Medical Tests for 

Prostate Problems

National Kidney and Urologic Diseases Information Clearinghouse 

U.S. Department 

of Health and 

Human Services 

NATIONAL 

INSTITUTES 

OF HEALTH 

What is the prostate? 

The prostate is a walnut-shaped gland that 

is part of the male reproductive system. It 

has two or more lobes, or sections, enclosed 

by an outer layer of tissue. The prostate is 

located in front of the rectum and just below 

the bladder, where urine is stored. It surrounds the urethra at the neck of the bladder 

and supplies fluid that goes into semen. 

 

 

Bladder 

Urethra 

Prostate 

Side view of male urinary tract 

What are some common 

prostate problems? 

The most common prostate problem in men 

younger than age 50 is inflammation, called 

prostatitis. Prostate enlargement, or benign 

prostatic hyperplasia (BPH), is another 

common problem. Because the prostate 

continues to grow as a man ages, BPH is the 

most common prostate problem for men 

older than age 50. Older men are at risk for 

prostate cancer as well, but it is much less 

common than BPH. 

What are the symptoms of 

prostate problems? 

The symptoms of prostate problems may 

include 

• urinary retention—the inability to 

empty the bladder completely

• urinary frequency—urination eight or 

more times a day 

• urinary urgency—the inability to delay 

urination 

• urinary incontinence—the accidental 

loss of urine 

• nocturia—frequent urination at night 

• trouble beginning a urine stream 

• weak or interrupted urine stream 

• blockage of urine 

• urine that has an unusual color or odor 

• pain after ejaculation or during 

urination
 

Different prostate problems may have 

similar symptoms. For example, one man 

with prostatitis and another with BPH may 

both experience urinary urgency. Sometimes 

symptoms for the same prostate problem 

differ among individuals. For example, one 

man with BPH may have trouble beginning 

a urine stream, while another may experience nocturia. A man in the early stages of 

prostate cancer may have no symptoms at all. 

Because of this confusing array of symptoms, 

a thorough medical exam and testing are 

vital. 

How are prostate problems 

diagnosed? 

To diagnose prostate problems, the health 

care provider will perform a digital rectal 

exam (DRE). The health care provider will 

also ask the patient 

• when the problem began and how often 

it occurs 

• what symptoms are present 

• whether he has a history of recurrent 

urinary tract infections 

• what medications he takes, both prescription and those bought over the 

counter 

• the amount of fluid he typically drinks 

each day 

• whether he consumes caffeine and 

alcohol 

• about his general medical history, 

including any major illnesses or 

surgeries 

Answers to these questions will help the 

health care provider identify the problem or 

determine what medical tests are needed. 

Diagnosing BPH may require a series of 

medical exams and tests. 

How is a digital rectal exam 

(DRE) performed? 

A DRE is a physical exam of the prostate. 

The health care provider will ask the patient 

to bend over a table or lie on his side while 

holding his knees close to his chest. The 

health care provider slides a gloved, lubricated finger into the rectum and feels the 

part of the prostate that lies next to it. The 

DRE may be slightly uncomfortable, but 

it is brief. This exam reveals whether the 

prostate has any abnormalities that require 

more testing. If an infection is suspected, 

the health care provider might massage the 

prostate during the DRE to obtain fluid to 

examine with a microscope. This exam is 

usually done first. Many health care providers perform a DRE as part of a routine 

physical exam for men age 50 or older, some 

even at age 40, whether or not the man has 

urinary problems. 

Prostate 

Rectum 

Bladder 

2 Medical Tests for Prostate Problems 

Digital rectal exam 
 

What is the first test 

for detecting prostate 

problems? 

The first test for detecting prostate problems 

is a blood test to measure prostate-specific 

antigen (PSA), a protein made only by the 

prostate gland. This test is often included in 

routine physical exams for men older than 

age 50. Because African American men 

have higher rates of getting, and dying from, 

prostate cancer than men of other racial or 

ethnic groups in the United States, medical organizations recommend a PSA blood 

test be given starting at age 40 for African 

American men. Medical organizations also 

recommend a PSA blood test be given starting at age 40 for men with a family history of 

prostate cancer. Some medical organizations 

even recommend a PSA blood test be given 

to all men starting at age 40. 

