Diagnosis of prostate adenoma

Adenoma is considered one of the most common diseases in men. The danger of benign prostatic hyperplasia (BPH) lies in the fact that for a long time it is asymptomatic, and the appearance of obvious signs of concern already indicates stage 2 or 3 of the pathological process. Timely diagnosis of prostate adenoma in men is one of the primary tasks of medical examinations, which must be carried out at least once a year. Modern equipment capabilities and informative laboratory tests make it possible to detect an insidious pathology in time and begin therapeutic treatment. A qualitative differential diagnosis of BPH is necessary to exclude a malignant course, as well as to establish a pathology of the urinary system in men with similar symptoms.

Diagnosis of prostate adenoma

Diagnosis of the prostate gland is carried out according to a plan that includes an extensive list of methods that help determine the presence of pathology and the stage of the disease.

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First of all, a thorough questioning of the man is carried out, identifying complaints and signs, the presence of which indicates the possible development of an adenoma.

The clinical picture of the disease is associated with urination disorders, increased nighttime diuresis, interruption of the urine stream, the appearance of tension in the abdominal area due to the need to make significant efforts to empty the bladder, and sexual dysfunction often occurs.

Assessing and recording the dynamics of complaints allows you to determine the degree of violations and conduct a differential diagnosis with other prostate diseases. At this stage, an important symptom is pain, which helps to differentiate between prostatitis, in which pain is associated with inflammation and is pronounced, and adenoma, which does not manifest itself as pain for a long time, since there are no inflammatory reactions, and the cause of the disorders is associated with hyperplastic changes.

The second stage is a transrectal examination of the prostate. The technique allows you to determine the parameters of the gland and find differences that are characteristic of a malignant course.

During manual diagnostics, the size and consistency of the prostate gland are assessed, which are different for adenoma and cancer. A rectal examination provides a picture of the course of the pathological process, which serves as the basis for prescribing more accurate diagnostic methods.

Basic data is entered into the medical record and is necessary for a detailed study of the condition of the prostate gland.

Preliminary diagnostic measures provide the basis for complex instrumental and laboratory methods for establishing an accurate diagnosis. High-precision computer diagnostic methods, CT and MRI, are the definitive ways to establish the presence of an adenoma and its degree, or to confirm malignant degeneration of gland tissue.

All results are entered into a special card with an assessment of indicators on a scale from 0 to 35, and a urination diary is also filled out, which records the values ​​of frequency, volume and total amount of diuresis, as well as the severity of violations of physiological norms.

PSA norm for prostate adenoma

One of the best diagnostic methods used to determine the presence of prostate adenoma in men is a laboratory blood test to determine the level of prostate-specific antigen (PSA). The amount of PSA depends on age and the degree of cell activity.

Normally, this enzyme is necessary to liquefy sperm and create an optimal habitat for sperm. Produced by prostate cells, it partially enters the blood, and its level is used to judge possible hyperplastic changes in the prostate tissue.

Age-specific PSA norms:

• up to 50 years – less than 2.5 ng/ml;
• from 50 to 60 years – less than 3.5 ng/ml;
• from 60 to 70 years – less than 4.5 ng/ml;
• over 70 years old – approximately 6.5 ng/ml.

Based on the level of antigen growth in a blood test, a benign course of the process is judged, in which the annual increase is 0.3 ng/ml, or in the presence of oncology in a man, when there is a pronounced increase of 3-4 ng/ml per year.

During laboratory diagnostics, PSA is determined in the blood in free or bound form. More than 15% of free antigen indicates the degeneration of hyperplasia, against the background of increased PSA density.

Differential diagnosis

Histological studies require taking tissue samples and are an informative method for establishing the nature of the tumor; differential diagnosis of prostate adenoma is carried out on the basis of PSA data if a malignant course of the pathological process is suspected. The examination is complex, painful and traumatic, so it is not necessary to carry it out without sufficient grounds, so it is necessary to obtain preliminary examination data and rectal examination in order to do a biopsy of prostate tissue.

To obtain biopsy material, a special needle is inserted through the anus, with which samples of prostate tissue are taken. Histological examination determines the quality of the cellular structure, and a diagnosis of cancer is possible only if there is a positive conclusion. This is the main way to differentiate between malignant and benign processes.

Modern computer methods cope with the task in a less extreme and painless way for men. With the help of radiation diagnostic devices, it is possible to determine the size, consistency, density of the affected gland, and determine its structure without the need to obtain tissue samples. The main advantage is the ability to establish the nature of the lesion and the degree of participation of nearby systems and organs in the pathological process.

