A transrectal Ultrasound uses sound waves to create an image of the inside the body. It is often used to examine the male pelvic organs. The most common use of ultrasound is to view the prostate gland and screen for prostate cancer.

It is 5-15 minutes outpatient procedure. A small lubricated probe is placed into the rectum this releases sound waves, which creates echoes as they enter the prostate. The echoes that bounce back are sent to the computer which translates the patterns of echoes into a picture of prostate. TRUS is a painless procedure. It is used to feel some tumors in the prostate gland that cannot be detected by DRE. In addition it also helps the doctor to estimate the size of the prostate gland and get a better idea of the PSA density, which helps distinguish BPH from prostate cancer.

Preparation for TRUS:

Prior to TRUS the patient may be asked to have an enema to remove feces and gas from the rectum that might impede the progress of the rectal probe.

TRUS Technique:

The patient traditionally lies on his left side, which is considered a more relaxing position as well allows the easy insertion of the rectal probe. After the probe is inserted into the rectum, the tester adjusts the console on the ultrasound machine to a baseline for the echoes of the normal prostate tissues, which will serve as a standard by which other tissues will be classified. Imaging is usually begun at the base of the bladder and then the probe is rotated to provide a full picture of the prostate.

The rectal probe that sends sound waves to the prostate gland helps bounce back echoes from both normal and abnormal tissues that are relayed on the computer.

  • Isoechoic areas, which represent normal tissue echo the same amount of sound waves as they received.
  • Hypo echoic areas sent back lesser echoes than they have received, indicating the presence of cancer.
  • Hyper echoic areas sent back significantly more echoes than they received indicating the presence of prostatic calcifications or tiny stones in the prostate. They are harmless unless infected.
  • PSA DENSITY, the blood PSA level divided by the size of the prostate as determined by TRUS helps in distinguishing between BPH and prostate cancer.

Prostate- Specific Antigen (PSA) is a protein produced in the cells of the prostate gland. The PSA test measures the level of PSA in the blood. PSA produced in the body can be used to detect disease. That is why it is sometimes called biological maker or tumor mark.

It is normal for men to have low PSA in their blood; however prostate cancer or benign conditions can increase the level of PSA in the blood. The most frequent benign prostate condition is Prostatitis inflammation of the prostate and benign prostate hyperplasia (BPH) – enlargement of prostate.

Why is PSA test performed?

The use of PSA test help doctors detect prostate cancer in men of 50years and above of age who have no symptoms? However a single elevated PSA does not confirm prostate cancer.

Men who are receiving hormone treatment for prostate cancer may have low PSA level during treatment.

For whom the PSA test may be recommended?

Doctors advise PSA test for men above 50. However the benefits and risks of the screening test are discussed first by the doctor with the patient.

How are PSA test results reported?

PSA test results are reported as nanograms per milliliter (ng/mL) of blood. There is no specific normal or abnormal PSA level. Patients have been detected with prostate cancer even with PSA level as low as 4.0ng/mL PSA level increases with age. Continuous increase in PSA level is an indication of prostate cancer.

What if screening test results show elevated PSA level? :

If screening test results show elevated PSA levels, doctors recommend repeated PSA level test and DRE to confirm prostate cancer.

What if the PSA level keeps rising during treatment for prostate cancer?

If the rise in PSA levels is accompanied with abnormal DRE results doctors recommend further treatment. Only a rise in PSA levels while a treatment is not something abnormal.

Limitation of PSA level test:

PSA level test can detect small tumor. But this does not reduce the man’s chance of dying from cancer. The test does not help fast growing aggressive cancer that has already spread in other parts of the body. False positive test results occur when PSA level is elevated but no cancer is detected. The test therefore faces controversy.

The prostate biopsy is taking tissue samples from the prostate gland and examining it under the microscope for cell differentiation. Cancerous cells are shaped and arranged differently than healthy cells. The more differentiated the cancerous cells are from the healthy cells the more aggressive the cancer .If no cancerous cells are reveal through the biopsy, it means either the patient does not have cancer or the biopsy missed the tumor. 75% of men report negative primary biopsy report.

Before the Prostate biopsy:

Before undergoing biopsy the patient has to take antibiotics to reduce the risk of infection after prostate biopsy. He should also stop taking anti-inflammatory drugs such as aspirin or ibuprofen that may increase the risk of bleeding after biopsy. Finally the doctor may also order an enema before biopsy to remove feces and gas from the rectum that may complicate the process of transrectal biopsy.

Types of Prostate biopsies:

There are three types of prostate biopsies – transrectal, transurethral and transperineal. The transrectal biopsy is guided by transrectal ultrasound through the anus into rectum. The transurethral biopsy is performed with a lighted cytoscope up through the urethra so that the doctor can look directly at the prostate gland. The transperineal biopsy collects the tissue through a small incision in the perineum.

