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What Causes A Small Pea Sized Swelling In Prostate Gland Surface On DRE?
Question: At the end of December 2015 I had a colonoscopy and the MD reported a nodule on the prostrate about the size of a pea. I just had a DRE and PSA in May of 2015 at a new urologist. Nothing was noted from the DRE and the PSA was 3.04 in May. The prior PSA was XXXXXXX 2013 and was 2.3 at a different lab company. After the report of the nodule from the December 2015 colonoscopy, I got another PSA just 2+ weeks ago. The PSA decreased to 2.31.
I have had occasional prior increases in PSA level and acceleraton that were resolved with taking CIPRO. Apparently I am occassionally susceptible to infections which cause inflamation (however, none detected since 2010) . To be certain, after an increase in PSA to a 4.6 in 2009 with acceleration beyond normal, I had a biopsy in 2009 which was negative. Since that time, my PSA has stayed down between 2 -3 with 7 follow up tests during that time.
Questions:
1) Can a site specific nodule be caused by infection and inflamtaion? I had always assumed the inflamations caused by infections would cause an overall swelling of the prostate; OR could the inflamation cause a site specific swelling that feels like a “nodule”?
2) Since my urologist did not find anything in May, is it possible that this is a fast growing cancer? I know most prostate cancers are slow growing but I understand some are fast growing. Could a fast growing cancer go from nothing perceptible on a DRE in May to become “pea size” in the next 7 months? Note again PSA went down almost a point in those seven months.
Are there other possible explanations for a pea size growth in 7 months time?
I have had occasional prior increases in PSA level and acceleraton that were resolved with taking CIPRO. Apparently I am occassionally susceptible to infections which cause inflamation (however, none detected since 2010) . To be certain, after an increase in PSA to a 4.6 in 2009 with acceleration beyond normal, I had a biopsy in 2009 which was negative. Since that time, my PSA has stayed down between 2 -3 with 7 follow up tests during that time.
Questions:
1) Can a site specific nodule be caused by infection and inflamtaion? I had always assumed the inflamations caused by infections would cause an overall swelling of the prostate; OR could the inflamation cause a site specific swelling that feels like a “nodule”?
2) Since my urologist did not find anything in May, is it possible that this is a fast growing cancer? I know most prostate cancers are slow growing but I understand some are fast growing. Could a fast growing cancer go from nothing perceptible on a DRE in May to become “pea size” in the next 7 months? Note again PSA went down almost a point in those seven months.
Are there other possible explanations for a pea size growth in 7 months time?
Brief Answer:
Very relevant questions.
Detailed Answer:
Hello XXXXXXX and welcome to HCM.
As an Urologist, i can fully understand and share your concern.
You've very common questions, that bug many people with fluctuating PSA levels.
PSA level below 4 is normal.
I'll venture to answer your questions, one by one.
1.A mild form of prostatitis, may cause a pea sized swelling or similar feel, in the prostate gland surface on DRE.
Prostatitis doesn't necessarily result in, generalised swelling of the entire gland.
So, understand that, every pea-sized swelling or nodule isn't a tumor.
2. You're right about prostate gland tumors being slow-growing.
Very few prostate gland cancers are very aggressive.
Pea sized nodule in 7 months, isn't exactly a very slow growing cancer.
Your doubts may be uncalled for, as your PSA, DRE and TRUS will raise the suspicion of a cancer, to be confirmed by a biopsy.
Yes, changes of chronic prostatitis, can cause similar pea sized swellings in 7 months. Again,a clinical examination,including a DRE by an Urologist, only raise this suspicion.
Don't get too anxious and tense about prostate cancer.
Be vigilant and check PSA annually.
Wish you good health.
Very relevant questions.
Detailed Answer:
Hello XXXXXXX and welcome to HCM.
As an Urologist, i can fully understand and share your concern.
You've very common questions, that bug many people with fluctuating PSA levels.
PSA level below 4 is normal.
I'll venture to answer your questions, one by one.
1.A mild form of prostatitis, may cause a pea sized swelling or similar feel, in the prostate gland surface on DRE.
Prostatitis doesn't necessarily result in, generalised swelling of the entire gland.
So, understand that, every pea-sized swelling or nodule isn't a tumor.
2. You're right about prostate gland tumors being slow-growing.
Very few prostate gland cancers are very aggressive.
Pea sized nodule in 7 months, isn't exactly a very slow growing cancer.
Your doubts may be uncalled for, as your PSA, DRE and TRUS will raise the suspicion of a cancer, to be confirmed by a biopsy.
Yes, changes of chronic prostatitis, can cause similar pea sized swellings in 7 months. Again,a clinical examination,including a DRE by an Urologist, only raise this suspicion.
Don't get too anxious and tense about prostate cancer.
Be vigilant and check PSA annually.
Wish you good health.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr Mangat,
Thank you for your thorough reply.
In your opinion, is my upcoming DRE, combined with my 2.0 PSA (lower than before detection of the pea sized nodule), capble of eliminating any concerns of cancer? Or will a TRUS and biopsy be required no matter what the DRE reveals?
At this point with the info I have available as provided to you, what is your percentage estimate of the odds that this could be cancer? Also, what are the odds of a fast growing cancer in this case?
Thank you!
Larry
Thank you for your thorough reply.
In your opinion, is my upcoming DRE, combined with my 2.0 PSA (lower than before detection of the pea sized nodule), capble of eliminating any concerns of cancer? Or will a TRUS and biopsy be required no matter what the DRE reveals?
At this point with the info I have available as provided to you, what is your percentage estimate of the odds that this could be cancer? Also, what are the odds of a fast growing cancer in this case?
Thank you!
Larry
Brief Answer:
Not possible to predict cancer changes in future.
Detailed Answer:
Hi XXXXXXX
A DRE, with elevation of PSA,(above 4 -10), or higher,and TRUS, showing nodule suspicious of cancer, needs a biopsy to confirm cancer.
Otherwise, there's no cause for concern about cancer.
If you don't need to worry about cancer, then why think about it any more.
No human being on earth, doctors included, can predict about, any benign swelling turning cancerous.
Hope you relax now and enjoy life with a positive attitude.
Wish you good health always.
Dr.Matthew J. Mangat.
Not possible to predict cancer changes in future.
Detailed Answer:
Hi XXXXXXX
A DRE, with elevation of PSA,(above 4 -10), or higher,and TRUS, showing nodule suspicious of cancer, needs a biopsy to confirm cancer.
Otherwise, there's no cause for concern about cancer.
If you don't need to worry about cancer, then why think about it any more.
No human being on earth, doctors included, can predict about, any benign swelling turning cancerous.
Hope you relax now and enjoy life with a positive attitude.
Wish you good health always.
Dr.Matthew J. Mangat.
Note: Consult a Urologist online for consultation about prostate and bladder problems, sexual dysfunction, kidney stones, prostate enlargement, urinary incontinence, impotence and erectile dysfunction - Click here.
Above answer was peer-reviewed by :
Dr. Yogesh D
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