Is an Enlarged Prostate Boggy and Tender?
No, an enlarged prostate from benign prostatic hyperplasia (BPH) is typically firm and non-tender on digital rectal examination, not boggy or tender. A boggy, tender prostate suggests acute bacterial prostatitis, which is a completely different condition requiring urgent antibiotic treatment.
Key Distinguishing Features on Digital Rectal Examination
Benign Prostatic Hyperplasia (BPH)
- The prostate in BPH is firm, smooth, and non-tender with symmetrical enlargement 1
- The gland may be significantly enlarged (often >30-40g) but maintains a rubbery consistency without tenderness 1, 2
- Patients present with lower urinary tract symptoms (weak stream, frequency, nocturia, hesitancy) but typically without pain 1, 3
Acute Bacterial Prostatitis
- The prostate is boggy, swollen, and exquisitely tender on examination 4
- Patients present with acute symptoms including fever, chills, dysuria, and pelvic/perineal pain 4
- This is an infectious process caused by uropathogens (primarily Gram-negative bacteria) requiring immediate antibiotic therapy 4
Clinical Implications for Diagnosis
When evaluating a patient with an enlarged prostate, the presence or absence of tenderness is critical for determining the underlying pathology:
- Non-tender, firm enlargement → Proceed with BPH evaluation including International Prostate Symptom Score (IPSS), urinalysis, and consideration of PSA testing 1
- Tender, boggy prostate → Diagnose acute prostatitis and initiate appropriate antibiotic therapy immediately; avoid vigorous prostatic massage as this can precipitate bacteremia 4
Common Pitfall to Avoid
Do not assume all prostatic enlargement represents BPH. The physical examination characteristics are fundamentally different between benign enlargement and inflammatory conditions 1, 4. A tender prostate requires urgent treatment for infection, while a non-tender enlarged prostate follows the standard BPH management algorithm with medical therapy (alpha-blockers, 5-alpha reductase inhibitors) or surgical intervention based on symptom severity 1, 2.