The main goal of differential diagnosis is the timely detection of oncology, as well as similar diseases of the urinary system.

A close study of the condition and functional activity of the prostate is required to compare the results obtained with physiological norms.

Thanks to the extensive range of diagnostic measures used, it is possible to timely detect hyperplasia in the early stages, when it responds well to therapeutic treatment, and also eliminate the risk of developing cancer.

Ultrasound

Ultrasound diagnostics is carried out to assess the condition of the organs of the reproductive and urinary systems, based on the ability of sound waves to detect diffuse compactions in tissues. Ultrasound is one of the examination methods that are included in the plan if it is necessary to clarify pathological processes in a man.

• The first and most commonly used method for identifying prostate diseases is the transrectal examination. The head of the ultrasound diagnostic device is inserted into the rectum; with this method, the sensor is as close as possible to the prostate area and allows you to visually study the necessary parameters in detail. A man needs to lie quietly on his left side with his legs bent; the discomfort is minimal and does not cause severe discomfort. Using a sensitive sensor of a special anatomical shape, the doctor makes the necessary sound measurements, on the basis of which a computer model of the condition of the prostate gland is built, based on its density, size, and structure. The same method makes it possible to detect pathological processes in organs located nearby, for example, the presence of strictures (narrowings) in the urethral canal, often leading to mechanical disruption of the conductivity of the urinary tract.
• Another option for ultrasound is performed in a more conventional way, through the abdominal wall. The transabdominal option is less informative, but in some cases it is the only available ultrasound diagnostic method, especially in cases of damage to the lower intestines in men or the presence of inflammatory processes in the anal area. Despite its lower accuracy, it allows you to obtain basic information about the condition of the pelvic organs and gives a clear picture regarding the relationship in the functioning of the genitourinary and excretory systems.

For an accurate diagnosis, it is necessary to carry out high-quality preparation for the examination.
Before the transrectal ultrasound examination, the man is given a cleansing enema.

Before a transabdominal ultrasound, you need to drink a large amount of fluid to fill the bladder and obtain accurate information about its functional state.

Deviations in the physiological structure allow one to draw a conclusion about the presence of pathology, and the nature of the changes is a differentiating sign of the development of benign hyperplasia in adenoma or malignant degeneration of tissue in oncology.

BPH is characterized by diffuse nodular changes located symmetrically or with a slight degree of unevenness throughout the prostate tissue. In a malignant course, these nodes differ in structure.

Specific subjects of study are the bladder and kidneys. The nature of the changes determines the stage of development of the pathological process in adenoma.

Initial changes mainly concern the thickening of the walls of the bladder, which is a compensatory reaction of the urinary system to the accumulation of large volumes of fluid.

The degree of kidney involvement and the depth of pathological changes are also assessed by the level of dilation of the ureters, renal pelvis and tubules. Deep deformations indicate stage 3 adenoma and require urgent measures.

An important part of ultrasound in terms of examination for adenoma is the detection of stones that can cause mechanical blockage, due to which the diagnosis of adenoma is changed to urolithiasis.

Diagnostic method uroflowmetry

During uroflowmetry, a man needs to urinate into a special funnel connected to a highly sensitive measuring device. The device records the filling of the jet and identifies the main problems associated with benign hyperplasia. Clinical and instrumental methods in combination help to diagnose an adenoma, and confirmation of complaints using uroflowmetry is the basis for a medical opinion.

An important stage of diagnosis is the exclusion of possible diseases with similar symptoms. Characteristic graphical data obtained using this method help to differentiate adenoma and urolithiasis, identify differences characteristic of prostatitis and urolithiasis, and establish basic indicators for compiling a set of other diagnostic procedures.

Carrying out uroflowmetry is very simple and does not cause any pain, discomfort or discomfort to a man. The urine-receiving funnel of the device is connected to a recording pen that records the data of the measuring equipment.

The sensors of the device allow you to evaluate:

• the average time it takes to urinate;
• the volume of urine excreted by a man at one time;
• number of approaches to completely empty the bladder;
• average urination rate per volume.

Each indicator has physiological norms associated with the age and individual characteristics of a man. Deviations from normal data are recorded in the examination card and are necessary for a comprehensive assessment in the totality of other diagnostic information obtained.