If urination problems are present or if a 

PSA blood test indicates a problem, additional tests may be ordered. These tests may 

require a patient to change his diet or fluid 

intake or to stop taking medications. If the 

tests involve inserting instruments into the 

urethra or rectum, antibiotics may be given 

before and after the test to prevent infection. 

Why is a prostate-specific 

antigen (PSA) blood test 

performed? 

A PSA blood test is performed to detect or 

rule out prostate cancer. The amount of 

PSA in the blood is often higher in men who 

have prostate cancer. However, an elevated 

PSA level does not necessarily indicate 

prostate cancer. The U.S. Food and Drug 

Administration has approved the PSA blood 

test for use in conjunction with a DRE to 

help detect prostate cancer in men age 50 or 

older and for monitoring men with prostate 

cancer after treatment. However, much 

remains unknown about how to interpret 

a PSA blood test, its ability to discriminate 

between cancer and problems such as BPH 

and prostatitis, and the best course of action 

if the PSA level is high. 

When done in addition to a DRE, a PSA 

blood test enhances detection of prostate 

cancer. However, the test is known to have 

relatively high false-positive rates. A PSA 

blood test also may identify a greater number 

of medically insignificant lumps or growths, 

called tumors, in the prostate. Health care 

providers and patients should weigh the benefits of PSA blood testing against the risks of 

follow-up diagnostic tests. The procedures 

used to diagnose prostate cancer may cause 

significant side effects, including bleeding 

and infection. 

What are additional tests 

for detecting prostate 

problems? 

If the DRE or the PSA blood test indicates a 

problem may exist, the health care provider 

may order additional tests, including urinalysis, urodynamic tests, cystoscopy, abdominal ultrasound, transrectal ultrasound with 

prostate biopsy, and imaging studies such as 

magnetic resonance imaging (MRI) or computerized tomography (CT) scan. 

Urinalysis 

Urinalysis is the testing of a urine sample for 

abnormal substances or signs of infection. 

The urine sample is collected in a special 

container in a health care provider’s office or 

commercial facility and can be tested in the 

same location or sent to a lab for analysis. 

3 Medical Tests for Prostate Problems 
 

If an infection is suspected, the health care 

provider may ask that the urine sample be 

collected in two or three containers during a 

single urination to help locate the infection 

site. After the first collection, the health care 

provider will have the patient stop the urine 

stream for a prostate massage before collecting more urine. If signs of infection appear 

in the first container but not in the others, 

the infection is likely to be in the urethra. If 

the urine contains significantly more bacteria 

after the prostate massage or bacteria are in 

the prostate fluid itself, the infection is likely 

to be in the prostate. 

Urodynamic Tests 

Urodynamic testing is any procedure that 

looks at how well the bladder, sphincters, 

and urethra are storing and releasing urine. 

Most urodynamic tests focus on the bladder’s ability to hold urine and empty steadily 

and completely. If the prostate problem 

appears to be related to urine blockage, the 

health care provider may recommend tests 

that measure bladder pressure and urine 

flow rate. One test involves urinating into 

a special device that measures how quickly 

the urine is flowing and records how many 

seconds it takes for the peak flow rate to be 

reached. Another test measures postvoid 

residual, the amount of urine left in the 

bladder when urination stops. A weak urine 

stream and urinary retention may be signs of 

urine blockage caused by an enlarged prostate that is squeezing the urethra. Some urodynamic tests are performed in a health care 

provider’s office without anesthesia. Other 

urodynamic tests are performed in a health 

care provider’s office, outpatient center, or 

hospital with local anesthesia. 

Cystoscopy 

Cystoscopy is a procedure that allows the 

health care provider to look for blockage 

in the lower urinary tract. A cystoscope is 

a tubelike instrument used to look inside 

the urethra and bladder. After a solution 

numbs the inside of the penis, the health 

care provider inserts the cystoscope through 

the opening at the tip of the penis and into 

the lower urinary tract. By looking through 

the cystoscope, the health care provider can 

determine the location and degree of the 

urine blockage. A cystoscopy is performed 

in a health care provider’s office, outpatient 

center, or hospital with local anesthesia. The 

procedure is usually performed by a urologist, a doctor who specializes in treating 

problems of the urinary tract and the male 

reproductive system. 