Transrectal Prostate Biopsy

In this biopsy the patient may experience a small amount of bleeding from the rectum after the biopsy. The process uses spring loaded needles to collect the sample tissues.

Transperineal Prostate Biopsy:

Patients opting to undergo the transperineal biopsy may be put under general anesthesia if they wish to be unconscious during biopsy. The patient may experience some tenderness and blood in the semen for one or two months after biopsy.

Transurethral Prostate Biopsy:

In this kind of biopsy the cytoscope is inserted into the urethra. Local anesthesia is given to numb the area. Doctors look directly at the prostate through the cytoscope and insert a cutting loop to extract tissue.

Side effects of Prostate Biopsy:

Though minimal pain is associated with prostate biopsy, men may experience blood in their urine and semen after the test.  Soreness and groggy feeling may also be experienced, for which the patient may need an attendant to be driven home. Repeated test has to be conducted if the tumor is small.

Doctors use the Digital Rectal exam as a relatively simple test to check the prostate. As prostate in an internal organ, it’s not possible for the doctor to see it from outside. It lies in front of the rectum and the doctors can see it by inserting a gloved finger into the rectum.

Who should get a Digital Rectal Exam?

For most men at an average risk screening is started at the age of 50. However men with a family history of prostate cancer can start their test at an early age say from the age of 40, with the schedule of follow up test to be decided individually.

What happens during Digital Rectal Exam?

The doctor inserts a gloved finger into the rectum and feels the prostate for hard, lumpy or abnormal areas. The test takes only a few minutes.

The patient feels slight discomfort during the test, with no significant pain and damage to the prostate.

What happens after the Digital Rectal Exam?

The patient may go about with his normal activities. Only if any kind of lump or abnormality is detected during the examination, or if the patient’s PSA level is elevated, he may be asked to go for an Ultrasound guided Biopsy.

The ‘Digital Rectal Exam’ is an examination of the lower rectum. The doctors first examine the outside of the anus for ‘hemorrhoids or fissures’. Inside the rectum a latex glove and lubricated finger is inserted.

The patient is asked to relax himself by taking deep breath during the insertion of the finger into the rectum by the doctor.

Why the test is performed? :

The test is performed by doctors not only to test any kind of abnormalities in the prostate gland but also to make sure that nothing is blocking the rectum before inserting any instrument; if at all surgery is required to remove the prostate cancer cells.

Results of the test:

A normal result means the doctor has not detected any problem during the test. An abnormal result may be due to:

  • A prostate problem such as prostate enlargement or prostate cancer.
  • Bleeding in gastrointestinal tract.
  • Tumor of rectum
  • Other problems within the rectum.

This is first preliminary test for prostate cancer, but before the test doctors always discuss the benefit and risk factors.

The presence of blood in the urine or hematuria is a condition in which, the urine appears red because of the presence red corpuscles (red blood cells) in the urine. The presence of blood in the urine can be caused by problems in the kidney or diseases of the urinary tract (ureteres, urinary bladder, uretra). In the presence of blood in urine (pink color) must carry out a consultation with a urologist to rule out kidney tumors, bladder or prostate.

Why blood may appear in urine?

This may be due to multiple benign and malignant diseases. The most important causes of hematuria are:

  • Bladder Tumors
  • Ureteral or kidney stones
  • Kidney tumors
  • Prostate Diseases
  • Idiopathic (no cause is found)

How serious is hematuria?

It is serious but, it depends on the disease that produces it. Thus, it is important that a person immediately seeks medical advice when blood appears in the urine, so that its root cause can be determined. The treatment of hematuria is purely dependant on diagnosis of its cause.

What should I do if my urine is pink?

You should see an urologist as he or she will tell you the appropriate tests to arrive at an accurate diagnosis and will treat the disease that causes the hematuria.

What tests will be conducted?

Urology institutes are experts in the diagnosis and treatment of hematuria. Initially they will give you a good history and physical examination. Depending on the findings of the tests, they will then prescribe a treatment which will help in curing the root cause of the disease.

In most cases make plain radiography, ultrasound and a blood and urine tests are enough to determine the causes of hematuria, but in certain cases, additional tests may be required.

How is hematuria treated?

Treatment depends on the cause or the disease that causes hematuria. If the tests indicate the presence of a tumor in the bladder, doctors must perform a procedure to remove the tumor through the passage of urine. It is called transurethral resection (TUR) and is performed under regional anesthesia and involves inserting a small device through the urethra to remove the tumor without open surgery.

If they discover a tumor in the kidney, the treatment option will be surgery. If the tumor is small they can remove the tumor and preserve the kidney. If your urine is pink, you should immediately consult an expert urologist.

