Thursday, October 23, 2008

Understanding Prostate Changes: Evaluating Prostate Health

Digital Rectal Examination (DRE)

The standard technique for evaluating the health of the prostate is by a physical examination called a digital rectal exam (DRE). Typically, a patient is asked to bend forward over a table while the doctor inserts a gloved and lubricated finger (called a digit in the medical community) into the patient's rectum. This allows the physician to feel the back portion of the prostate gland. In addition to gauging the gland's size, the doctor is able to evaluate its firmness and texture. The doctor looks for answers to some key questions: Has its usual rubbery feel changed? Are there any hard areas or lumps, which could signal a cancer? Has a growth spread beyond the prostate?

Prostate-Specific Antigen (PSA)

This is a substance produced by cells of the prostate gland. PSA circulates in the blood and can be deducted and measured with a relatively simple blood test. When the gland enlarges, PSA levels rise. PSA levels can also rise if cancer develops.

Generally, doctors consider readings below four nanograms per milliliter (ng/ml) to be normal, scores between four and 10 to be slightly elevated, scores between 10 and 20 to be moderately elevated and anything above that to be highly elevated. Most men with Benign Prostatic Hyperplasia (BPH) have levels of 10 ng/ml or below.

But many factors can influence PSA levels. Some prostate glands naturally produce more PSA than others. PSA scores also tend to increase with age. Another influence on PSA levels is race: PSA levels tend to be higher in African Americans, and lower among Japanese, than in white Americans.

A variety of conditions can raise PSA levels temporarily. These include prostatitis, prostate biopsy and transurethral prostate surgery.

Transrectal Ultrasound (TRUS)

This procedure uses a small probe that is inserted into the rectum. The probe emits and picks up high frequency sound waves. The sound waves bounce off the prostate, producing a pattern that is converted into a video image. Areas of cancer produce a different pattern than healthy tissue. The value of a TRUS is strongly influenced by the quality of the equipment and the skill of the person operating it.

While ultrasound does not provide enough specific information to make it a good screening toll by itself, doctors find it useful as a follow up to suspicious DRE or PSA. TRUS is also used to guide biopsies in sampling abnormal areas of the prostate, to estimate the volume of the prostate for calculating PSA density and to situate radiotherapy implants.

Self Test for BPH

To help patients and their physicians assess the severity of BPH symptoms, the American Urological Association has developed a seven questions index:

Over the past month how often have you:

1.) Had a sensation of not emptying your bladder completely after urinating?
2.) Had to urinate again less than two hours after urinating?
3.) Found you stopped and started again several times during urination?
4.) Found it difficult to postpone urination?
5.) Had a weak urinary system?
6.) Had to push or strain to begin urination?
7.) Had to get up several times to urinate from the time you went to bed at night until the time you got up in the morning?

How to score:

For the first six questions, give yourself a score of 1 for having problems less than one time in five, a score of 2 for having problems less than half the time, a score of 3 for having problems about half the time, a score of 4 for having problems more than half of the time, and a score of 5 for having problems almost all the time.

For the seventh question, give yourself 1 for each time you got up in the night. (If you had to get up five times or more, use 5 for scoring.)

Symptoms are classified as mild if your score totals 1 to 7, moderate from 8 to 19 and severe from 20 to 35.

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