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Urology (Expert Forum)
Boggy/nodular prostate
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D.
Boston - MA
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
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Boggy/nodular prostate
by MMPPDD, Jan 14, 2005 12:00AM
You gave me some very good advice several weeks ago; I'd like to get some more from you …
Problem: Pain between anus and scrotum. Pain is much worse when sitting, and is primarily a burning/stinging sensation near the surface and a burning sensation below. First had it 2.5 yrs ago and it lasted 1 week; it went away on its own, but came back 2 yrs ago and has been constant since. Some days are better than others, and severity tends to cycle over ~2 week period. Various diagnoses were: anal fissure, hemorrhoids, yeast, other skin problems; corrective actions did not alleviate symptoms at all. You suggested prostate exam, and I went to my general practitioner for this.
My GP had given me a prostate exam 1.5 yrs ago and then found it "firm". This time it is "boggy and nodular". After the exam/message I provided a urine sample for the lab to test for white blood cells. I didn't get a chance to touch base with the Dr. after the sampling (he was with another patient), but will presumably after the test comes back. This is giving me time to research the problem, anyway, although I have been finding conflicting information on the net.
My questions are:
1) What besides infection could cause the "firm" to "boggy/nodular" transition?
2) Is it worthwhile to check for cancer? (I am 43 yrs old; cancer does not run in my family)
3) Are there other diagnostic tests worth doing?
4) What is the likelihood of a false negative for the white blood cell test (i. e., even if negative, could it still be an infection)?
5) I understand the protocol for infection is lengthy anti-biotic treatment; should this be done regardless of white cell test, just in case? If so, are there any potential side effects?
6) What other treatment options should be considered?
7) I know I've given you very limited information (but it's all I have), what is your best guess that (a) a "boggy and nodular" prostate (or whatever causes a boggy and nodular prostate) will explain my symptoms, and (b) the probability of successful cure after this has been going on for 2 years?
Of course, I will discuss this all the next time I see my Dr., but would appreciate your input beforehand so I'm better prepared for the discussion.
Thank you in advance for your thoughts, and also THANK YOU FOR YOUR PREVIOUS ADVICE!! After travelling down many false paths I am cautiously hopeful that I've finally found the cause of the problem.
Problem: Pain between anus and scrotum. Pain is much worse when sitting, and is primarily a burning/stinging sensation near the surface and a burning sensation below. First had it 2.5 yrs ago and it lasted 1 week; it went away on its own, but came back 2 yrs ago and has been constant since. Some days are better than others, and severity tends to cycle over ~2 week period. Various diagnoses were: anal fissure, hemorrhoids, yeast, other skin problems; corrective actions did not alleviate symptoms at all. You suggested prostate exam, and I went to my general practitioner for this.
My GP had given me a prostate exam 1.5 yrs ago and then found it "firm". This time it is "boggy and nodular". After the exam/message I provided a urine sample for the lab to test for white blood cells. I didn't get a chance to touch base with the Dr. after the sampling (he was with another patient), but will presumably after the test comes back. This is giving me time to research the problem, anyway, although I have been finding conflicting information on the net.
My questions are:
1) What besides infection could cause the "firm" to "boggy/nodular" transition?
2) Is it worthwhile to check for cancer? (I am 43 yrs old; cancer does not run in my family)
3) Are there other diagnostic tests worth doing?
4) What is the likelihood of a false negative for the white blood cell test (i. e., even if negative, could it still be an infection)?
5) I understand the protocol for infection is lengthy anti-biotic treatment; should this be done regardless of white cell test, just in case? If so, are there any potential side effects?
6) What other treatment options should be considered?
7) I know I've given you very limited information (but it's all I have), what is your best guess that (a) a "boggy and nodular" prostate (or whatever causes a boggy and nodular prostate) will explain my symptoms, and (b) the probability of successful cure after this has been going on for 2 years?
Of course, I will discuss this all the next time I see my Dr., but would appreciate your input beforehand so I'm better prepared for the discussion.
Thank you in advance for your thoughts, and also THANK YOU FOR YOUR PREVIOUS ADVICE!! After travelling down many false paths I am cautiously hopeful that I've finally found the cause of the problem.
Doctor's Answer
by Kevin Pho, MD, Jan 15, 2005 12:00AM
, Jan 15, 2005 12:00AM
To answer your question:
1) A prostate infection can lead to a "boggy" prostate. In addition to the rectal exam, a transrectal ultrasound can be considered to evaluate for this.
2) A digital rectal exam is normally suggested after the age of 40 to look for suspicious masses. A blood PSA test is recommended after the age of 50.
3) A transrectal ultrasound or an MRI would be tests that can further evaluate the prostate.
4) Yes, if negative, there can still be an infection.
5) The side effects of prolonged antibiotic treatment would be emerging resistance of the bacteria to the antibiotic. Whether you need this should be discussed with your physician.
6) I would consider further imaging studies if the current course is non-conclusive.
7) That would depend on what is causing the symptoms. Some kind of prostate infection should be considered.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
1) A prostate infection can lead to a "boggy" prostate. In addition to the rectal exam, a transrectal ultrasound can be considered to evaluate for this.
2) A digital rectal exam is normally suggested after the age of 40 to look for suspicious masses. A blood PSA test is recommended after the age of 50.
3) A transrectal ultrasound or an MRI would be tests that can further evaluate the prostate.
4) Yes, if negative, there can still be an infection.
5) The side effects of prolonged antibiotic treatment would be emerging resistance of the bacteria to the antibiotic. Whether you need this should be discussed with your physician.
6) I would consider further imaging studies if the current course is non-conclusive.
7) That would depend on what is causing the symptoms. Some kind of prostate infection should be considered.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
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