If it is necessary to obtain additional data, a second stage of examination is carried out with the introduction of a contrast agent and an assessment of urination, starting with the filtration process in the kidneys.

Urography in combination with uroflowmetry helps to assess the dynamics of urination, find the cause of the delay and carry out a differential diagnosis of adenoma with diseases that are associated with mechanical blockage of the urinary ducts.

The examination plan for prostate adenoma in men includes a comprehensive set of measures and is associated with the need to clarify the diagnosis and conduct a differential assessment of other pathological conditions with similar symptoms. The order of the examination depends on the man’s initial complaints, laboratory test data and rectal examination.

More complex diagnostic options require drawing up an individual plan in each specific case. The most important thing for a man is to follow the recommendations of the urologist and undergo a preventive examination at least once a year.

This will allow the disease to be identified at an early stage and eliminate the risk of developing complex pathologies associated with oncological processes.

Doctor of the highest category, Candidate of Medical Sciences, Diploma in General Medicine, Russian State Medical University named after. N. I. Pirogova (2000) Experience 17 years

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Source: https://kisstyle.ru/predstatelnaya-zheleza/adenoma-prostaty/diagnostika-adenomy-prostaty-u-muzhchin/

Diagnosis of prostate adenoma

The initial diagnosis of such a common disease among men as prostate adenoma is based primarily on a patient interview, during which associated symptoms are determined.

Diagnosis of the disease based on accompanying symptoms

In men, upon reaching a certain period, which begins, in most cases, at the age of 60 or earlier, increased growth of glandular tissue cells occurs in the area of ​​the isthmus of the bladder.

The accessory glands adjacent to the urethra, as well as the prostate’s own tissue, enlarge. As a result of this process, benign prostatic hyperplasia (BPH), that is, prostate adenoma, develops.

Growing tissues deform the urinary tract, preventing the complete flow of urine. When going to the toilet, due to the narrowing of the lumen of the urethra, men begin to strain, squeezing fluid out of the bladder.

Signs of the disease are present both when emptying and when filling the bladder. When emptying:

• difficulty starting the urination process;
• the need to tense the abdominal muscles to remove urine;
• weak stream;
• at the end of urination, dripping of urine is observed for some time;
• worried about the feeling of urinary retention and incomplete emptying.

When filling, the following painful manifestations may bother you:

• unbearable and frequent urge at any time of the day;
• urinary incontinence appears.

Why does the urination process suffer with BPH? The thing is that when filling, pressure is created on certain areas located on the inner walls of the bladder. The enlarged prostate also begins to put pressure in these places. Because of this, the patient’s life is complicated by frequent urge to urinate.

Prostate adenoma occurs slowly, progressing with age. Symptoms are not always permanent. During the course of the disease there are periods when they intensify or weaken.

If you have suspicious symptoms, you should not delay a visit to the doctor, who, first of all, will ask the patient about the complaints and manifestations of the disease: its onset, dynamics, concomitant chronic diseases, previous injuries, allergic reactions, living conditions. Information about the presence of diseases that can cause urinary problems is especially important:

• spinal injuries;
• multiple sclerosis;
• spinal cord problems;
• diabetes mellitus;
• alcoholism and others.

Analyzing the collected information and taking into account the patient’s examination data, the doctor makes a preliminary diagnosis. Subsequently, it can be confirmed or refuted by additional diagnostic measures.

Rectal examination of the prostate

Rectal palpation of the prostate is mandatory for men of older age (after 40 years) who have been diagnosed with prostate disease by a urologist. This method is quite informative and can be used by any urologist. The patient does not require any special preparation.

During palpation, the patient can be in the following positions:

• standing, bending over and resting your hands;
• on all fours, leaning on elbows and knees;
• in a horizontal position, with legs bent and pressed to the body.

The doctor, wearing examination gloves, applies lubricant to one of the fingers. This can be Vaseline oil or a special gel. Then he spreads the halves of the buttocks and carefully, slowly inserts a finger through the anus into the rectum. Before this, the doctor informs the patient about the essence and purpose of the rectal examination, so as not to provoke an undesirable reaction in him.

This examination allows you to obtain sufficient information about the size and shape of the prostate gland, the clarity of its interlobar groove, the symmetry of the lobes, consistency, the presence of formations, stones, etc. A visual and laboratory assessment of the released prostate secretion is carried out.

