taken from Small Gland, Big Problem 4th Edition
by Professor Roger Kirby, Health Press 2011

Some measurements will be taken to assess your general health. For example, height, weight and abdominal girth may be measured, as obesity is a risk factor for prostate cancer, diabetes and heart disease. Your blood pressure is also likely to be checked, as early identification of hypertension is important to prevent the development of complications. For similar reasons, blood tests for sugar and cholesterol (see below) may be carried out.

Your urologist may also repeat tests that your GP has already carried out, such as the PSA and percentage free PSA measurements. He may want to check your situation for himself; for some tests it is advisable that the samples are always sent to the same laboratory
for analysis if you are being monitored over a period of time.

Blood tests

The basis of the PSA test was described earlier on pages 12 and 13. Other tests, such as your fasting blood sugar and cholesterol level, may be used as indicators of your general health and to rule out diabetes or an abnormal lipid profile (e.g. raised HbA1c or cholesterol). They can also be used to estimate the risk of future problems, such as heart disease or stroke.

Urine tests

You may be asked to provide a urine specimen. This could be checked for bacteria, as you may have a urinary tract infection. It may also be tested for the presence of blood. Blood can be found in the urine if prostate cancer has spread into the urethra, which runs through the prostate, so its presence is a clue to the urologist about the nature of your problem. Other important causes of blood in the urine include bladder stones and bladder cancer, so this is a finding that should not be ignored. Urine may also be routinely tested for sugar in order to detect diabetes.

Physical examination and digital rectal examination

The urologist may examine you in general, but will almost certainly perform a digital rectal examination. Undeniably, it is an uncomfortable experience and one that some men dread, but the discomfort is actually only mild. Urologists perform this day in, day out, but if that does not reassure you, just keep thinking about the consequences of ignoring your condition. A few moments of minor discomfort are surely worthwhile.

Your urologist will put on a glove and apply some lubricant jelly to his finger. He will tell you which position to adopt – probably one where you lie on your side with your legs pulled up towards your chest. He will then gently insert his finger into your rectum, passing through the sphincter muscle that keeps the anus closed. He will then feel your prostate, noting its size, shape, firmness and how its surface feels – an enlarged but soft prostate suggests benign enlargement of the gland, while a firm nodule may indicate cancer. The examination is not painful, just uncomfortable. Try to relax until it is over – it literally only lasts a few moments.

rectal examination
A digital rectal examination is uncomfortable but not painful and only lasts a few moments

Urination questionnaire

Prostate cancer may be affecting your ability to empty your bladder or you may have BPH that is affecting your urine flow. In order to investigate your symptoms in a meaningful way, your urologist may give you a questionnaire to fill in (see overleaf). You may be asked to fill it in while you are in the clinic or you may be able to take it home with you to complete and return at your convenience.