Human Papilloma Virus (HPV) infection is the most common sexually transmitted infection (STI) in the genital areas of males and females during vaginal, anal sex, oral sex and genital-to-genital contact. It can be passed on between straight and same-sex partners—even when the infected partner has no signs or symptoms.

There are more than 40 HPV types. The mouth and throat are mostly infected. Most people unaware of it even they have it.

Signs and Symptoms

Mostly the body’s immune system clears HPV naturally within two years.  But uncleared HPV can cause different symptoms and health problems:

Genital warts

A small bump or group of bumps appears in the genital area in small or large, raised or flat, or shaped like a cauliflower. Warts can appear within weeks or months after sexual contact with an infected partner. Genital warts might go away, remain unchanged, or increase in size or number if left untreated. They will not turn into cancer.

Recurrent Respiratory Papillomatosis( RRP)

Rarely warts grow in the throat, block the airway, and cause a hoarse voice or troubled breathing.

Other HPV-related cancers

These are less common but serious cancers and not visible until they are advanced and hard to treat which include cancers of the vulva, vagina, penis, anus, and oropharynx (back of throat including base of tongue and tonsils).


Certain Pap test findings of HPV tests can be used for women at certain ages for cervical cancer. There is no general / approved test for men or women to check one’s overall “HPV status”.

Preventions & Recommendations

  • Genital warts:  Protecting by vaccine (Gardasil)
  • Cervical Cancer:  Preventing women by Cervarix and Gardasil vaccines, routine cervical cancer screening and follow-up of abnormal results.
  • Anal Cancers:  Protecting female and male by Gardasil vaccine. Screening is not routinely recommended since it needs more information.
  • Penile Cancers: No approved screening test to find early signs.
  • Oropharyngeal Cancers: No approved screening test to find early signs
  • RRP: Cesarean delivery is not recommended for women with genital warts to prevent juvenile-onset RRP (JORRP) in their babies. Because it is not sure that prevents JORRP in infants and children.

Testicular Pain in males is a sensitive issue. There are varied causes of this disorder. It is necessary for the patient to consult a health expert and find out the appropriate cause and get treated accordingly.

The affected individual may experience any of the following symptoms:

  • Swelling, tenderness, or redness of the testicles and scrotum
  • Nausea and vomiting
  • Fever
  • Painful urination or penile discharge
  • Pain with sexual intercourse, pain with ejaculation, or blood in the urine or semen

The causes of the “acute scrotum” or testicular pain include:

Testicular torsion:  This is a common cause of acute scrotal pain in young men (though more classically seen in the pediatric population).  This is due to inadequate fixation of the testis to the tunical vaginalis via the gubernaculum testis.  The testis may twist, squeezing off blood flow in the spermatic cord, eventually causing ischemia.

Epididymitis: A common cause of acute scrotal pain in adults.  This can be infectious or non-infectious.  Given the patient’s recent trauma, non-infectious epididymitis would be more likely.  This is thought to occur due to reflux of urine, which then causes a chemical inflammation.  This may be prompted by prolonged periods of sitting or vigorous exercise (such as heavy lifting), though may also occur after local trauma.

Torsion of testicular appendage:  The appendix testis is a small vestigial outpouching on the anterosuperior part of the testis.  This can twist upon itself and is a common cause of testicular pain in the pediatric population.

Trauma causing hematocele, intratesticular hematoma, or rupture:  This usually occurs after severe trauma (direct blow or straddle injury, causing testicle to become compressed against pubic bones).  A hematocele occurs when blood accumulates within the tunica vaginalis; you can also get a bruise within the testicular parenchyma known as an intratesticular hematoma.  Finally, there can be disruption of the testicular capsule (tunica albuginea) causing rupture.

There are various tests like blood tests, urinalysis, testicular ultrasound etc to detect the problem.  Depending on the cause of the pain, treatment is prescribed to the patient.  Various antibiotics and pain killers help the patient to overcome testicular pain.


The liver, located in the right upper portion of the abdominal cavity just beneath the right side of the rib cage, has many vital functions. Briefly, some of these functions are:

  • Detoxification of blood
  • Production of important clotting factor and other important proteins
  • Metabolizing (processing) medications and nutrients
  • Processing of waste products of hemoglobin
  • Storing of vitamins, fat, cholesterol, and bile
  • Production of glucose

In general, liver blood tests are used to detect an injury or an inflammation to the liver. These tests are commonly ordered and performed in many situations, such as in routine health screening, evaluation of abdominal pain, or suspected liver disease. The liver blood tests are typically done as a part of the comprehensive metabolic panel which also includes electrolyte levels and kidney function.

Liver blood tests are some of the most commonly performed blood tests. These tests can assess liver functions or liver injury. An initial step in detecting liver damage is a simple blood test to determine the presence of certain liver enzymes (proteins) in the blood.