  Consequences of surgery to remove prostate adenoma

• In a healthy state, the prostate is round in shape with clear contours, has two equal lobes separated by a groove, a smooth surface, uniform consistency, seminal vesicles that cannot be palpated, and tolerates the procedure painlessly.
• In the case of BPH, a symmetrical increase in the lobes is detected while maintaining a homogeneous consistency, a smooth surface, a slightly smoothed median groove, the upper part of the gland, due to its strong enlargement, is inaccessible for digital examination, the sensitivity of the organ is low.
• Despite the improvement in the technical equipment of medical institutions, palpation examination still remains in demand, and in many cases, irreplaceable.

Laboratory diagnostics

Blood and urine tests for uncomplicated BPH should be normal. With their help, inflammatory processes, kidney or liver dysfunction, and hemocoagulation disorders are diagnosed.

1. An increased number of leukocytes, erythrocytes or bacteria reveals the presence of an inflammatory disease in the patient’s genitourinary system. High concentrations of salts in the urine collection may be detected in the presence of stones in the urinary tract.
2. Biochemical analysis characterizes the functioning of the kidneys and reveals renal failure. Fluctuations in creatinine and urea concentrations will indicate renal dysfunction. If there is an imbalance of calcium, potassium and sodium or low hemoglobin and red blood cells, this may also indicate a decrease in kidney function.
3. Hematuria indicates urolithiasis.
4. Deviation of blood clotting from the norm is present in kidney dysfunction and chronic pyelonephritis.
5. Taking a PSA test helps to detect a malignant tumor process in time, as well as select patients to undergo a prostate biopsy procedure. The analysis is taken before undergoing a digital rectal examination, since after it the PSA content may increase.

Lower urinary tract examination

It is carried out following a prostate examination. Its purpose is to determine the patency of the urethra and the volume of residual urine. A catheter, which is a soft tube, is inserted into the urethra. Extreme caution is required, as the integrity of the mucous membranes can easily be damaged. Displacement of the urethra, as well as elongation of its posterior part, indicate prostate adenoma.

Bladder catheterization makes it possible to determine at what stage the disease is, the tone of the muscle responsible for urine output, and also identifies concomitant pathologies (stones, tumors, etc.).

With constant urinary retention in patients with a flaccid abdominal wall, it is possible to visually, as well as by digital examination, identify a spherical tumor formation, slightly protruding in the suprapubic region.

An external examination of the stretched organ reveals a smooth surface, as well as rather expressive contours. Pressing the bladder with your fingers causes and intensifies the urge to empty it.

During bladder catheterization, the rate of urine flow is determined. A good jet pressure indicates normal muscle tone. If the flushing fluid or urine flows sluggishly through the catheter and is released in drops, this indicates that the organ has partially lost its contractility. If the fluid does not flow out at all, this indicates a complete loss of muscle function.

By using catheterization after urination, they learn about the amount of remaining urine. It depends on the tone of the muscle that removes urine from the bladder.

If more than 100 ml of fluid is detected, it means that there is incomplete emptying. The same can be determined by ultrasound. The data obtained help to establish the stage of prostate adenoma disease.

Also, diagnostics using a catheter makes it possible to exclude diseases such as urethral stricture.

In some cases, catheterization is contraindicated. For example, patients with aseptic (sterile) urine. Such patients are very susceptible to urinary infections and instrumental examination poses a certain danger for them. Therefore, if it is impossible to do without the use of a catheter, antibiotics are taken along with the procedure.

  Diffuse changes in the prostate gland: what is it?

Ultrasound of the prostate

After a digital examination, the patient is sent for ultrasound diagnostics. Ultrasound is often performed transrectally. This allows the specialist to obtain the most reliable information about the structure and condition of the prostate and seminal vesicles.

The patient does not experience any discomfort during this diagnostic procedure. The sensor with which internal research is carried out is small in size, up to 2 cm in diameter. Therefore, there is almost no discomfort felt. The patient lies on his left side with his legs bent and pressed to his stomach.

Ultrasound diagnostics can also be performed externally, through the wall of the abdominal cavity. But this method is only indicative, as it gives an approximate idea of ​​the picture of the disease. The patient should arrive for the procedure with a full bladder and have an enema the night before.

Ultrasound helps a specialist determine with maximum accuracy the structure of the prostate gland, size, density, homogeneity, and the presence of tumors. A patient with prostate adenoma has an enlarged organ and adenomatous nodes.

Changes in the shape and nature of the nodes, blurred and indistinct contours, rapid growth, changes in density indicate a malignant lesion.

