A male patient with a PSA index (prostate-specific antigen level) higher than 4 on a blood test was referred to the urology department. “Is this cancer?” he asked nervously.
I explained to the patient, “The PSA number reflects the protein secreted by the prostate. A 4 to 10 index has a 1 in 5 chance of cancer; 10 to 20 a higher chance of cancer. Don’t worry too much though, because the number Higher levels are not necessarily caused by cancer, but can be caused by prostate inflammation or benign prostatic hyperplasia.”
Prostate hyperplasia (hypertrophy) is mostly a natural aging phenomenon and is very common. The most basic tests are urine and blood tests. If there is bacteria in the urine, it means the urinary system is inflamed and can be treated with antibiotics. In addition, a blood test can check for kidney problems that interfere with urination.
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Urine status is also the basis for diagnosis. The normal size of the prostate gland is like a walnut. If it grows, it will compress the bladder and urethra, causing lower urinary tract symptoms. The patient said, “I have had difficulty urinating in recent years. I have to urinate all the time, and I have a sudden urgency. Sometimes urination will be intermittent, dripping, and not clear…” However, the situation of urination is a subjective feeling, and doctors also have methods Objectify the data.
For example, the doctor instructs the patient to keep a “urine diary”, recording the frequency of urination between meals, nocturia, the amount of urine measured by the measuring cup, and whether there is any leakage of urine, etc. Generally, three days are enough. Medically, it is normal to urinate 2 liters and urinate 6 to 9 times a day. Some patients only “believe” that their toilet habits are normal following they have finished their diary, but it is just hypochondriasis. There are also patients who urinate dozens of times a day, hundreds of milliliters each time, which is abnormal and may be related to diabetes or lack of hormones.
In addition, a urine speed test can also help diagnose symptoms. If the urine flow is too slow, it may be because an enlarged prostate is pressing on the urethra. During the examination, the patient can drain the urine into a device with a funnel device, and the flow and intensity of the patient’s urine can be measured. After the test, the doctor can use an ultrasound to check for any urine left in the bladder for further evaluation.
General benign prostatic hyperplasia can be treated with drugs, but if the drug does not work well and the patient has persistent urination problems, further examination is necessary. For example, transrectal ultrasound is to insert the instrument probe from the anus into the rectum, and use ultrasound to measure the size of the prostate, whether there is a tumor, or to observe the residual urine volume in the bladder, whether there are stones, and so on. If the doctor suspects that the patient has bladder disease, it is necessary to perform a cystoscopy (Cystoscopy), which is inserted through the urethra to examine the condition of the urethra and bladder. Finally, if prostate cancer is suspected, a biopsy of prostate tissue is performed to see if there are any cancer cells under a microscope.
After diagnosis, it turned out that the patient had a hyperplasia of the prostate gland. Since the medication failed to improve the problem of urination, he underwent an “electrocution” operation to cure the hyperplasia of the prostate tissue. After the patient was diagnosed with prostate cancer, he was relieved, but he still asked nervously, “Can benign prostatic hyperplasia become cancer?” I replied, “Don’t worry! Prostatic hyperplasia is benign tissue growth, while prostate cancer is abnormal cells. Splitting. There is no absolute relationship between these two diseases, and most benign prostatic hyperplasias are benign and do not cause cancer.”
▲ Wang Mingxi, a specialist in urology.
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Written by: Specialist in Urology, Wang Minghao Hong Kong Medical Center
