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Urology/Why is the prostate ultrasound examination (without biopsy) rare in the diagnosis of the prostatitis and BPH?

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QUESTION: A patient is 50s and has been diagnosed chronic prostatitis and BPH by the CT scan and cystoscopy. A doctor only used the ultrasound to examine the patient residual urine but never ordered the prostate ultrasound examination. I noticed if the ultrasound is ordered, most of them are for the biopsy. Can you explain why the prostate ultrasound examination (without biopsy) is rare in the diagnosis of the prostatitis and BPH?

ANSWER: Ray:

Use of ultrasound and particularly prostatic ultrasound is rare for prostatitis, BPH or prostate cancer because the results are unreliable and it doesn't really help in the diagnosis.  It is, however, very helpful in making sure that when we decide to do a prostate biopsy, that we have adequately checked all the areas of the prostate and didn't leave any location out.

While we can do a reasonably reliable estimate of prostate size by ultrasound, this is not needed in the routine diagnosis or treatment of BPH.

Ultrasound is not helpful at all in diagnosing prostatitis so it isn't used for that either.

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QUESTION: I read the prostate ultrasound can detect the prostate abscess and whether the seminal vesicles is enlarged or not and demonstrate fibrotic areas, calcifications, and cysts as well as the accurate size of the prostate. It is not understanable why the cost effective prostate ultrasound is not popular in the diagnosis of none cancerous prostate disease though it has some advantages in the diagnosis.

Answer
Ray:

It is true that prostatic ultrasound can detect these things, but with the exception of prostatic abscesses (which are quite uncommon), none of the other entities that you mentioned require any treatment.  The bottom line is that prostatic ultrasound is just not that helpful as a diagnostic tool which is a shame since I have one here and I'd love to use it more but it just doesn't help that much and is unnecessary except for doing biopsies where it is critically important

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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