Uroflowmetry

After undergoing an ultrasound, the patient is asked to urinate into a special apparatus located in the urologist’s office. The examination is carried out as if it were natural urination. Uroflowmetry is an electronic test that determines the speed of urinary flow.

Using the device, the doctor determines the true physical parameters of urination, which may not coincide with the patient’s subjective complaints. This will allow you to choose the right therapy. After the procedure, the patient is again sent for an ultrasound to determine the volume of remaining urine.

Equipment for uroflowmetry consists of a device for receiving urine, including a flow sensor, a graphic display, a computer, and a printer. When the patient directs the jet to the designated place, the data is recorded and processed by computer, with its subsequent printing in the form of a graphic drawing, a uroflourogram.

Cystoscopy

This method allows you to examine the lower urinary tract from the inside. A cytoscope (a thin tube with an optical system) is inserted into the bladder through the urethra. Miniature instruments can also be inserted through the tube to remove biomaterial for analysis.

The doctor fills the bladder with water and examines it from the inside. The procedure must be performed on an outpatient basis. The patient may be given spinal, general or local anesthesia.

Cytoscopy can detect unwanted structural changes, including prostate enlargement, obstruction of the bladder neck or urethra, stones, and anatomical abnormalities. And also using this diagnostic method you can determine the presence of bladder cancer, various infections, and the causes of blood in the urine.

Is it necessary to perform a biopsy for prostate adenoma? This diagnostic measure is not mandatory or necessary to detect a benign formation in the tissues of the prostate gland.

However, after testing for PSA, if its elevated content is detected and the results of a digital examination are indeterminate, the urologist may refer the patient to perform a prostate biopsy.

This will make it possible to exclude the presence of a malignant process in the patient.

A sample of prostate tissue is obtained using a biopsy needle. The procedure can be performed using different methods, but in most cases, prostate tissue is collected rectally, through the lining of the rectum.

In addition, in accordance with individual indications, the patient can be referred for other types of studies, for example, radioisotope diagnostics, excretory urography and others.

Source: https://oprostatite.info/urologiya/prostatit/dobrokachestvennye/adenoma-predstatelnoj-zhelezy-diagnostika

Methods for diagnosing prostate adenoma

Prostate adenoma is diagnosed in 99% of the male population of the planet. Prostate hyperplasia is not just a problem for one person.

The whole environment suffers: the wife - due to the spouse's frequent trips to the toilet at night, colleagues - due to the unpleasant smell of urine, the patient himself suffers not only physically, but also mentally.

Prostate adenoma is a curable disease, but it requires timely and high-quality diagnosis.

Causes of adenoma

The prostate is located in the projection of the anterior wall of the rectum and consists of two lobes. The shape of the gland resembles a chestnut. The size of a normal organ is approximately 3x3 cm, the consistency is dense-elastic. The normal tissue volume is 28 cm³.

After 30 years of age, connective tissue begins to grow in the prostate gland. The size of the organ increases every year, which worsens the quality of life and can lead to the development of cancer. During a rectal examination, the doctor finds an enlarged dense formation, sometimes with bumpy contours, usually painless.

The concepts of “hyperplasia” and “adenoma” of the prostate gland are synonymous, but the first of them is a modern term, and the second is outdated.

It is impossible to prevent the process of proliferation in the connective tissue organ. The older the man, the more pronounced the changes. Pathological degeneration can only be slowed down by eliminating provoking factors from your life, which include:

• sedentary lifestyle;
• long work at the computer;
• obesity;
• poor nutrition.

Almost the entire male population of the planet is exposed to the influence of these factors. Therefore, it is important to analyze your lifestyle and adjust it in time.

Clinical manifestations

Any diagnostic process begins with collecting an anamnesis.

The patient first notes frequent getting up at night, the desire to urinate again, difficulty urinating, sluggish flow of the stream, the need to wipe drops of urine from shoes (symptom of “wet shoes”).

If the disease develops for more than one year, the man indicates frequent urination throughout the day and a feeling of fullness of the bladder.

Some patients become aware of their illness when urination suddenly stops. This situation is called acute urinary retention. It can be provoked by the use of alcoholic beverages, bladder stones, and prolonged ignoring of signs of ill health.

Diagnosis of the disease

During the examination, the doctor palpates and percusses the abdomen to determine the level of the bottom of the bladder. Rectal palpation of the prostate reveals the size of the organ, its consistency and the presence of seals.

