Prostate matters is a not for profit organisation committed to providing free information about prostate issues from leading Clinical Authorities.

Stockholm 3 – What to do if you have an equivocal test result

Mr Alan Doherty Copnsultant Urological Surgeon

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If you are visiting this page, the results of your Stockholm 3 test are equivocal with further information on prostate gland volume and/or from a  DRE (Digital Rectum Examination) being required.

The first thing to say is to try not to be anxious, you have time to consider your options.

The first thing you need is for your GP to refer you to either your local NHS Trust Urology department or a private urologist to determine your prostate volume and perform a DRE. Any urology department can do this.

However, In all cases there is an an initial obstacle in the NHS you need to overcome, which is you need a referral via your GP.  Your GP will probably never have heard of Stockholm 3, he or she will be used to referring patients based on PSA results. To overcome this obstacle we have developed a pro forma letter to your GP in word which you can edit to add the GP and your name and present to him or her along with your Stockholm 3 results.

At this stage your risk is unclear so you do not have to make the decision as to which NHS Trust or private urologist you wish to be referred to if you need to go on the prostate cancer diagnostic pathway.

Information on prostate volume or a DRE to determine risk

Let us deal with this case of requiring further information on prostate volume.

One of the things that Stockholm 3 considers is  the level of prostate-specific antigen (PSA) in your blood. However, what really matters is your PSA density. Say your PSA was 3.8ng/ml but your prostate volume was 60ml. In that case your PSA density would be low and your overall Stockholm 3 prostate cancer risk would be relatively low. However if your prostate volume was small, say 30ml, then your PSA density would be high and this combined with the other risk factors, would tip you into the high risk of prostate cancer category. Click the link to see an example report for this case:

What does a DRE involve?

The doctor or nurse will ask you to lie on your side on an examination table, with your knees brought up towards your chest. They will slide a finger gently into your back passage. They’ll wear gloves and put some gel on their finger to make it more comfortable.

What do DRE results mean

Your prostate may feel:

  • normal –  Prostate volume typically increases from 24 cc at the age of 50–54 years to 38 cc at the age above 75 years. So Stockholm 3 risk score will depend on the volume cut off you have been given.
  • larger than expected for your age – which means your PSA density is low and your Stockholm 3 prostate cancer risk is also low.
  • hard or lumpy – this could be a sign of prostate cancer and indicates high risk of prostate cancer.

The DRE is not a completely accurate test which is why the local NHS Urology department or private urologist will want to determine prostate volume.

Determining prostate volume using ultrasound

Typically this is a rectal ultrasound where a  small probe called a transducer  is about the size of a finger, is placed into your rectum, From the ultrasound images the stenographer measures the following to determine prostate volume.

• Length (L): can be obtained by measuring the longitudinal diameter between the urinary bladder and the proximal external sphincter.
• Width (W): can be obtained by calculating the maximal transverse diameter at the midgland level of the prostate.
• Height (H): is the prostate’s anteroposterior diameter, and can be found on either the axial or sagittal planes.


The prostate volume or DRE calculation can determine and clarify your prostate cancer risk

What to do if the prostate volume results and or DRE indicate a high risk of prostate cancer

If it transpires that following these tests that you are high risk, come back to prostate matters and visit these pages, links below, which will explain both your NHS and private options. Always remember you do not have to stay with your local NHS Trust or initial private urologist. How to be referred to the Urologist of your choice, either in the NHS or privately is explained in the pages below.

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