interpret ultrasound results

My father, who is 70 years old, went to have an ultrasound today. Ten
years ago, he was diagnosed with an enlargement of the prostate. His
PSA reading, obtained last week, is 5.25. He's going to see a
urologist next week. I'm curious as to what the ultrasound readings
indicate:

ULTRASOUND OF THE PROSTATE GLAND:

Multiple transverse and longitudinal scan of the prostate gland was
obtained.
Urinal bladder wall is thickened.
Pre void volume: 268cc
Post-void volume: 225cc
Prostate gland is markedly enlarged, inhomogenous with intravesical
extension. It measures 6.9 x 7.3. 6.2 cm (164 grams)

IMPRESSION:
Marked prostatomegaly with inhomogenous parenchyma and intravesical
extension.
Cystitis with markled residual urine.

Do we have to be concern about prostrate cancer here? What is
inhomogenous paranchyma and intravesical extension? Thanks for your
help. I'd appreciate it.

I'm worried about the size. Isn't the size at the high end? Are
ultrasound results accurate as to determining size?

Hello:

I did a quick Google search. "Inhomogenous paranchyma" means that the
tissue is differentiated in color (in the ultrasound), not uniform.
Maybe doctors view it as suspicious?

I'm guessing here, but I think that "intravesical extension" means
that prostate tissue has extended into or against the seminal
vesicles. Seems to be more associated with an enlarged than with
prostate cancer -- but I'm not an md.

It seems to me a little odd that he has not already been seing a
urologist, since he has an enlarged prostate. Who made that
diagnosis?

--charlie

he saw a urologist and had a negative biopsy ten years ago, but has
not gone back since. he just has PSA tests once in a while and took
proscar. he figured it was not a big deal at his age, as long as his
PSA tests came back around 4 and under.

On Mar 16, 4:34 am, "prawned" <bartus...@yahoo.com> wrote...snip...

> Prostate gland is markedly enlarged, inhomogenous with intravesical
> extension. It measures 6.9 x 7.3. 6.2 cm (164 grams)

164 gm is an extremely large prostate, the average is around 35-45
gm. But prostate size determined by ultrasound is fairly crude. A
healthy prostate that size would be expected to express about 0.066*
164 = 10.8 ng/ml of PSA. Below, you mention that he is on Proscar,
that would be expected to cut the PSA roughly in half to about 5.4 ng/
ml. That's pretty close to his 5.25 ng/ml.

Your dad has BPH, I wonder if, even with the proscar, he has trouble
urinating? The urologist will probably due a DRE (digital rectal
exam). If that turns out normal, then concerns about prostate cancer
seem (to me) rather low. If he's not having any problems urinating,
then I'd guess that the urologist will just tell him to keep on doing
what he's been doing. Nice of you to be helping your dad out...Best
wishes and good health, ron

thanks for the inputs, guys. ron, he does have trouble urinating, but
he says its still manageable. he's supposed to take proscar every
day, but he said he has been taking it only every other day in the
past years. now he's back to taking it every day. i really hope
things turn out to be ok.

"prawned" <bartus_ph@yahoo.com> wrote in message
news:1174058043.952348.155550@y66g2000hsf.googlegr oups.com...
> thanks for the inputs, guys. ron, he does have trouble urinating, but
> he says its still manageable. he's supposed to take proscar every
> day, but he said he has been taking it only every other day in the
> past years. now he's back to taking it every day. i really hope
> things turn out to be ok.

Another common drug used when there is difficulty urinating
is Flomax. I think your Dad probably did the right thing to use
as few drugs as he could, but if he has to, Flomax or other
drugs might help him.

There are also surgical procedures that can be done, including
a trans-urethral resection of the prostate, or TURP. As I
understand it, it's a sort of roto-rooter job - terribly unpleasant
to think about, but some men have had great relief from it.

Best of luck.

Alan

my dad went to see the urologist today. the doctor saw the ultrasound
pictures and felt the prostate. he said the prostrate had grown so
big that my father was retaining 80% of his urine. the good news is
that he thinks the prostate enlargement is benign. but he's
recommending an operation to 'scrape' (i dont know the exact term) off
part of the prostrate. if he sees it cannot be scraped effectively,
he will remove it entirely.

i wasn't with them when my dad and mom went to see the doctor. what
serious complications should we be concerned about from this scraping
or removal operation? at his age, my dad still seems to be physically
ok, but for the prostate problem. the doctor however, to be sure, is
asking for a heart checkup.

should we be seeking a second opinion on the operation? are there
alternatives to not having it operated?

