Clinical features

Clinical features

Prostatic calculi are usually symptomless, being discovered on TRUS, on radiography of the pelvis, during prostatectomy or associated with carcinoma of the prostate or chronic prostatitis. In cases associated with severe chronic prostatic infection, the associated fibrosis and nodularity are di ffi cult to di ff erentiate - from carcinoma. On radiographs or ultrasound scans, these stones are often seen to form a horseshoe ( Figure 84.13 ) or a circle. It is postulated that they are associated with BOO.

Figure 84.13 Endogenous prostatic calculi.

Clinical features

Only advanced disease gives rise to symptoms, but even advanced disease may be asymptomatic. Symptoms of advanced disease include: /uni25CF BOO; /uni25CF pelvic pain and haematuria; /uni25CF bone pain, malaise, ‘arthritis’, anaemia or pancytopenia; /uni25CF renal failure; /uni25CF locally advanced disease or even asymptomatic metastases, which may be found incidentally on investigation of other symptoms. Early prostate cancer is asymptomatic and may be found: /uni25CF incidentally following TURP for clinically benign disease (T1a and b); /uni25CF T1c – because of serum PSA screening; /uni25CF as a nodule (T2) on rectal examination. Summary box 84.7 The presentation of men with prostate cancer /uni25CF /uni25CF

Figure 84.15 Transrectal ultrasound scan of a T2 nodule in the pros

tate. Often men are asymptomatic and detection is by opportunistic PSA testing Cancer is detected in men describing LUTS or may present with symptoms of metastatic disease