measures the size of the prostate and the residual urine, but the texture of the gland and suspicious lumps can only be felt by touch, so the two examinations complement each other.
How often should the prostate check be repeated?
The interval is individual. With a low PSA and no symptoms it may be every few years; when an enlarged prostate is being treated or the results are borderline, once a year or more often.
I have a fever and severe pain when passing urine – should I wait for my booked appointment?
No. A fever with shivering and difficulty passing urine may be acute bacterial prostatitis, which often needs intravenous treatment. Go to an emergency department the same day.
The information on this website is for general education and does not replace an examination and consultation with a doctor. If you have urgent symptoms, seek medical help immediately or call 112.