Diagnostic studies that relate to the male reproductive organs and the ability to participate in sexual activity include the following.
The prostate gland produces a substance known as prostate-specific antigen (PSA). It can be measured in a blood specimen,and levels increase with prostate cancer. Many factors can increase PSA levels, including BPH, prostate cancer, and infections of the prostate and urinary tract. PSA levels are measured in nanograms per milliliter (ng/mL). The PSA test and DRE are used to detect prostate cancer (Smith, Cokkinides, von Eschenbach, et al., 2002).
The range of values considered normal is 0.2 to 4.0 ng/mL. Values over 4.0 are considered elevated. An elevated PSA level is not a specific indicator of prostate cancer. A number of condi-tions (eg, BPH, transurethral resection of the prostate, acute uri-nary retention, and acute prostatitis) can also cause an elevated PSA level in the absence of prostate cancer. Despite these limita-tions, in combination with other procedures, PSA is useful in identifying men at risk and in monitoring patients following treatment for cancer of the prostate (Barry, 2001). A PSA test, along with DRE, is recommended by the American Cancer So-ciety annually for men at high risk, specifically those with a fam-ily history of prostate cancer and for African American men.
Transrectal ultrasound (TRUS) studies may be performed in pa-tients with abnormalities detected by DRE or those with elevated PSA levels. After DRE, a lubricated, condom-covered, rectal probe transducer is inserted into the rectum along the anterior wall. Water may be introduced to the condom to help transmit sound waves to the prostate. TRUS may be used in detecting nonpal-pable prostate cancers and in staging localized prostate cancer. Needle biopsies of the prostate are commonly guided by TRUS.
Specimens of prostate fluid or tissue may be obtained for culture when disease or inflammation of the prostate gland is suspected. A biopsy of the prostate gland may be necessary to obtain tissue for histologic examination. This may be performed at the time of prostatectomy or by means of a perineal or transrectal needle biopsy.
If the patient cannot engage in sexual intercourse to his satisfac-tion, a detailed history is obtained. Nocturnal penile tumescence tests may be conducted in a sleep laboratory to monitor changes in penile circumference during sleep (using a mercury strain gauge placed around the penis); the results help to identify the cause of erectile dysfunction. Arterial blood flow to the penis is measured with the Doppler probe. Nerve conduction tests and psychologi-cal evaluations are also part of the diagnostic workup and are usu-ally conducted by a specialized team of health care providers.
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