Instrumental examination methods

Most often, an ultrasound examination of the prostate gland is prescribed. This method allows you to measure the volume of the prostate (normally - 28 cm³, stage 1 adenoma - 50 cm³, stage 2 - 55 cm³, stage 3 - 60 cm³ or more), visualize hypo- and hyperechoic areas, the presence of cysts or stones, residual urine volume .

To clarify the diagnosis (benign or malignant), a prostate biopsy is performed. The examination is carried out after cleansing the rectum with a special gun. To obtain reliable results, tissue is collected from several points.

Before collecting tissue for research, you need to prepare:

• cleanse the intestines (for this use enemas or laxatives);
• 30 minutes before the procedure, drink an antibiotic or administer it parenterally (intravenously, intramuscularly) to prevent infection of the injection sites;
• shave the perineal area, especially the inner surface of the buttocks, so that the hair does not interfere with the doctor.

In difficult cases, pelvic computed tomography or magnetic resonance imaging is prescribed. Such studies are necessary to determine the nature of the pathology of the pelvic organs, the presence of malignancy, and the growth of metastases.

Laboratory methods

The urologist recommends a general and biochemical blood test, a general urinalysis and, according to Nechiporenko, a spermogram. Blood is drawn for a blood test for PSA (prostate-specific antigen). This substance is produced by prostate tissue and partly enters the blood, and partly is found in the gland itself.

An increase in the gland by 1 cm³ gives a quantitative increase in PSA concentration by 0.3 ng/ml; a tumor growth by 1 cm³ gives an increase in the marker by 3.5 ng/ml.

For timely detection of the disease, age-specific test standards for prostate adenoma have been developed. The gradation of laboratory results was necessary for the reason that previously a single standard was established for everyone, and what was not a disease for an elderly person was regarded as a pathology.

Quantitative indicators of normal PSA levels in different age groups of men are as follows:

• 2.5 ng/ml or less - for persons from 30 to 50 years old;
• 3.5 ng/ml or less - from 50 to 60 years;
• 4.5 ng/ml and less - from 61 to 70 years;
• 6.5 ng/ml or less - from 71 years of age and older.

Exceeding these indicators may indicate a pathological process in the organ. A PSA level of 10 ng/ml indicates prostate hyperplasia. Exceeding this quantitative threshold suggests the development of a malignant tumor of the organ.

Urologists evaluate not only the PSA level, but also the ratio of total and free fractions of the substance. Normal numbers are considered to be 1:10. A violation of the ratio towards the general indicator indicates malignant cell growth in the gland.

The increase in PSA per year should not exceed 0.75 ng/ml, otherwise prostate cancer should be looked for.

1. Avoid drinking alcoholic beverages for a week;
2. do not eat spices 3-4 days before the test;
3. do not donate blood for 4 weeks after the prostate biopsy (in some sources - 2 weeks). The most correct result will still be obtained after 4 weeks, since the formation of full-fledged connective tissue in the areas of invasion occurs in 21 days;
4. avoid sexual intercourse or masturbation 3-4 days before the test;
5. do not go for a prostate massage 7 days before the biopsy;
6. after a digital examination of the prostate, donate blood no earlier than 7 days later;
7. exclude heavy physical activity, especially cycling, a week before the examination.

All of the above factors can distort the result, and then additional examinations will be required.

The gold standard for differential diagnosis of benign and malignant changes is a biopsy of gland tissue and histological examination of the material.

Studying the composition of prostate juice is another important indicator for prostate adenoma in the diagnosis of pathological abnormalities. An increased level of leukocytes is found in the secretion, and rarely malignant cells.

What to do if PSA is increased?

Any laboratory values ​​that are outside the normal range in apparently healthy patients are always rechecked and a repeat blood test is prescribed. At the same time, it is important to analyze whether all points were followed in preparation for the analysis.

If the second result shows an increase in PSA levels, you should consult your doctor. An increase in the concentration of prostate-specific antigen may indicate prostate hyperplasia, organ tumor or inflammatory pathology.

The doctor prescribes further examination and, based on the data obtained, treatment.

Diagnosis of prostate adenoma (benign hyperplasia)

The Vikings said that you need to be treated seven years before illness, and not seven minutes before death.

Therefore, it is important to try not to harm your own health: rest more, walk, play sports, have a regular sex life, listen to your body, visit a urologist once a year and take a PSA blood test.

