Left Prostate Nodule Found During Exam: Is Cancer a Concern?

There is a hard mass on the left side during digital rectal examination, and the PSA level is normal?

Hello doctor, I previously had aseptic prostatitis, and whenever I accidentally ate something too spicy, I would experience symptoms including a tight, heavy feeling in the perineum extending to the area around the anus, along with burning sensations in the urethra and incomplete urination.
This time, I have the same symptoms, but during a digital rectal examination, the doctor noted a hard lump on the left side of the prostate.
Two years ago, my PSA was 0.9, and this time it was 0.89.
The doctor has prescribed medication for urinary tract relief and advised monitoring the symptoms.
Could this be a sign of cancer? Thank you.

Wallace, 30~39 year old female. Ask Date: 2023/04/23

Dr. Li Xinyi reply Urology

Basically, it resembles a phenomenon of fibrosis following inflammation, and the likelihood of cancer is very low.
However, no doctor can provide an absolute guarantee; a definitive diagnosis requires a biopsy.
If a biopsy is not performed, careful monitoring in an outpatient setting can be considered.

Reply Date: 2023/04/23

More Info

When a left prostate nodule is found during an examination, especially in a patient with a history of non-bacterial prostatitis, it raises important questions regarding the potential for prostate cancer. Your previous PSA levels of 0.9 and 0.89 are considered low, as normal PSA levels are typically below 4.0 ng/mL, although this threshold can vary based on age and other factors. The stability of your PSA levels suggests that there may not be an aggressive process occurring, but it does not completely rule out the possibility of cancer.

The presence of a hard nodule in the prostate can be concerning, as it may indicate a variety of conditions, including benign prostatic hyperplasia (BPH), prostatitis, or prostate cancer. Given your history of non-bacterial prostatitis, it is possible that the nodule is related to inflammation or scarring from previous episodes. Inflammation can lead to changes in the prostate tissue, which may present as hard nodules.

To determine whether the nodule is cancerous, a biopsy is often necessary. While imaging studies such as ultrasound or MRI can provide additional information about the prostate and the nodule's characteristics, they cannot definitively diagnose cancer. A biopsy involves taking a small sample of tissue from the prostate to be examined under a microscope for cancer cells. This is the gold standard for diagnosing prostate cancer.

Your doctor’s decision to start you on medication for urinary symptoms and to monitor your condition is a reasonable approach, especially given the low PSA levels. However, it is essential to maintain close follow-up and consider further evaluation, such as a biopsy, if there are any changes in your symptoms or if the nodule shows signs of growth or other concerning features.

In summary, while the presence of a hard nodule in the prostate can be alarming, it does not automatically indicate cancer, especially in the context of stable PSA levels and a history of prostatitis. Continuous monitoring and possibly a biopsy will provide clarity on the nature of the nodule. It is crucial to have open communication with your healthcare provider about your concerns and the next steps in your evaluation and management.

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