Prostate Enlargement

Age-related Prostate Enlargement or Prostate Cancer?

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It is generally advisable for men with prostate enlargement and elevated PSA levels to have their prostate glands examined by a doctor. The combined occurrence of prostate enlargement and elevated PSA levels in men above the age of 50 may be related prostate cancer.

Malignant Prostate Enlargement

Prostate enlargement is a common occurrence in men as they grow older. The enlargement results from the development of benign nodules (adenomas) in the center (or periurethral region) of the prostate gland. This very common enlargement is not necessarily a cause for concern, unless it is accompanied by the independent development of malignant tissue lesions hidden among the many nodules. This, however, is a far less common occurrence given that most malignant tumors develop in what is referred to as the peripheral zone of the prostate. This peripheral zone can, however, become compressed by the enlargement of the central region. If prostate enlargement is accompanied by an elevated PSA level, then it will be essential to determine whether prostate cancer may be playing a role in the changes. While ultrasound does not provide an especially reliable means of visualizing tissue changes in the prostate, and is therefore not well-suited to the task of distinguishing between benign and malignant tissue, the MRI procedure we use enables us to detect even the smallest of tissue changes and therefore to distinguish between benign and pathological tissue structures.

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Benign Prostate Enlargement

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Benign prostate enlargement – also referred to as benign prostatic hyperplasia or BPH – is a common disorder in middle-aged men that is caused by the growth of benign nodules (adenomas) in the prostate. As the condition worsens, the growth in the prostate may begin to compress the urethra and the bladder, thereby interfering with the normal flow of urine and causing various symptoms such as a continuous urge to urinate. The cause of the benign nodules or growths is thought to be related to the accumulation of certain hormones and a reduction in the ratio of testosterone to estrogen.

Symptoms

Prostate enlargement takes place very gradually. This is why the change usually goes unnoticed in the beginning and why the condition is generally not diagnosed until symptoms appear. The first signs of enlargement include a weak or slow urinary stream and the need to get up at night to urinate (nocturia). The compression of the urethra that comes with prostate enlargement ultimately leads to general urinary dysfunction, including urinary hesitancy, incomplete urination, urinary tract infections and urinary retention. Moreover, as the bladder muscle is forced to work harder to expel urine, it tends to become thicker and overly sensitive before ultimately weakening.

Diagnosis

The conventional approach to diagnosing prostate enlargement involves the use of ultrasound. However, although an ultrasound examination will enable your doctor to measure the size of the prostate, it will usually not provide critical information relating to the presence of conspicuous changes in the tissue structure. This is why we use MRI (magnetic resonance imaging) to examine the prostate. MRI allows us to measure the prostate, determine the location of the benign nodules, demarcate these benign nodules from any conspicuous tissue structures and evaluate the orientation of the prostate in relation to neighboring structures such as the urinary bladder.

MRI and PSA Testing

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MRI enables us to distinguish between the nodules that cause benign prostatic hyperplasia and other conspicuous tissue structures that could be related to cancer. Special measuring techniques are used to evaluate the status of the prostate tissue. In addition to this, patient PSA levels are tested along with other blood parameters that may be important when it comes to assessing the prostate. Abnormal blood test results and MRI scans, which permit the detection of conspicuous areas of tissue, are crucial when it comes to arriving at a proper diagnosis. The detection of a conspicuous area of tissue provides a sound basis for performing a biopsy (the removal of a tissue sample) of the affected area. At our clinic, we use MRI to guide the biopsy procedure. This allows us to make sure that the tissue sample is removed directly from the conspicuous area in question. When performing our MRI-guided prostate biopsy, we enter the prostate through an incision in the perineum and do not pass through the wall of the rectum. Using this access route makes it unnecessary to administer antibiotics prior to the procedure because no intestinal bacteria are allowed to enter the prostate.

(-> For more information, please refer to prostate biopsy)

Treatment of Benign Prostatic Hyperplasia

Prostate enlargement can usually be treated quite effectively using conservative means (e.g. the administration of medication). However, if the symptoms (e.g. continuous urge to urinate) diminish the patient’s quality of life too greatly, it may be necessary to perform surgery. A broad range of new, minimally invasive procedures is available.

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Pathologie Partner

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33602 Bielefeld
Tel: +49 521 260 555 44
Fax: +49 521 260 555 14
info@alta-klinik.de

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Reinhardtstr. 23-27
10117 Berlin
Tel: +49 30 814 501 8118
Fax: +49 30 814 501 8119
berlin@alta-klinik.de

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