What is the clinical significance of a soft, non-tender, and non-distended abdomen with no palpable masses, normal prostate size (approximately 30 grams) on digital rectal examination (DRE), and no abnormalities in the anus, phallus, testicles, or inguinal lymph nodes?

From the Guidelines

The patient's physical examination findings are normal, and no further action is needed based on these findings, though regular screening examinations should continue according to age-appropriate guidelines. The abdomen is soft, nontender, and nondistended without masses or organ enlargement. There is no tenderness over the kidneys and no leg swelling. The prostate is normal sized (approximately 30 grams) without concerning findings, such as induration, palpable mass, or nodules, and the patient denies tenderness on palpation 1. The anus appears normal with good sphincter tone, and the penis is uncircumcised without abnormalities, such as lesions or discharge. The testicles are properly descended without masses or tenderness, and there is no lymph node enlargement in the groin area.

These findings represent a comprehensive normal male genitourinary and abdominal examination without any pathological findings that would require intervention. This type of thorough examination is important for detecting conditions such as hernias, prostate abnormalities, testicular masses, or abdominal pathology that might require treatment. According to the American Cancer Society guidelines, asymptomatic men who have less than a 10-year life expectancy based on age and health status should not be offered prostate cancer screening 1. For men who choose to be screened for prostate cancer after a process of shared or informed decision making, screening is recommended with the PSA test with or without DRE, and a PSA level of 4.0 ng/mL or higher has historically been used to recommend referral for further evaluation or biopsy 1.

However, the patient's current examination findings do not indicate any need for immediate screening or biopsy. The patient should continue to receive regular screening examinations according to age-appropriate guidelines, taking into account their individual risk factors, such as family history, age, and ethnicity 1. It is essential to consider the potential benefits and harms of screening, including the risk of false-positive results, overdiagnosis, and overtreatment, as well as the potential benefits of early detection and treatment 1.

In terms of prostate cancer screening, the European Randomized Study of Screening for Prostate Cancer (ERSPC) and the Prostate, Lung, Colorectal, and Ovarian Cancer Screening (PLCO) Trial have provided valuable insights into the benefits and harms of screening 1. The American Urological Association (AUA) has also issued guidelines on prostate cancer early detection testing, recommending that men ages 55 to 69 years should discuss the benefits and harms of screening with their healthcare provider 1.

Overall, the patient's normal physical examination findings and lack of concerning symptoms or risk factors do not necessitate any immediate intervention or screening. However, regular follow-up examinations and discussions with their healthcare provider about prostate cancer screening and other health concerns are essential for maintaining their overall health and well-being.

From the Research

Physical Examination Findings

• The patient's abdomen is soft, nontender, nondistended, with no masses palpable, no hepatosplenomegaly, and no CVA tenderness 2.
• The patient has no lower extremities edema.
• The prostate is approximately 30 grams, with no induration, no palpable mass, no nodules, and denies tenderness on palpation.
• The anus is intact, with no fissures/lesions noted, no skin tags/hemorrhoids, and good anal sphincter tone.
• The phallus is uncircumcised without lesions or discharge, no urethral meatal stenosis.
• The testicles are descended bilaterally without tenderness, hydroceles or masses.
• There is no inguinal lymphadenopathy.

Benign Prostatic Hyperplasia (BPH) Treatment

• 5-alpha-reductase inhibitors (5-ARIs) are commonly used to treat BPH, as they can reduce the risk of acute retention and BPH-related surgery 3, 4, 5, 6.
• Combination treatments with alpha-blockers and 5-ARIs have been shown to be effective in treating BPH, with acceptable rates of side effects 3, 5.
• 5-ARIs can also be used in combination with other medications, such as phosphodiesterase type 5 inhibitors (PDE5Is), to counteract the negative androgenic sexual side effects of 5-ARIs and combine their synergistic effects on lower urinary tract symptoms (LUTS) 5.

Prostate Size and 5-ARIs

• The patient's prostate size is approximately 30 grams, which may benefit from 5-ARI treatment, as these medications are particularly beneficial for patients with larger prostates (>30-40ml) 5.