Prostate Disease Diagnosis
The prostate gland is situated between the penis and the urinary bladder, just in front of the rectum. The urethra traverses through the mid portion of the prostate, extending from the urinary bladder to the penis, allowing excretion of urine from the body.
The prostate gland is found only in men. It forms part of the male reproductive system and releases a fluid that protects and nourishes sperm. This fluid is secreted into the urethra and is discharged along with sperm as semen during ejaculation.
In young men, the prostate is about the size of a walnut. The gland increases in size during puberty and attains its full size during the early twenties and remains stable thereafter. Sometimes, between the ages of 40 and 45, the cells in the prostate gland undergo multiplication and cause the gland to further enlarge, which in turn presses against the urinary bladder and urethra, causing problems during urination.
Some of the common problems include:
- Benign Prostatic Hyperplasia (BPH) – More common in elderly men causing dribbling after urination and urinary frequency especially at night.
- Prostatitis – Inflammation of the prostate usually caused by bacterial infection
- Prostate Cancer – Abnormal growth of the prostate caused by uncontrolled cell division
Signs and Symptoms of Prostate Disease
Some of the common signs and symptoms associated with prostate problems include:
- Lower urinary tract symptoms (LUTS) are common in elderly men. Symptoms include increased frequency and urgency, hesitancy, poor stream, sporadic flow, and straining during urination.
- International prostate symptom score (IPSS) questionnaire helps urologists to better analyse the severity of LUTS. A total score of 0-7 is considered mildly symptomatic; 8-19 moderately symptomatic; and 20-35 severely symptomatic.
- Acute urinary retention is a urological emergency characterized by the sudden lack of ability to pass urine.
- Chronic urinary retention symptoms appear infrequently and are similar to LUTS. There is difficulty with urination and symptoms may include a weak flow, increased frequency, and dribbling. The discomfort is often mild when compared to AUR.
- Infection & bleeding: Inflammation of the prostate is known as prostatitis. Acute prostatitis is a condition caused by bacterial infection of the prostate. Bleeding is often a common symptom of an enlarged prostate and/or urinary tract infection. It can also be a sign of advanced prostate cancer.
- Prostate cancer is one of the most common types of cancers found in men where abnormal cells grow out of control in the prostate gland. It may be confined within the gland or may be aggressive and spread to other parts of the body and cause serious complications.
The chances of a successful treatment are better when prostate diseases are detected in its early stages.
Diagnosis of Prostate Disease
Prostate-Specific Antigen (PSA) Test: Prostate-specific antigen (PSA) is a protein produced by cells of the prostate gland. The PSA test is a blood test that measures the level of PSA in the blood. It is normal for men to have a low level of PSA in their blood. However, prostate cancer or benign (non-cancerous) conditions can increase a man’s PSA level.
PCA3: PSA levels are not specific for prostate cancer and some cancers in patients with normal PSA levels can go undetected. Serum PSA levels can be influenced by several factors such as the amount of BPH tissue, age, inflammation, and medications whereas PCA3 scores are not affected by these factors. The urinary PCA3 test is a new cancer marker test with greater prostate cancer specificity than PSA testing.
USG/transabdominal- transrectal (used for biopsy): Transabdominal and transrectal ultrasonographies are used as standard clinical methods to evaluate the prostate. Ultrasonography uses high-frequency sound waves to create video or photographic images of body tissues. A transabdominal ultrasonography is performed externally. During this procedure, the surgeon applies a special gel on the patient’s abdomen and a small handheld probe known as a transducer is moved over the abdomen. The sound waves from the transducer are viewed as images on a monitor. Transrectal ultrasonography involves a probe that is inserted a short way into the patient’s rectum. It forms images on a monitor and helps the surgeon perform a prostate biopsy by guiding several small needles through the wall of the rectum to the abnormal areas of the prostate.
Nuclear Bone scan: A bone scan is an imaging test that detects areas of increased or decreased bone metabolism. Bone scans assist in identifying tumours, infection, or fractures. The radiopharmaceutical most commonly used is 99mTc-Medronate (MDP). MDP is injected into a vein, usually in the arm, where it is transported by the bloodstream to the bones.
CT (Computed Tomography): A CT scanner uses a series of X-ray beams to build up images of the body in slices. The CT scanner emits a succession of narrow beams of radiation as it moves through an arc. The X-ray detector within a CT scanner can see hundreds of different levels of density within the organs of the body including the tissues. A computer uses this information to work out the relative density of the tissues examined and finally processes the results displaying them as a two-dimensional picture on a monitor.
MRI (Magnetic Resonance Imaging): MRI is a way of getting pictures of various parts of your body without the use of X-rays. Unlike X-rays and computed tomographic (CT) scans, which use radiation, MRI uses powerful magnets and radio waves. A radio wave antenna is used to send signals to the body and then receive signals back. These returning signals are converted into pictures by a computer attached to the scanner. Pictures of almost any part of your body can be obtained at almost any particular angle.