Jul
7
EXAMINATIONS TO CONFIRM BPH
The first exam will be the digital one. Since the prostate is right next to the rectum, it can be palpitated. In this slightly uncomfortable digital exam, the doctor is checking to see if your prostate feels enlarged. He is also finding out if there are any hard spots or lumps or nodes on the two lobes he can touch.
The healthy prostate is smooth, elastic and about the size of a walnut. If there is BPH, the prostate will still feel about the same way but it will be obviously enlarged.
Most urologists say that a digital examination can’t confirm 100 per cent the presence of BPH. They point out, however that with such an exam showing the prostate is soft and rubbery, that there is an enlargement outward of two of the prostate lobes, and that the patient reports three symptoms of BPH, there is sufficient evidence to diagnose BPH.
In the fast paced routines in many HMO’s these days, a patient with these workups may very well be told he has BPH, be shown a video tape concerning the problem, and be told what to do to make living with the condition easier.
He’ll be told that in the early stages of BPH, a patient is not a good candidate for surgery or other regular treatment. Rather he will be put on a “maintenance” program where he is checked by a urologist yearly for any progress of the condition.
Many doctors and urologists say this is the proper course of care. They show histories of men in their fifties who have been on maintenance care for ten, even fifteen years before the prostate enlarged to such a point that surgery or one of the new treatments was necessary.
Another test your urolgist may make is a peak flow test. This can be done with an instrument that will record the flow much as the charts below show.
The first chart shows a more or less normal rate of flow with a peak about half way through and stopping quickly. The lower chart shows a much weaker flow and over twice to three times the length of time. This usually means some serious blockage in the urethra and the urologist will want to follow up with other tests.
Some urologists use a stop watch and a timed urination into a glass to approximate the same results.
25 ml/s Flow Rate
Results of UROFLOWMETRY
T100 17 s
TO 17 s
TOmax 7 s
Qmax 24.0 ml/s
Qave 14.1 ml/s Vcomp 247 ml
0 10 20 s
25 ml/s Flow Rate Results of UROFLOWMETRY
I
T100 60 s
TO 51 s
TQmax 8 s
Qmax 10.2 ml/s
Qave 4.1 ml/s Vcomp 211 ml
I T I
10 20 30 40 50 60 70 s
ARE ANY OTHER TESTS AVAILABLE?
Yes, there are several other tests that urologists can use with the prostate. Some of these are used when prostatic cancer is suspected.
However, since some ten percent of all surgery done to relieve BPH results in finding early stages of prostatic cancer development, some men ask for additional tests. They want to make sure that their prostate is not cancerous as well as having BPH.
These tests in effect become Negative Testing, to assure the patient that there is no cancer in the prostate lobes that can’t be felt by the digital exam.
One of these routines is a simple blood test called the prostate specific antigen (PSA) test. If this test shows an elevation of the antigen, it is a positive factor that cancer possiblyy is present in the prostate. A companion test, the PAP test for prostatic acid phosphatase, may show if the cancer has spread outside the prostate to other parts of the body.
A biopsy could be performed on the prostate, but it would be done only if the doctor found hard lumps and suspected spots on the outer lobes when he examines them digitally.
ULTRASOUND TESTING
One of the newer tools of the urologist is the use of ultrasound. This is sometimes called sonography. It simply uses high-frequency sound waves to examine a specific part of the body and make a record of it.
The record can be a sonogram on special film or on paper, or the whole process can be recorded on video tape for critical examination later, and as a record for comparison later of any growth or changes or condition of the examined areas.
The test is quick, simple and painless. A wand instrument called a transducer is passed back and forth over the area being examined. The wand transmits sound waves that are echoed back to it much like a radar does.
The echoes are electronically transmitted to the recording or viewing device.
When examining the bladder and prostate with ultrasound, the bladder needs to be full of urine. Then the test is repeated after the man has urinated to see what urine remains in the bladder.
Ultrasound is becoming more and more popular with urologists and most hospitals have it available. Many urologists now have ultrasound capability as a part of their office equipment for use when needed.
Another use of the ultrasound system is called a transrectal probe. It can be used in conjunction with a surface sonogram.
Many urologists recommend the transrectal. In this test a probe, covered with a rubber balloon which is then filled with water, is inserted into the rectum. This creates an ultrasonic image of the prostate and bladder area that can be recorded and at the same time viewed on a screen.
Some urologists say the transrectal sonogram will show many false leads that are not really cancer. Others say it is a fine method to determine if there is an area that seems to be a cancer and calls for more investigation.
MAGNETIC RESONANCE IMAGING
MRI is an expensive testing method that is painless and quick and can produce a three-dimensional cross section of any part of the body. Users say it is even more detailed than the images produced by a CAT scan.
This test is non-invasive and has no radiation. It uses radio waves in a magnetic field to produce the picture. This test is almost always done in a large hospital.
These days, all testing is expensive. If you have the three-symptom case of BPH, and the digital examination has led to a diagnosis by the physician that as far as he can feel there is no sign of cancer, then it is up to you to decide if you wish to have any more tests to prove to yourself that you are cancer free. Some of these tests, such as ultrasound, are not covered by some of the insurance companies.