Abdominal Ultrasound 

Ultrasound uses a device, called a transducer, that bounces safe, painless sound 

waves off organs to create an image of their 

structure. The transducer can be moved to 

different angles to make it possible to examine different organs. In abdominal ultrasound, the health care provider applies a gel 

to the patient’s abdomen and moves a handheld transducer over the skin. The gel allows 

the transducer to glide easily, and it improves 

the transmission of the signals. The procedure is performed in a health care provider’s 

office, outpatient center, or hospital by a specially trained technician and interpreted by a 

doctor, usually a radiologist—a doctor who 

specializes in medical imaging. Anesthesia 

is not needed. An abdominal ultrasound can 

create images of the entire urinary tract. The 

images can show damage or abnormalities in 

the urinary tract resulting from urine blockage at the prostate. 

4 Medical Tests for Prostate Problems 
 

Transrectal Ultrasound with 

Prostate Biopsy 

Transrectal ultrasound is most often used 

to examine the prostate. In a transrectal 

ultrasound, the health care provider inserts 

a transducer slightly larger than a pen into 

the man’s rectum next to the prostate. The 

ultrasound image shows the size of the prostate and any abnormal-looking areas, such 

as tumors. Transrectal ultrasound cannot 

definitively identify prostate cancer. 

To determine whether a tumor is cancerous, 

the health care provider uses the transducer 

and ultrasound images to guide a needle 

to the tumor. The needle is then used 

to remove a few pieces of prostate tissue 

for examination with a microscope. This 

process, called biopsy, can reveal whether 

prostate cancer is present. A transrectal 

ultrasound with prostate biopsy is usually 

performed by a doctor in a health care provider’s office, outpatient center, or hospital 

with light sedation and local anesthesia. The 

biopsied prostate tissue is examined in a 

laboratory by a pathologist—a doctor who 

specializes in diagnosing diseases. 

Bladder Prostate 

Needle 

Needle 

guide 

Transducer 

5 Medical Tests for Prostate Problems 

Transrectal ultrasound with prostate biopsy 

MRI and CT Scan 

An MRI is a test that takes pictures of the 

body’s internal organs and soft tissues without using x rays. The MRI machines use 

radio waves and magnets to produce detailed 

pictures. An MRI may also involve the injection of dye. A CT scan uses a combination 

of x rays and computer technology to create 

three-dimensional (3-D) images. A CT scan 

may also involve the injection of a dye. MRI 

and CT scan images can help identify abnormal structures in the urinary tract, but they 

cannot distinguish between cancerous tumors 

and noncancerous prostate enlargement. 

Once a biopsy has confirmed cancer, these 

imaging techniques will show how far the 

cancer has spread. MRIs and CT scans are 

usually performed at an outpatient center or 

hospital by a specially trained technician and 

interpreted by a radiologist; anesthesia is not 

needed. For an MRI, light sedation may be 

used for people with a fear of confined spaces. 

What happens after the 

prostate tests? 

Urodynamic tests and cystoscopy may cause 

mild discomfort for a few hours after the procedures. Drinking an 8-ounce glass of water 

every half-hour for 2 hours may help reduce 

discomfort. The health care provider may 

recommend taking a warm bath or holding 

a warm, damp washcloth over the urethral 

opening to relieve discomfort. A prostate 

biopsy may produce pain in the area of the 

rectum and the perineum, which is between 

the rectum and the scrotum. A prostate 

biopsy may also produce blood in urine and 

semen. 

An antibiotic may be prescribed for 1 or 

2 days to prevent infection. Patients with 

signs of infection—including pain, chills, or 

fever—should call their health care provider 

immediately. 
 

How soon will prostate test 

results be available? 

Results for simple medical tests such as some 

urodynamic tests, cystoscopy, and abdominal 

ultrasound are often available soon after the 

test. The results of other medical tests such 

as PSA blood test and prostate tissue biopsy 

may take several days to come back. A 

health care provider will talk with the patient 

about the results and possible treatments for 

the problem. 

Eating, Diet, and Nutrition 

Eating, diet, and nutrition have not been 

shown to play a role in causing or preventing 

prostate problems. 

Points to Remember 

• Common prostate problems are prostatitis and benign prostatic hyperplasia 

(BPH). 

