Diagnosing Benign Prostate Enlargement
You might have several different tests to find out if you have an enlarged prostate.
A GP may do some of these tests, such as a urine test, but others might need to be done at a hospital.
Some tests may be needed to rule out other conditions that cause similar symptoms to BPE, such as prostate cancer.
Side View Of The Prostate
The prostate is a walnut-sized gland located between the bladder and the penis. The prostate is just in front of the rectum. The urethra runs through the center of the prostate, from the bladder to the penis, letting urine flow out of the body.
The prostate secretes fluid that nourishes and protects sperm. During ejaculation, the prostate squeezes this fluid into the urethra, and itâs expelled with sperm as semen.
The vasa deferentia bring sperm from the testes to the seminal vesicles. The seminal vesicles contribute fluid to semen during ejaculation.
How Many Grams Is An Enlarged Prostate
4.3/5prostategramsgramsprostatic
The mean weight of the normal prostate in adult males is about 11 grams, usually ranging between 7 and 16 grams. The volume of the prostate can be estimated by the formula 0.52 ×length× width ×height. A volume of over 30 cm3 is regarded as prostatomegaly .
Secondly, how do you reduce the size of an enlarged prostate? To help control the symptoms of an enlarged prostate, try to:
Also to know is, what is enlarged prostate size?
Enlarged prostate. The prostate gland surrounds the urethra, the tube through which urine passes out of the body. An enlarged prostate means the gland has grown bigger. Prostate enlargement happens to almost all men as they get older. An enlarged prostate is often called benign prostatic hyperplasia .
At what size of prostate requires surgery?
For patients with prostate glands larger than 80 grams, an open prostatectomy is performed. After the surgeon makes an incision from the navel to the pubic bone, the bladder is opened and tissue of the prostate is removed.
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Questions You May Want To Consider Asking Your Doctor Include:
- What type of prostate problem do I have?
- Is more testing needed and what will it tell me?
- If I decide on watchful waiting, what changes in my symptoms should I look for and how often should I be tested?
- What type of treatment do you recommend for my prostate problem?
- For men like me, has this treatment worked?
- How soon would I need to start treatment and how long would it last?
- Do I need medicine and how long would I need to take it before seeing improvement in my symptoms?
- What are the side effects of the medicine?
- Are there other medicines that could interfere with this medication?
- If I need surgery, what are the benefits and risks?
- Would I have any side effects from surgery that could affect my quality of life?
- Are these side effects temporary or permanent?
- How long is recovery time after surgery?
- Will I be able to fully return to normal?
- How will this affect my sex life?
- How often should I visit the doctor to monitor my condition?
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What Other Problems Might An Enlarged Prostate Cause
A small number of men may find it difficult to empty their bladder properly this is called urine retention. If youve been diagnosed with an enlarged prostate, your doctor will look at your test results to see if youre at risk of urine retention. You may be more likely to get urine retention if:
- youre aged 70 or over
- your prostate is very large
- you have a raised prostate specific antigen level
- you have severe urinary symptoms and a very slow flow.
Chronic urine retention
This is where you cant empty your bladder fully, but can still urinate a little. It usually develops slowly over time. Chronic means long-lasting. The first signs often include a weak flow when you urinate, or leaking urine at night. You may feel that your abdomen is swollen, or that youre not emptying your bladder fully.
Chronic urine retention is usually painless. But the pressure of the urine can slowly stretch your bladder muscle and make it weaker. This can cause urine to be left behind in the bladder when you urinate. If you dont empty your bladder fully, you might get a urine infection, need to urinate more often, leak urine at night, or get painful bladder stones. You might also see some blood in your urine. Chronic urine retention can damage your bladder and kidneys if it isnt treated.
There are treatments for chronic urine retention, including:
- passing a thin, flexible tube called a catheter to drain urine from your bladder
- surgery to widen the urethra.
