When is a prostate nodule a nodule and do nodules always mean prostate cancer?

a friend is someone who after you’ve made a fool of yourself doesn’t feel you’ve done a permanent job.

Question: I have a 70 yo friend with a strong fam hx of prostate cancer — his father died of it.  Despite a psa of 1.2, he recently had a nodule felt by his family doctor and his urologist on dre, which was followed by a biopsy that was negative — no cancer, and nothing else unusual found.  His urologist told him yearly exams were all he needed at this point.  Would you be more aggressive?  Please explain.

The term “nodule” is used a bit broadly and even I in yesterdays video with Penelope spoke of a nodule in “broad strokes.”

  • A true palpable prostatic cancer nodule of the prostate would most commonly show cancer on biopsy.
  • It is very common for the prostate to have asymmetry and I am sure the doctor or the patient “mis-communicates” exactly what the exam revealed. I could see me telling a patient that I felt something and the patient in turn inferred “nodule.”
  • So..there are nodules or areas of firmness or asymmetry that are not because of cancer. Prostate stones are common and can give the feel of a nodule..but it’s not.
  • Chronic prostatitis and the resultant area of induration or fibrosis would feel like a cancer nodule but the biopsy would be negative and with elements of inflammation.
  • Granulomatous prostatitis does this and I have examined a gland that I was certain it was cancer only to be inflammatory changes of prostatitis.
  • The prostate can have ridges, shelves, prominent ampulla of the vas at the base of the prostate which can all masquerade as prostate cancer.
  • Benign enlargement often times is assymetrical…i.e. doesn’t feel normal but may be “physiologically” normal.

So what to do…?

In the above case the likelihood is that the palpable abnormality was something other than cancer and the negative biopsy is very encouraging. Now that we have a normal PSA, a normal biopsy and a slightly atypical exam the goal is to monitor and consider repeating a biopsy if any of the parameters change. Whether this is done on a six month basis or yearly depends on several factors to include the age and health of the patient, the anxiety mentality, and the comfort level of the urologist. In this case the patient could easily ask his family doctor to get a PSA at six months to assure that it is not changing dramatically and to provide comfort that the plan is adequately checking on things.

Remember medicine is an art not a science…so a lot of what we come up with is a blend of medicine and the interaction of the doctor and patient. I.e an anxious patient might request to be seen twice a year, the more laid back guy once a year or even asked to be returned to his family doctor.

12 Replies to “When is a prostate nodule a nodule and do nodules always mean prostate cancer?”

  1. Hello Dr. McHugh. Posted I just got my prostate biopsy results. On the whole I’m pretty encouraged. The Histopathologic Diagnosis was: “A&B: GLANDULAR HYPERPLASIA WITH CHRONIC PROSTATITIS” which is good however the Clinical Diagnosis was: “BPH, R/O CA”. I think “BPH” is Benign Prostate Hyperplasia however I found out is “R/O CA” means “Rule Out Carcinoma”. I’m not sure what to make of the results. Should I be happy or sad?

    Thanks for your response and advice.

    Martin Wong


  2. I, too, was wondering about this. I just got my TRUS results and the impression was that I have an “Ill to fairly-defined hypoechoic nodular focus in the left central zone. This may be part of the central zone heterogeneity or a true nodule.” Not so conclusive.

    I had a biopsy 8 months ago which was negative for cancer but positive for BPH. My PSA a couple months back was 7 but is down from the 9 I had prior to biopsy. My urologist said that the PSA was due to BPH but to be sure I should get a TRUS. Now I’m not so sure what the next step is. Should I get another biopsy so soon after the last one?

    Any suggestions would be greatly appreciated.

    Thank you.


  3. My GP said he felt a nodule on my prostate during DRE. I will have a PSA in a few days. What is the next step if the psa is low. For the last 6 years it has ranged from 0.2 to 0.6. Of course that is my hope.

    Is a biopsy best practice, with a GP nodule and low PSA? I guess if I have noticeably higher PSA I’m definitely off to the urologist.


  4. there was breast cancer with three sisters, one deceased. Older brother has had two negative
    Biopsies. I have what may be nodules on my prostate. I usually have a low 1.1 -1.5 PSA.
    Last PSA was 4.1. Older brother has had a PSA as high as 9.


  5. I see all these questions but where the hell is some feed back from the doctors? I am 59 healthy with a spot on my prostate. My PSA isnt even 1.0. I do get up to empty baldder x2 nightly. But it is good stream and full bladder. Urine is clear with no microscopic abnormality. Doc has not said biopsy yet and my Anthem may not pay him. I am in the poor section of Anthem insurance. Thanks Obama you bastard for messing up most of America you can, even insurance for regular folks. I got assistance last year as I had Ky Connect O(obama care) This year 2016 I have to pay income tax on the insurance break to the toon of 7,000 to be taxed.I will be so glad when obama is gone gone gone. Jon Van Winkle Owensboro Ky


  6. Am 73 have caclcifications, cysts and nodulations not palpable in my prostate. Nothing on the periphery. Its size is 6x5x4 weighs 70 gramas have a history of infectios and have a high PSA at 11. What to do?


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