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
BENIGN PROSTATIC HYPERPLASIA (BPH)
Benign Prostatic Hyperplasia, sometimes called Hypertrophy, is the medical way of saying that the prostate gland has enlarged. In early stages this enlargement may not cause any problems. As it enlarges more and more with a man’s increasing age, it may squeeze the urethra smaller and smaller.
This reduces the force and size of your urine stream, and if left untreated, BPH could lead to the closure of the urethra resulting in severe sickness and even death.
Doctors say that in BPH the glandular tissue within the prostate capsule enlarges, grows, and no one seems to know why it happens or how to prevent or stop this growth.
This is a benign growth. That means it is not cancerous, it does not spread to other parts of the body or attack other tissues or cells. If it were malignant, as in cancer of the prostate, it would destroy and attack other tissue or cells and spread.
In the drawings here, notice how the urethra is fully open in the first one. It passes through the prostate allowing normal flow of urine from the bladder through the urethra and out the penis.
In the second drawing, the darker growth of benign tissue has begun and already has taken the bulge out of the urethra. In the third drawing, the BPH tissue has almost closed the tube the urine must pass through, making urination extremely difficult and bringing on all sorts of BPH symptoms and problems.
We come back to the apple example. Your prostate is like an apple with the core taken out. Through the core goes the urethra. The size of the urethra may begin to shrink when the prostate starts to enlarge when most men are about forty to forty-five. Often by the time a man is in his fifties he’s noticing some changes in his urination pattern.
It is just outside the urethra where the benign growth of the prostatic tissue begins, and it usually grows in both directions, which at once impacts the size of the urethra.
The growth of the tissue usually is not uniform or consistent all along the urethra. It may develop in one section and not in another, so the urethra is not compressed all along its length, at least not at first.
However, as with any tube or a garden hose, pressure at any one spot can shut off the tube entirely and cause all sorts of problems.
The new growth in the prostate consists of the same types of tissue as the normal prostate gland has, but in different proportions. The new, benign growth is going to have more of the glandular type of tissue.
The new growth in the prostate usually develops in both an inward and outward direction, toward the urethra and toward the exterior of the gland. When it grows outward it compresses the normal prostatic tissue against the sturdy outer capsule of the prostate.
When this outer growth takes place in the two lobes of the prostate nearest the rectum, a specialist can feel this with a digital examination. The outward growth does not narrow the urethra so there would be none of the usual BPH symptoms.
In most cases, however, when there is an outward growth of the tissue, it also grows toward the inside as well. Now we get the narrowing of the urethra over the years, and the normal symptoms of BPH.
The prostate has several sections, and digital examination can touch only the back part of the prostate. The sections that can’t be felt can harbor benign or malignant growth. This is one of the reasons for other tests for prostatic cancer that we’ll explain in detail later.