Acute urine retention
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Anatomy Of The Prostate
The prostate is a small gland in the male reproductive system. It is situated in front of the rectum, below the bladder, and surrounds the urethra, which is the tube through which urine flows out of the body. The main function of the chestnut-sized prostate is to secrete part of the seminal fluid that combines with sperm to form semen.
Treatments Options For High
The prostate is a walnut-sized organ that is part of the male reproductive system. It sits in front the bladder and above the rectum. The prostate is responsible for the production and supply of fluid that helps nourish sperm in the ejaculate. The urethra, where urine travels from the bladder to the penis, runs through the prostate.
As a result of family history, lifestyle, diet, and natural hormonal changes, the prostate begins to grow in size as men age, starting in their mid-30s. When the prostate becomes more enlarged over time, it might press against the urethra and block urine flow . This condition is called benign prostatic hyperplasia, or BPH.
Enlarged prostates differ in size. The size can be estimated on digital rectal exam or prostate imaging like an ultrasound. People with very enlarged prostates have several treatment options. However, size is not the only factor used to choose a treatment.
When doctors evaluate the prostate, symptoms are just as important as size. In addition, size and symptoms don’t always correspond. For example, one person might have a mildly enlarged prostate with noticeable symptoms, while another person could have a very large prostate with no symptoms.
All of this information is the basis of a personalized treatment plan. Here are the options for patients with very enlarged prostates, with or without symptoms.
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What If A Screening Test Shows An Elevated Psa Level
If a man who has no symptoms of prostate cancer chooses to undergo prostate cancer screening and is found to have an elevated PSA level, the doctor may recommend another PSA test to confirm the original finding. If the PSA level is still high, the doctor may recommend that the man continue with PSA tests and DREs at regular intervals to watch for any changes over time.
If a mans PSA level continues to rise or if a suspicious lump is detected during a DRE, the doctor may recommend additional tests to determine the nature of the problem. A urine test may be recommended to check for a urinary tract infection. The doctor may also recommend imaging tests, such as a transrectal ultrasound, x-rays, or cystoscopy.
If prostate cancer is suspected, the doctor will recommend a prostate biopsy. During this procedure, multiple samples of prostate tissue are collected by inserting hollow needles into the prostate and then withdrawing them. Most often, the needles are inserted through the wall of the rectum . A pathologist then examines the collected tissue under a microscope. The doctor may use ultrasound to view the prostate during the biopsy, but ultrasound cannot be used alone to diagnose prostate cancer.
What Is The Psa Test
Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the level of PSA in a mans blood. For this test, a blood sample is sent to a laboratory for analysis. The results are usually reported as nanograms of PSA per milliliter of blood.
The blood level of PSA is often elevated in men with prostate cancer, and the PSA test was originally approved by the US Food and Drug Administration in 1986 to monitor the progression of prostate cancer in men who had already been diagnosed with the disease. In 1994, FDA approved the use of the PSA test in conjunction with a digital rectal exam to test asymptomatic men for prostate cancer. Men who report prostate symptoms often undergo PSA testing to help doctors determine the nature of the problem.
In addition to prostate cancer, a number of benign conditions can cause a mans PSA level to rise. The most frequent benign prostate conditions that cause an elevation in PSA level are prostatitis and benign prostatic hyperplasia . There is no evidence that prostatitis or BPH leads to prostate cancer, but it is possible for a man to have one or both of these conditions and to develop prostate cancer as well.
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History And Physical Examination
In men with bothersome lower urinary tract symptoms, a history should be performed to establish the severity of symptoms, evaluate for causes other than BPH , and identify contraindications to potential therapies. The American Urological Association Symptom Index is a validated seven-question instrument that can be used to objectively assess the severity of BPH.6
Differential Diagnosis of Lower Urinary Tract Symptoms in Men
| Clinical finding |
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Differential Diagnosis of Lower Urinary Tract Symptoms in Men
| Clinical finding |
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American Urological Association Symptom Index
Figure 1.
