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Prostate Pathology Quiz
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Which digital rectal examination finding is most suggestive of prostate cancer rather than benign prostatic hyperplasia?
- A Irregular and hard prostate gland You picked ✓
- B A symmetrically enlarged prostate with a firm, rubbery consistency You picked ✕
- C A small prostate with a palpable midline groove and firm consistency You picked ✕
- D An enlarged prostate with an easily palpable median sulcus and symmetrical lobes You picked ✕
- E A prostate with a fluctuant area and oedematous overlying mucosa You picked ✕
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The answer is A: Irregular and hard prostate gland
Explanation
Why A is correct
See Prostate Cancer. Option A is correct: a hard, irregular prostate on digital rectal examination (DRE, where the examiner feels the gland through the rectal wall with a gloved finger) is the finding most suggestive of prostate cancer. Cancer disrupts the normal glandular structure and makes areas of the gland firm, so the surface feels uneven and sometimes nodular (lumpy). In benign prostatic hyperplasia (BPH, a non-cancerous overgrowth of the prostate) the whole gland grows evenly, so it feels smooth and symmetrical, and the central groove (the sulcus, a shallow midline furrow between the two lobes) is usually still present. In acute bacterial prostatitis the gland is tender. A simple memory aid: smooth means benign, hard and lumpy means cancer until proven otherwise. The examination has limits: findings overlap, and a normal or benign-feeling gland does not exclude cancer, so the result is always read together with the PSA blood test and the history.
- Finding: a hard, irregular prostate on digital rectal examination is the most suggestive of prostate cancer.
- Mechanism: cancer disrupts the normal glandular structure and makes areas of the gland firm, uneven and sometimes nodular.
- In BPH: the whole gland grows evenly, so it feels smooth and symmetrical, and the central groove is usually still present.
- Limit: a normal-feeling gland does not exclude cancer, so read the result with the PSA and the history.
Why the other options are incorrect
- B. A symmetrically enlarged prostate with a firm, rubbery consistency: A firm, rubbery, symmetrical enlargement is the typical feel of BPH; the even overgrowth preserves the gland's elastic, smooth character. It is not the hard, irregular texture that raises suspicion of cancer. Your answer
- C. A small prostate with a palpable midline groove and firm consistency: A small prostate with a palpable midline groove and firm consistency is a normal or benign finding. It does not show the hard, irregular focus that would raise concern for cancer, although DRE cannot exclude a small tumour. Your answer
- D. An enlarged prostate with an easily palpable median sulcus and symmetrical lobes: An enlarged prostate with a preserved median sulcus and symmetrical lobes is the classic BPH pattern. Prostate cancer tends to obliterate the sulcus and cause asymmetrical hard irregularity, so this points away from cancer. Your answer
- E. A prostate with a fluctuant area and oedematous overlying mucosa: A fluctuant area and oedematous overlying mucosa suggest a prostatic abscess or acute prostatitis. These are inflammatory features; prostate cancer on DRE is hard and irregular rather than fluctuant. Your answer
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More questions from this set. Start the quiz to answer them and see each explanation.
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1
Which statement best describes how the Gleason score is calculated in prostate cancer?
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2
A 58-year-old man presents with urinary hesitancy, weak stream and nocturia. Examination suggests benign prostatic enlargement. Which mechanism most directly explains the development of this condition?
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