Prostate adenoma detected in time is highly treatable, but neglected disease can not only ruin life, but also interrupt it.

Source: https://MedExpert.guru/prostata/adenoma/metody-diagnostiki.html

Modern methods for diagnosing prostate adenoma

Prostate adenoma is a common pathology in older men, characterized by long-term development. Symptoms of the disease are associated with impaired urination and a feeling of discomfort in the perineal area.

Timely access to a medical institution allows the patient to undergo the necessary diagnostic methods, including laboratory and instrumental studies.

It is important to note that during the examination, it is necessary to distinguish an adenoma from prostate cancer, as well as from benign hyperplasia (BPH), which differ in their prognosis for the patient and approaches to treatment.

Main symptoms

Symptoms of obstruction include difficulty urinating, prolongation of urination time, and a feeling of a full bladder after visiting the toilet. Irritative manifestations, i.e. associated with irritation, characterized by urinary incontinence, frequent urge to urinate, including at night.

Doctors distinguish three stages of development of prostate adenoma, each of which is characterized by certain features of complaints:

• at the first stage of development of the disease, the man notes a slight increase in the number of urges to urinate, which also occur at night. Typically, patients do not go to the doctor, since there are no serious complaints. It is important to note that at the first stage of adenoma development, the patient may still notice the appearance of a “waiting” period when going to the toilet - urination does not occur immediately, but after 5 or more seconds, which is associated with a decrease in the lumen of the urethra;
• the second stage of the disease is characterized by the development of a subcompensated state. The volume of the bladder in patients increases, and after going to the toilet there is always 150-250 ml of urine left in it. The process of urination is difficult and the man has to constantly strain his abdominal muscles to increase the pressure in the bladder. At this stage, urodynamic disturbances develop, which leads to the appearance of kidney pathology;
• The third stage of prostate adenoma is associated with a man’s constant desire to go to the toilet. The residual volume in the bladder is 200-400 or more milliliters, which is associated with the loss of its tone. During urination, as well as with the urge to urinate, the patient experiences a feeling of discomfort or even pain in the abdomen. There are serious disturbances in the functioning of the bladder, ureters and kidneys, which leads to the development of renal failure.

Despite the pronounced clinical symptoms, it is possible to accurately diagnose prostate adenoma only with the help of additional research methods based on the use of instrumental or laboratory procedures.

Rectal examination

The procedure is carried out as follows. The doctor carefully inserts a gloved finger through the rectum and feels the prostate. It is very important to evaluate its size, shape, the presence of local compactions and the appearance of pain in a man upon palpation. This procedure becomes possible due to the direct presentation of the prostate gland to the rectum.

It is important to note that the information content of the procedure is quite low, however, if the doctor has extensive experience, he can easily determine pathological changes in the organ.

In this case, the study does not require special preparation of the patient and is carried out within a few minutes.

In addition to prostate adenoma, the procedure allows you to diagnose tumor lesions of this localization, the formation of hemorrhoids and polyposis of the rectal mucosa.

Source: https://prostatitaid.ru/adenoma-prostaty/diagnostika-adenomy/sovremennaya-diagnostika.html

Prostate adenoma: diagnosis and treatment

Diagnosis of benign prostatic hyperplasia is usually not difficult and includes the following studies:

The following are required:

• Completing the IPSS questionnaire and 24-hour voiding diaries
• Laboratory tests: general and biochemical blood tests, general urinalysis, total blood PSA level (prostate-specific antigen),
• An elevated level of total PSA in the blood may indicate possible infectious or even malignant diseases of the pancreas,
• Digital rectal examination of the pancreas,
• Ultrasound of the prostate gland (transabdominal and/or transrectal) Ultrasound of the bladder, Ultrasound of the kidneys (assessing the volume of the prostate gland, the presence of residual urine volume after urination, the condition of the upper urinary tract in chronic or acute urinary retention),
• Uroflowmetry (qualitative assessment of the speed of the urinary stream).

For individual indications, the following studies can be performed:

• Urine culture for flora and determination of sensitivity to antibiotics
• Urterocystoscopy
• Prostate biopsy
• Complex urodynamic study (CUDI).

Carrying out differential diagnosis with diseases such as: bladder tumors, bladder stones, bladder trauma, chronic pelvic pain syndrome, chronic prostatitis, neurogenic bladder, prostate cancer, urethral strictures, urinary tract infections, etc.