Under normal circumstances, these enzymes reside within the cells of the liver. But when the liver is injured for any reason, these enzymes are spilled into the blood stream. Enzymes are proteins that are present throughout the body, each with a unique function. Enzymes help to speed up (catalyze) routine and necessary chemical reactions in the body.

Among the most sensitive and widely used liver enzymes are the aminotransferases. They include aspartate aminotransferase (AST or SGOT) and alanine aminotransferase (ALT or SGPT). These enzymes are normally contained within liver cells. If the liver is injured or damaged, the liver cells spill these enzymes into the blood, raising the enzyme levels in the blood and signaling liver disease.

The main values measured in liver blood tests are the aminotransferases (alanine aminotransferase or ALT and aspirate aminotransferase or AST). The other measurements include alkaline phosphate, albumin, and bilirubin. It is important to note that these tests are commonly referred to as “liver function tests”, but this term is misleading as the aminotransferases and alkaline phosphatase do not reflect the function of the liver. Strictly speaking, the true liver function tests (LFT’s) include albumin, bilirubin, blood coagulation panel, and glucose.

More specifically, AST, ALT, and alkaline phosphatase are called the liver enzymes and they typically are used to detect damage or injury to the liver (not its function)

AST (SGOT) is normally found in a variety of tissues including liver, heart, muscle, kidney, and brain. It is released into the serum when any one of these tissues is damaged. For example, its level in serum rises in heart attacks or with muscle disorders. It is therefore, not a highly specific indicator of liver injury as it can occur from other injured tissues.

ALT (SGPT) is, by contrast, normally found largely in the liver. This is not to say that it is exclusively located in liver, but that is where it is most concentrated. It is released into the bloodstream as the result of liver injury. Thus, it serves as a fairly specific indicator of liver status.

Abnormal liver tests may be detected in the blood in a variety of liver conditions:

  • Mild to moderate elevations of the liver enzymes are common.
  • Chronic hepatitis B and hepatitis C is a cause of chronic mild to moderate liver enzyme elevations.
  • Chronic and acute alcohol use is also a common cause of abnormal liver tests.
  • Some medications can cause mild to moderate increase in the liver enzymes.

A monospot test is a blood test that is used to help diagnose mononucleosis, also known as “mono. It is frequently ordered along with a CBC (complete blood count). The CBC is used to determine whether the number of white blood cells (WBCs) is elevated and whether a significant number of reactive lymphocytes are present.

The test works by detecting certain proteins called heterophile antibodies. The body makes these proteins to fight the Epstein-Barr virus (EBV) or cytomegalovirus (CMV) — the two viruses that cause mono.

A strep test may also be ordered with the mono test to determine whether a person’s sore throat is due to strep throat, a streptococcal infection instead of or in addition to mononucleosis.

If the mono test is initially negative, the doctor still suspects mono, he may order a repeat test in a week or so to see if heterophile antibodies  have developed and/or order one or more EBV antibodies to help confirm or rule out the presence of a current EBV infection.

Additional tests that can help your doctor make a mononucleosis diagnosis include:

  • A complete blood count (CBC) to see if your blood platelet count is lower than normal and if your lymphocytes (lymph cells) are abnormal
  • A chemistry panel to see if your liver enzymes are abnormal.

Epstein-Barr virus test is a blood test to detect antibodies to the Epstein-Barr virus (EBV) antigens. Blood is typically drawn from a vein, usually from the inside of the elbow or the back of the hand. The site is cleaned with germ-killing medicine (antiseptic). The health care provider wraps an elastic band around the upper arm to apply pressure to the area and make the vein swell with blood.

Epstein – Barr virus (EBV) antibodies are used to help diagnose Mono if you are symptomatic but have a negative Mono test. The Centers for Disease Control and Prevention (CDC) recommend ordering:

  • Viral capsid antigen (VCA)-IgM, VCA-IgG and D early antigen (EA-D) — to detect a current or recent infection
  • VCA-IgG and Epstein Barr nuclear antigen (EBNA) — to detect a previous infection

In pregnant women with symptoms of a viral illness, one or more of these EBV antibodies may be ordered along with tests for CMV, toxoplasmosis, and other infections (sometimes as part of a TORCH screen) to help distinguish between EBV and conditions that may cause similar symptoms.

Occasionally, a VCA-IgG or other EBV antibody may be repeated 2-4 weeks after the first test, either to see if a test changes from negative to positive or to measure changes in antibody concentrations to see if they rise or fall.

A VCA-IgG test, and sometimes an EBNA test, may be ordered on an asymptomatic patient to see if that person has been previously exposed to EBV or is susceptible to a primary EBV infection. This is not routinely done, but it may be ordered when a patient, such as an adolescent or an immune compromised patient, has been in close contact with a person who has Mono.