On Mar 22, 10:12 am, "prawned" <bartus...@yahoo.com> wrote:

> ...recommending an operation to 'scrape' (i dont know the exact term) off
> part of the prostrate. if he sees it cannot be scraped effectively,
> he will remove it entirely.

That is very lkikely the TURP that Alan Meyer discussed. The urethra
passes through the prostate, so if the prostate gets too big, it puts
enough pressure on the urethra to make urinating difficult or
impossible. A TURP widens the urethra's path through the prostate by
'scraping' away prostate tissue. I believe this is done with electric
cauterization.

In The Prostate Book, Scardino discusses side effects of TURP. Expect
some bleeding afterwards that should abate. Yous father may have some
erectile dysfunction; Scardino does not say whether that's short-term
or long-term. He may also experience retrograde ejaculation, which is
harmless. There are some other side effects that are very rare.

Is it possible for you to be present when your father visits the
doctor? ( I found that I had to do this a couple of times when my
mother was going through pancreatic trouble.) Your questions are
reasonable ones that a patient should be asking, but I know that our
parents are intimidated by doctors in a way that we aren't.

You might wnat to get yourself a copy of a book on the prostate.
Peter Scardino's book is very good; Patrick Walsh's book is good, too,
though it's older -- at least the paperback I just bought has a 1997
copyright. Both are especially right for you because they include
information not only about prostate cancer, but also about other
conditions of the prostate, like BPH or prostatitis.

All the best,

charlie

"prawned" <bartus_ph@yahoo.com> wrote in message
news:1174572721.675909.289560@b75g2000hsg.googlegr oups.com...
> my dad went to see the urologist today. the doctor saw the ultrasound
> pictures and felt the prostate. he said the prostrate had grown so
> big that my father was retaining 80% of his urine. the good news is
> that he thinks the prostate enlargement is benign. but he's
> recommending an operation to 'scrape' (i dont know the exact term) off
> part of the prostrate. if he sees it cannot be scraped effectively,
> he will remove it entirely.
>
> i wasn't with them when my dad and mom went to see the doctor. what
> serious complications should we be concerned about from this scraping
> or removal operation? at his age, my dad still seems to be physically
> ok, but for the prostate problem. the doctor however, to be sure, is
> asking for a heart checkup.
>
> should we be seeking a second opinion on the operation? are there
> alternatives to not having it operated?
>

Sounds like the old adage, "if you have to ask, you can't afford it."

If the "we" includes your father, in other words if he is concerned, then a
second opinion is definitely warranted. No one wants to go through life
wondering if they should have made another choice when a serious side effect
rears its ugly head.



--
PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA <.1 <.1 <.1 .27 .37 .75
EBRT 05-07/2002 @ 47
PSA .34 .22 .15 .21 .32
Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05,
2/06, 6/06
PSA .07 .05 .06 .09 .08 .132 .145
Casodex added daily 07/06
PSA <0.04, <0.05
Non Illegitimi Carborundum

@chasjac
yes i will be with them on a visit to another urologist. thanks for
the book recommendation.

@steve kramer
i would have been straight and said we can't pay for it if we could
not.

> @steve kramer
> i would have been straight and said we can't pay for it if we could
> not.

That was not my concern. My concern was that you were talking about more
than two people and I did not know if it was you and another or you and your
father who were concerned. If he is concerned with the recommendation of
his doc, he should see another for peace of mind.

On Mar 22, 6:12 am, "prawned" wrote:

> should we be seeking a second opinion on the operation?

I believe I would recommend a 2nd opinion anytime a procedure of this
magnitude is involved. That includes
radiation, seeds, surgery.

Medicare does cover a 2nd opinion.

my father's nervous about operations in general. we went to see
another urologist. this doctor did not recommend an operation for now
but wanted to see first if his urine retention problem can be
alleviated by medication. he prescribed xatral for this and
antibiotics for the bladder infection. my father is to come back
after a month and have another ultrasound. i saw my father visibly
relieved.

actually it turns out the first doctor also prescribed xatral and
antibiotics. the first doctor may have thought with the prostrate
having grown as large as it is, my father would need an operation
anyway down the road that he might as well have it now while he
appears to be healthy. he even said my father's prostrate should have
been scraped years ago. personally, if it turns out both urologists
agree he needs an operation, i prefer the first urologist who's more
senior and has more surgical experience. i'd appreciate any thoughts
on this. thanks.