American Urological Association Symptom Index to assess severity of benign prostatic hyperplasia . A score of 7 or less indicates mild BPH a score of 8 to 19 indicates moderate BPH a score of 20 to 35 indicates severe BPH.
Adapted with permission from American Urological Association. Guideline on the management of benign prostatic hyperplasia . http://www.auanet.org/guidelines/bph.cfm. Accessed September 19, 2007.
American Urological Association Symptom Index
Figure 1.
American Urological Association Symptom Index to assess severity of benign prostatic hyperplasia . A score of 7 or less indicates mild BPH a score of 8 to 19 indicates moderate BPH a score of 20 to 35 indicates severe BPH.
Adapted with permission from American Urological Association. Guideline on the management of benign prostatic hyperplasia . http://www.auanet.org/guidelines/bph.cfm. Accessed September 19, 2007.
Relationship Between Measured And Estimated Prostate Volumes
The estimated volume from TRUS imaging assumes an ellipsoid geometrical shape of the prostate using the formula . In order to identify the best coefficient for this series of 153 fresh prostate specimens, we used the measured prostate weight converted to measured prostate volume by using 1.02g/cc as the density, as defined above. Thus, the mean measured volume of our cohort was 48.1cc .
Measured prostate volumes along with TRUS-obtained prostate dimensions were then used to calculate a new coefficient from the rearranged algebraic formula: Coefficient=V/L x H x W, where L, H and W were all obtained by TRUS, and V is the measured prostatic volume of fresh prostates, obtained just after surgery, as mentioned above. This calculation was performed for each of the 153 prostates, which led to a calculated mean coefficient of 0.66.
Linear regression plots were created in order to compare the newfound coefficient of 0.66 with the ellipsoid coefficient of 0.52. Figure a shows that plotting estimated prostate volumes against measured prostate volumes using 0.66 as a coefficient yielded an equation of y=0.892x+8.8829 with an R2 value of 0.42 . By performing the same analysis using 0.52 as the coefficient, the equation generated was y=0.5652x+13.028 with R2=0.32 .
Fig. 1Fig. 2Fig. 3
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Positive Psa Score Association With Other Conditions
The amount of PSA in your blood test may increase with other prostate conditions such prostatitis, enlarged prostate , or within two days after ejaculation.
Rest assured, even though your results may be high, it doesnt necessarily mean you have prostate cancer. Just a greater risk of developing it.
What Are The Signs And Symptoms Of An Enlarged Prostate
An enlarged prostate is the most common cause of urinary problems in men as they get older. Possible symptoms include:
- a weak flow when you urinate
- a feeling that your bladder hasnt emptied properly
- difficulty starting to urinate
- dribbling urine after you finish urinating
- needing to urinate more often, especially at night
- a sudden urge to urinate you may sometimes leak before you get to the toilet.
You may not get all of these symptoms, and some men with an enlarged prostate dont get any symptoms at all. These symptoms can also be caused by other things, such as cold weather, anxiety, other health problems, lifestyle factors, and some medicines. Blood in your urine may be a symptom of an enlarged prostate. But this is rare and is usually caused by something else.
If you have any of the symptoms above, you should visit your GP to find out what may be causing them.
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Basic Characteristics Of Freshly Resected Prostates
The mean prostate weight was 47.1g, ranging from 22.2g to 115.9g for the 153-patient cohort. The weight range of the series of 8 prostates used in the water displacement experiments, that are representative of radical prostatectomy cohorts, was from 21.0g to 82.2g, with a mean weight of 50.2g and diverging from the overall cohort by 6.6%. Based on the new ISUP Grade Grouping the 8 prostates were classified as: 2 GG 1 5 GG 2 and 1 GG 3 pT2c to pT3b 5 to 10% tumor volume. Using Archimedes Principle, we determined the density of the average prostate to be 1.02±0.01g/cc.
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Heres How This Could Be A Problem:
The urethra is like a hose attached to your bladder. It goes through the prostate and out of your penis. So when the prostate swells, it can put pressure on the bladder and squeeze the urethra.