One patient was adamant about receiving more tests. He had the three symptom BPH, felt fine, but had a friend who was dying of prostatic cancer. It was well worth it to him to have a $200 sonogram taken that showed no noticeable sign of cancer in his prostate. He was still concerned about the 10 percent of BPH surgery that reveals prostatic cancer. His doctor pointed out to him that such surgeries were performed at a much later point in life than he was. The doctor also said that such BPH problems were much farther developed and had been growing for a greater length of time than his had.
He understood the logic of the urologist. He had been living with his BPH for only about five years. He left the office but a week later called for another appointment. When he came in he said he wanted to take the two blood tests that could reveal the presence of cancer in the prostate, the PAP and PSA tests. Both were made and both showed up negative. Another sign that he did not have prostatic cancer.
The patient was now convinced. He told the urologist that he was not showing disrespect for his qualifications or his skills, but he wanted a little more assurance that he didn’t have cancer than the simple digital examination by the doctor.
Jul
7
WHAT IS MY PROSTATE? THE GENITOURINARY SYSTEM, PROSTATE, COMMON PROBLEMS
July 7, 2009 | Leave a Comment
WHAT IS
MY PROSTATE?
In the male of the species, the prostate is situated directly below the bladder and in front of the inner wall of the rectum. The bladder stores urine produced in the kidneys. A tube going from the bladder to the penis is called the urethra. The urethra passes through the middle of the prostate something like an apple core is in the center of an apple.
Urinary bladder
Pubic bone Prostate gland
Penis Urethra
Rectum
Bulbourethral
gland
Anus
Coccyx
THE GENITOURINARY SYSTEM
The prostate is both muscle and gland, so it’s called musculoglandular. It is made up of true prostate tissue and of a harder, fibrous material on the outside called the prostate capsule.
This roughly triangular shaped gland is one to one and a half inches in width, and can weigh between fifteen and twenty grams, depending on the size of the man. That means the prostate gland in most men normally weighs less than an ounce.
When you were born, your prostate was about the size of a medium garden pea and grew gradually. At puberty, the prostate takes a spurt of quick growth. This growth continues at a slower pace until a man is about thirty. At this point the prostate reaches its full adult size.
Striated voluntary muscle
Arteries, veins and venous sinuses
Striated muscle On the surface of the prostate
Urethra
Sinus
pocularis Ejaculatory ducts
Longitudinal cross section of ducts leading from the
lobules of the prostate gland
LONGITUDINAL CROSS SECTION OF PROSTATE
SHOWING THREE DISTINCT LOBULES AND
CENTRAL URETHRAL AREA
Urinary bladder
Striated voluntary muscle
in the bladder
Ejaculatory ducts
into urethra
Prostate gland external
muscular wall
Levator ani
(pelvic diaphragm)
Internal portion of the prostate gland
Pubic bone
Bulbourethral gland Urethr
Crus of penis Skin
Bulb of the penis
Glans penis
Foreskin
From thirty to fifty years of age, most men’s prostates remain about the same size, but after fifty, for some unknown reason, the prostate in most men begins to enlarge. Medical experts say this growth may be the result of a change in the male hormone balance in the system, or it could be some other result of age sneaking up on us that we don’t know about yet.
The prostate gland itself is a complex one. It is made up of muscles, glands and fibrous tissues. The many small glands in the prostate are where the fluid is produced that is emptied into the prostatic urethra.
This fluid is injected into the urethra. At the same time the tube that brings the spermatozoa from the testes also emits its product into the urethra. These two fluids, plus one from the seminal vesicles all are combined in the urethra and then ejaculated by the spasmodic contractions of muscles surrounding the urethra.
Which is all to say that the prostate has a big role to play in the male animal, and his ability to function normally in sexual intercourse. So most men are afraid that anything that disrupts the normal operation of the postrate can have an adverse affect on their sex life. This is true only in some cases, and we’ll get to those points as we move along.
Many men go through a serious change in life, in lifestyle, perhaps in their work and relationships with others at this fifty-year-old time period.
The enlargement of the prostate and its resulting problems can have a bad psychological effect on a man already burdened with other life problems.
Some men have a sharp decline in their sexual performance about this time. Others might be having work or career problems. A man’s wife might be having her own changeof-life difficulties and the children often are drifting away from a close family unit about this time.
When things start to happen to his “water works”, and he isn’t sure how this will affect his performance in bed, many men become over sensitive about prostate and prostatic problems.
The extent of this enlargement during the fifties and later often is accompanied by three gradually developing habit patterns: there is a decrease in the force and stream of urine. This sometimes is accompanied by a hesitancy to begin urination. Another early symptom that something is wrong is what doctors call nocturia, or simply the need to get up once, twice, or three times a night to urinate.
These minor difficulties are not horrendous, and you can learn to live with them with little disruption of your normal daily activity. Many men live through their fifties and sixties with few of the symptoms of BPH. These letters will be used a lot in this book. They stand for Benign Prostatic Hyperplasia. That simply means a non-cancerous enlarge-ment of the prostate gland.
In the seventies and eighties in most men, more problems can occur and other prostate ailments and dysfunctions can arise. We’ll be dealing with them in detail later on.
One expert said that sixty percent of all men over sixty years of age have some BPH, and more than ninety-five percent of men in their eighties have some BPH problems.
What we’re saying here is that BPH is simply a factor of older age, like balding heads and weakening muscles. BPH is a fact of life that almost all of us are going to have to learn to live with. The more we can know about it, and the other prostatic problems now, the better we’ll be able to cope with it when it becomes serious about hitting us where it hurts.