• Prostatitis is the most common prostate 

problem for men younger than age 50. 

• BPH is the most common prostate problem for men older than age 50. 

• Older men are at risk for prostate 

cancer, but it is much less common than 

BPH. 

• Because different prostate problems 

have similar symptoms, diagnosing the 

problem may require a series of medical 

exams and tests. 

• Medical tests to detect prostate problems include prostate-specific antigen 

(PSA) blood test, urinalysis, urodynamic tests, cystoscopy, and abdominal 

ultrasound. 

• If prostate cancer is suspected, transrectal ultrasound with prostate biopsy is 

performed. 

• Some medical tests require no preparation, while others may require changes 

in diet and fluid intake or a stop of 

medications. 

• Some medical tests may be slightly 

uncomfortable. Others cause mild 

discomfort for a few hours after the 

procedure.

• Some medical test results are available 

soon after the test, while other medical test results may take several days to 

come back. 

Hope through Research 

The National Institute of Diabetes and 

Digestive and Kidney Diseases (NIDDK) 

conducts and supports a variety of research 

in diseases of the kidney and urinary tract. 

Much of the research targets disorders of 

the lower urinary tract, including prostate 

problems. The knowledge gained from these 

studies is advancing scientific understanding 

of why prostate problems develop and may 

lead to improved methods of diagnosing and 

treating prostate problems. 

The benefits of prostate cancer screening 

are still being studied. For example, the 

National Cancer Institute is conducting a 

long-term study to determine whether certain 

screening tests reduce the number of deaths 

from prostate, lung, colorectal, and ovarian 

cancers. The DRE and the PSA blood test 

are also being studied to see whether yearly 

screening will decrease the risk of dying from 

prostate cancer. 

Participants in clinical trials can play a more 

active role in their own health care, gain 

access to new research treatments before 

they are widely available, and help others 

by contributing to medical research. For 

information about current studies, visit 

www.ClinicalTrials.gov.

6 Medical Tests for Prostate Problems 
 

 

 

 

 

 

 

 

 

 

For More Information 

American Urological Association Foundation 

1000 Corporate Boulevard 

Linthicum, MD 21090 

Phone: 1–800–828–7866 or 410–689–3700 

Fax: 410–689–3998 

Email: auafoundation@auafoundation.org 

Internet: www.auafoundation.org 

www.UrologyHealth.org 

The Prostatitis Foundation 

1063 30th Street, Box 8 

Smithshire, IL 61478 

Phone: 1–888–891–4200 

Fax: 309–325–7189 

Internet: www.prostatitis.org 

For information about prostate cancer, 

contact the 

National Cancer Institute (NCI) 

NCI Office of Communications 

and Education 

Public Inquiries Office 

6116 Executive Boulevard, Suite 300 

Bethesda, MD 20892–8322 

Phone: 1–800–4CANCER (1–800–422–6237) 

TTY: 1–800–332–8615 

Email: cancergovstaff@mail.nih.gov 

Internet: www.cancer.gov 

Acknowledgments 

Publications produced by the Clearinghouse 

are carefully reviewed by both NIDDK scientists and outside experts. This publication 

was originally reviewed by Steven A. Kaplan, 

M.D., of the Weill Cornell Medical College, 

and Michel A. Pontari, M.D., of the Temple 

University School of Medicine. 

You may also find additional information about this 

topic by visiting MedlinePlus at www.medlineplus.gov.

This publication may contain information about 

medications. When prepared, this publication 

included the most current information available. 

For updates or for questions about any medications, 

contact the U.S. Food and Drug Administration tollfree at 1–888–INFO–FDA (1–888–463–6332) or visit 

www.fda.gov. Consult your health care provider for 

more information. 

7 Medical Tests for Prostate Problems 
 

 

 

 

 

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The National Kidney and Urologic Diseases 

Information Clearinghouse (NKUDIC) 

is a service of the National Institute of 

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(NIDDK). The NIDDK is part of the 

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Established in 1987, the Clearinghouse 

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This publication is available at 

www.urologic.niddk.nih.gov.

U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES 

National Institutes of Health 

NIH Publication No. 12–5105 

January 2012 

The NIDDK prints on recycled paper with bio-based ink.