Test: Prostate Palpation

Video Link

Background/Purpose

The prostate gland is a heart-shaped organ whose posterior surface can be palpated through the anterior wall of the rectum. The apex of the prostate, near the anal verge, is the narrowest and most distal extent. The base, or proximal extent, is at the junction of the bladder neck with the prostate.

Procedure

The best position of the patient for digital examination is standing, with the hips flexed 90 degrees, allowing him to lean forward onto an examination table or chair. The legs should be spread wide apart with the toes pointed inward. This position allows maximal relaxation of the anal sphincter and thereby facilitates a thorough but comfortable examination for the patient. In this position gravity pulls the prostate down for easier palpation. If the patient is not able to get out of bed, then digital examination should be done alternatively in the modified lithotomy position. This position is similar to that used for bimanual pelvic examination in a female.

The size and consistency of the entire prostate should be noted along with any focal changes in consistency. A nodule or indurated area suggests carcinoma. The diameter of any abnormal area should be estimated and a drawing made of these findings. The prostate gland should be symmetric with respect to the median sulcus, which is a midline groove on its posterior surface. Any asymmetry, despite normal consistency, is suggestive of carcinoma and warrants further investigation. Except in extremely large prostate glands, the lateral sulcus on each side should be palpable without a change in consistency or depth of the sulcus.

The seminal vesicles and ampulla of the vas deferens are not palpable in their normal state. A mass or area of induration superior to the prostate on digital rectal examination, therefore, warrants further investigation.
Performed: Bilaterally

Dialog

Manual digital palpation of the prostate organ.

Criteria

• Symmetric
• Normal size
• Normal consistency

Measurement

LOINC Code

Scale/Grading

selection range; grade - LOINC ID
Option - Value option selection range; grade - LOINC IDPass ; Pass - Fail ; Fail -