The normal prostate gland: Palpated through the anterior rectal wall, the normal prostate is a rounded heart-shaped structure about 2.5cm in length, projecting less than 1 cm into the rectal lumen. The median sulcus can be felt between the two lateral lobes. Only the posterior surface of the porstate is palpable. Anterior lesions, including those that may obstruct the urethra, may not be detectable by physical examination.
Benign Prostatic Hypertrophy: A very common condition in men over 50yrs. Benign prostatic hypertrophy presents as a firm smooth symmetrical enlargement of the gland. It may bulge more than 1 cm into the rectal lumen. The hypertrophied tissue tends to obliterate the median sulcus.
Carcinoma of the Prostate: A hard irregular nodule, producing asymmetry of the gland and a variation in its consistency, is especially suggestive of carcinoma. Prostatic stones and chronic inflammation can produce similar findings, and differential diagnosis often depends upon biopsy. Later in its course, the carcinoma grows in size, obliterates the median sulcus and may extend beyond the confines of the gland, producing a fixed, hard irregular mass.
Prostatitis: Acute inflammationof the prostate. Presents as swollen, tender and often somewhat asymmetrical. The gland of chronic prostatitis is variable: it may
- feel normal
- be somewhat enlarged, tender and boggy
- contain scattered firm areas of fibrosis
Bates, Barbara. 1974. A Guide to Physical Examination. J.B. Lippincott Company, Toronto.