Palpate the Prostate Gland

The prostate gland lies anterior to the wall of the rectum. The size, surface, consistency, sensitivity, and shape of the prostate gland should be assessed.

The prostate is a bilobed, heart-shaped structure approximately 1.5 inches (4 cm) in diameter. It is normally smooth and firm and has the consistency of a hard rubber ball. The apex of the heart shape points toward the anus. Identify the median sulcus and the lateral lobes. Note any masses, tenderness, and nodules. Only the lower apex portion of the gland is palpable. The superior margin is usually too high to reach. The examination of the prostate is illustrated in Figure 17-37. The size of the prostate in relation to the examiner's finger is illustrated in Figure 17-38.

A hard, irregular nodule produces asymmetry of the prostate gland and is suggestive of cancer. Carcinoma of the prostate frequently involves the posterior lobe, which can easily be identified during the DRE. Carcinoma of the prostate is the third leading cause of death in men (9% of all cancer deaths) in the United States. In 2007, there were 218,890 new cases and

Figure 17-34 Technique of the rectal examination. A, Inspection. B, Palpation. The examiner's finger is inserted with the palm of the hand facing downward.

Figure 17-34 Technique of the rectal examination. A, Inspection. B, Palpation. The examiner's finger is inserted with the palm of the hand facing downward.

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