Prostate Health: PSA, DRE, and PVR Tests Explained

Introduction

When a man reaches the age of 40, he should make an effort to have a formal prostate exam. Prostate diseases mainly affect men 50 and older due to changes in the prostate size as we age. The prostate is a walnut-sized gland located between the male bladder and the penis. The prostate is just in front of the rectum. The urethra runs through the center of the prostate, from the bladder to the penis, letting urine flow out of the body. The mean weight of the normal prostate in adult males is about 11 grams, usually ranging between 7 and 16 grams. It surrounds the urethra just below the urinary bladder and can be felt during a rectal exam.

Main Item

"Prostate-related diseases such as prostatitis, BPH or elevated PSA can occur for a number of reasons. They mainly affect older men because as we age, the prostate gland increases in size which can cause inflammation of the prostate and affect urinary control," noted Dr. David Samadi, Chairman of Urology and Chief of Robotic Surgery at Lenox Hill Hospital.

A Formal Prostate Exam Should Include:

1 - Prostate Specific Antigen (PSA) Blood Test

Considered the gateway to prostate cancer, the PSA is the main prostate cancer screening tool used to gauge activity around the prostate gland. Prostate Specific Antigen is a protein produced by cells in the prostate gland.

A PSA test is a simple blood test that measures how much PSA there is in a man's blood.

Male anatomy picture showing location of the prostate gland.

This type of test is most often done by a urologist when men turn a certain age or when men possess certain symptoms or risk factors relating to prostate conditions. The blood test is then sent to a laboratory to be analyzed.

• Baseline PSA should be determined at the age of 40, then taken every year
• A "normal" PSA level is generally between 1.0 and 4.0 ng/mL. Anything above 4.0ng/mL is considered "abnormal" or elevated.
• If you have an elevated PSA, you should see a urologist. A urologist will do a number of tests to determine exactly what is causing the elevated PSA. Additional tests may include another PSA test, a urinalysis test, post-void residual, assessment of medical history and family history, and possibly a prostate biopsy or cystoscopy.

2 - Digital Rectal Exam (DRE)

A digital rectal exam is an examination of the lower rectum area. The urologist uses a gloved, lubricated finger to check for any abnormal activity around the prostate.

• This test is key to understanding if the prostate is enlarged.
• It also provides key insights into the anatomy of the prostate gland and can identify any abnormal bumps or other changes.
• If the PSA comes back normal, the DRE may assist further in diagnosing a prostate condition such as BPH or inflammation of the prostate that the blood test did.

"The DRE exam and PSA test are an essential part of a man's prostate health. These should be assessed on an annual basis as part of a man's physical exams," stressed Dr. Samadi.

3 - Post Void Residual Test (Optional)

For patients who express issues with urinary control or emptying their bladder, a prostate exam may also call for a PVR exam. This urine test measures the amount of urine left in the bladder after urination.

This test helps evaluate:

• Incontinence (accidental release of urine)
• Urination problems
• Enlarged prostate (benign prostatic hyperplasia, or BPH)