A normal bladder holds about 16 ounces.
The pressure makes it feel like you have to go for a pee, even if the bladder isnt full. This is often what wakes men up at night. To make matters worse, pinching the urethra is kind of like kinking a hose. In other words, it can be hard for the urine to get out.
This can make a big difference. Think of a grapefruit versus a walnut.
If youre like me you probably ask yourself the question, how does that happen and how do I avoid it?
Unfortunately, doctors and scientists dont have a concrete answer on how it happens. But they believe it might be due to changes in the balance of sex hormones as men grow older.
Scientists believe the male hormone dihydrotestosterone may encourage the cells of the prostate gland to continue to grow.
Heres how it works…
Testosterone converts to DHT through the enzyme 5–reductase.
Therefore, if you can block the 5–reductase enzyme, you can limit DHT and improve prostate health.
Ok, thats a lot of info… if youre still with me I’m impressed!
Lets now answer the most important question
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Prostate Growth And Sex
Urinary problems caused by BPH are known as lower urinary tract symptoms, or LUTS. Men with LUTS often have problems in the bedroom.
The link between LUTS and sexual problems is not fully understood. But many of these men have a lowered sex drive, trouble maintaining an erection, and theyâre less satisfied with sex. Depression, loss of sleep due to frequent nighttime trips to the toilet, or some related physical cause may play a role.
Whatever the reason, the worse LUTS get, the more trouble a man may have in the bedroom. LUTS can be treated, so see a doctor early, before the symptoms cause a bladder problem or begin to spoil your sex life.
Comparison Of Measured And Trus
The next step was to examine differences in individual prostate dimensions according to the method used to obtain them. We compared each dimension estimated by ultrasound prior to surgery vs. the same respective prostate dimensions measured post-surgery from our initial cohort of 153 patients. This comparison is shown in Fig. . We observed that the mean length of the prostate was overestimated by 10.8% using ultrasound . The mean height was overestimated using TRUS by 11.1% . Finally, the width of the gland estimated by TRUS was fairly similar to the measured value .
Fig. 4
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Does The Size Of Prostate Affect Psa
Because PSA , also known as Prostate Specific Antigen, is almost exclusively produced in the prostate gland, changes in the prostates size invariably lead to more PSA-producing cells and an increase in PSA levels . If the prostate gland structure is severely impaired, then this size-dependent increase causes a marked increase in blood PSA level .
Men may worry that the link between an enlarged prostate and PSA increases their risk of developing prostate cancer. However, the available evidence suggests otherwise. The risk of prostate cancer is the same between men with an enlarged prostate and those without an enlarged prostate.
Can You Reduce An Enlarged Prostate
Yes anti-androgens that block the production of androgens or inhibit their biological activity can starve the prostate of essential growth factors. Inhibiting the growth-promoting effects of these factors helps to reduce the size of the prostate gland.
Common medicines include:
- 5-alpha reductase inhibitors block the conversion of testosterone to the active DTH. Finasteride is an example of a 5-alpha-reductase inhibitor. However, there are certain associated with the use of 5-alpha reductase inhibitors that patients do need to be aware of. These side-effects can be unpleasant. Retrograde ejaculation has been noted in some patients.The patient may also note a reduction in their erectile function. This can cause symptoms associated with erectile dysfunction.
- Alpha blockers- Alpha-Blockers are a class of prescription medications used to relax muscles around small blood vessels. There are several medications available as alpha-blockers, with Flomax being one of the most commonly prescribed.
Though these medications shrink the prostate, they often leave most of the prostate gland untouched, allowing the condition to return. Aim to maintain a healthy prostate by reducing inflammation, healthy diet, and physical activity.
Lifestyle changes and home treatment will not stop the prostate from growing bigger but can help with your symptoms.
These lifestyle changes have utility in reducing the symptoms of enlarged prostate:
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