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Why is Prostate Size Important?

The DRE
The most basic part of any physical exam performed by the urologist on any male patient is
the trans-rectal examination of the prostate (the Digital Rectal Exam or DRE). As performed
today, the information derived from the DRE is interpreted in both a qualitative and a
quantitative fashion. The physician attempts to identify certain characteristics of the gland that
will aid in formulating both diagnostic and therapeutic criteria. Size, lobular symmetry and
irregularity of consistency, contour and lateral margins are all determined. Of all of these
characteristics, size is probably the single most important for both the physician and the
patient, and the one most difficult to accurately define using current methods (the DRE). The
interpretation of DRE data is extremely subjective making it difficult to compare any changes
that may have occurred over time.

Because the DRE examination is dependant upon a very subjective impression, it does not
provide an accurate basis for periodic comparison and monitoring. Furthermore, recent studies
have shown the DRE to be extremely poorly correlated with actual prostate size,
1
and there is
even greater variability for studies involving multiple examiners.
2
Sensors for Medicines
prostate measurement device adds a quantitative measurement of the palpable surface of the
prostate which has been shown to be a good predictor of total prostatic volume.

Urologists each perform roughly 3,500 DREs annually (the rule is perform a digital rectal
exam every time you see a patient). At the time of the exam, the patient invariable asks his
urologist: Is it bigger? With the accurate size data, the doctor is in a position to answer to this
question.

Prostate Disease Diagnosis and Treatment
Accurate size measurement is very helpful in interpreting PSA: Is it cancer (i.e., is a needle
biopsy required?); or is it normal growth and/or prostatitis/prostate infection/cold medication
that has elevated the PSA level? For BPH (benign prostatic hyperplasia), it is critical in
determining the need for treatment (men at risk), appropriate treatment(s) (i.e., should he be
put on 5-reductase inhibitor therapy, and alpha blocker or both), and for monitoring
treatment efficacy.

A recent study
3
in the J. Urology found that BPH is both predictable and preventable. BPH
disease progression was associated with increasing prostate volume, a concomitant decrease
in urinary flow, and in symptomatic deterioration which can cause major life-style
interference as well as serious clinical complications, e.g., AUR (acute urinary retention),
resulting in surgical interventions (another study
4
correlates the risk of AUR recurrence with
prostate size and thus size drive treatment choice for AUR patients). This recent study found
that the risk of BPH disease progression was directly correlated to prostate size, as well as to
serum PSA (but, in the case of PSA, only after prostate cancer was excluded a
determination more easily said than done especially in an office setting, and one for which
PSAD is particularly useful).

1
Accuracy of Prostate Weight Estimation by Digital Rectal Examination versus Transrectal
Ultrasonography, Stacy Loeb, Misop Han,* Kimberly A. Roehl, Jo Ann V. Antenor
And William J. Catalona. J. Urology 173/63-65, Jan 05.
2
Correlation between Prostate Size Estimated by Digital Rectal Examination and Measured by
Transrectal Ultrasound, Roehrborn et al. Adult Urology 49(4), 1997.
3

Prevention of Benign Prostatic Hyperplasia Disease, Leonard S. Marks, Claus G. Roehrborn and
Gerald L. Andriole. J. Urology 176/1299-1306, Oct 06.
4
Prostate Size Influences the Outcome after Presenting with Acute Urinary Retention, A.S. McNeill,
S. Rizvi, and D.J. Byrne. J. Urology, 175/227-228, Jan, 06.
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Accurate size data is important for determining the appropriate treatment for BPH disease.
Diagnosis and treatment decisions are based on three parameters: 1) unusual topology and
variations in density (indicates potential cancer), 2) size, and 3) urinary symptoms.
5
Drug,
and/or surgical treatments may be appropriate depending on these factors. Once drug therapy
is initiated, prostate size is an important parameter for monitoring its efficacy as well as
patient compliance. If surgical intervention
6
is necessary to relieve symptoms, size
measurement allows the urologist to monitor whether there is re-growth and if so, how much.


5
Determined by a score from the AUA symptom screening questionnaire.
6
e.g., partial resection of the prostate, freezing, microwave therapy or laser treatment
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