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Since carcinoma of the prostate is the third most frequent cause of cancer deaths in men,3 the importance of doing routine rectal examinations in all men more than 40 years old cannot be overemphasized. Normally, the prostate is felt as a bilobar structure with a medial sulcus between the lateral lobes. The lobes are symmetrical, and have the consistency of the end of one's nose when palpated. Any irregularity, nodularity, or increased firmness must be considered as a possible neoplasm until investigations prove it otherwise.
When a suspicious area in the prostate is felt, an abdominal-pelvic roentgenogram and the serum alkaline and acid phosphatase values should be obtained in addition to performing other routine studies. Prostatic infection, calculi, granulomas, and other nonneoplastic lesions may simulate a prostatic carcinoma. The ability of the physician to discern the true nature of the prostatic nodule by rectal examination alone is certainly less
Volk WL, Mebust WK. The Management of the Prostatic Nodule. JAMA. 1969;209(11):1697. doi:10.1001/jama.1969.03160240053013