Only an integrated approach, based on the above studies, helps the doctor establish the correct diagnosis and determine further treatment tactics - conservative or surgical, depending on the indications.

Treatment of prostate adenoma

In the initial stages of BPH, in the absence of symptoms of the disease, the patient may be recommended to “active surveillance” with an annual examination and examination by a urologist once a year. Treatment is primarily needed to reduce lower urinary tract symptoms. To achieve this, the urologist has two powerful “options” in his arsenal: conservative and surgical treatment.

Conservative treatment

consists of taking medications. There are two types of medications used in the treatment of BPH: alpha-blockers and 5-alpha-reductase inhibitors.

Alpha-adrenergic blockers - these drugs selectively block alpha1a-adrenergic receptors of the smooth muscles of the prostate gland, bladder neck and prostatic urethra, thereby reducing the tone of the smooth muscles of these organs, improving urine outflow, reducing symptoms of obstruction and irritation of the urinary tract. They are recommended for patients with moderate severity of symptoms (IPSS score 8 or more).

• Tamsulosin* (Tamsulosinum) (Has the greatest selective effect),
• Alfuzosin* (Alfuzosinum),
• Doxazosin* (Doxazosinum),
• Terazosin* (Terazosinum)

Possible side effects:

• From the nervous system and sensory organs: dizziness, headache, asthenia, drowsiness/insomnia.
• From the cardiovascular system: orthostatic hypotension, fainting, palpitations, tachycardia, chest pain.
• From the gastrointestinal tract: nausea, vomiting, constipation/diarrhea.
• From the genitourinary system: retrograde ejaculation, decreased libido, priapism.

Alpha reductase inhibitors block the conversion of testosterone to the more active androgen dihydrotestosterone (DHT). Drugs such as Finasteride and Dutasteride are highly effective in reducing the concentration of DHT both in the blood and in prostate tissue.

Suppression of DHT formation is accompanied by a decrease in the size of the prostate gland, an increase in maximum urinary flow rate and a decrease in the severity of symptoms associated with prostatic hyperplasia.

Unlike alpha-blockers, the effect of alpha-reductase inhibitors develops over several months.

These drugs are more effective in patients with an initially large volume of the pancreas and, with long-term use, reduce the risks of: the development of acute urinary retention and the need for surgical interventions, incl. transurethral resection of the prostate gland. Most men notice improvement after 6 months from the start of treatment.

Possible side effects:

• From the immune system: frequency unknown - hypersensitivity reactions, incl. angioedema (including swelling of the lips, face and larynx).
• From the mental side: often - decreased libido; frequency unknown - depression, decreased libido, which persists after cessation of therapy.
• From the side of the heart: frequency unknown - palpitations.
• From the liver and biliary tract: frequency unknown - increased activity of hepatic transaminases.
• From the skin and subcutaneous tissues: infrequently - rash; frequency unknown - urticaria, itching.
• From the genital organs and mammary glands: often - erectile dysfunction; infrequently - impaired ejaculation, enlargement and tenderness of the mammary glands; frequency unknown - testicular soreness, erectile dysfunction that persists after cessation of therapy, male infertility and/or decreased quality of seminal fluid.

IMPORTANT! When assessing the results of laboratory tests, it is necessary to take into account that in patients receiving treatment with alpha-reductase inhibitors, the PSA content in the blood plasma decreases.

Most patients experience a rapid decline in PSA during the first months of therapy, followed by stabilization.

The initial PSA value established after therapy is approximately half the corresponding value observed before the start of treatment. Thus, in patients receiving treatment for 6 months.

or more, the PSA value should be double the normal value in untreated men.

• Combination therapy - the combined use of alpha-blockers and alpha-reductase inhibitors is recommended for patients with severe symptoms of urinary dysfunction who do not respond to monotherapy.
• Dietary supplements (BAS) or herbal remedies - unfortunately, for most patients, there is currently no evidence of the effectiveness of these substances, and their use is not recommended by professional urological communities.
• Lifestyle changes are used as an addition to basic drug therapy and include the following recommendations:

• Limit fluid intake a few hours before bed.
• Limit caffeine and alcohol-containing drinks
• Try to urinate in stages - after urinating, wait a few seconds and try to urinate again, without straining too much or pressing on the bladder.

Source: https://uroportal.ru/services/giperplaziya-predstatelnoy-zhelezy/adenoma-predstatelnoy-zhelezy-diagnostika-i-lechenie/