Diagnosing a Median Lobe
Posted , 11 users are following.
I am wondering what methods are available for diagnosing a median lobe. From some limited research that I've done, it appears that 3T multiparametric MRI is a very good method. I have had both transabdominal ultrasound (TAUS) and a transrectal ultrasound (TRUS). No mention of a median lobe was mentioned in the written results from the TAUS. I've had two urologists look at the TRUS picture and neither one would say that I have a median lobe issue. One urologist did note, however, that the prostate is "displacing" space that the bladder would occupy (i.e. it looks like it is pushing into the bladder but the prostate in that area has an apparent shape like it is part of a sphere as opposed to a knob pushing into the bladder. I say apparent because on the ultrasound photograph where the median lobe would be, it is pretty much black and you have to estimate (draw a connecting line) to estimate where the lobe is. Both uros seemed to think that this "black area" was the normal result of a TRUS.
Any thoughts? My symptoms seemed to have improved somewhat since I've been taking alfuzosin and dutasteride for 4 months. I have not had a PSA test in that time (post BPH drug result should be low due to the dutasteride) nor have I had a repeat TAUS or TRUS.
I'm due for a checkup in December or early January. That will be about 5 months since starting the BPH drugs. In the past, PSA tests have been part of my normal checkup with my GP, so I think I'll insist that a PSA test be done. I might request a TAUS to see if there is any change in size. TAUS is very easy to do and I could compare the result prior to taking the BPH pills with one about 5 months later.
Does this seem like a reasonable plan? A 3T MRI (with and without contrast) would cost somewhere around $1200 to $1400. I can afford it, I'm just not sure if I should have one at this time.
0 likes, 12 replies
hank1953 rdemyan
Posted
My uro seemed to think that he can find out with cystoscopy during Urolift. I refused the Urolift so I never did find out that I have median lobe or not. Hank
lew82832 hank1953
Posted
Why did you refuse the Urolift I am scheduled to get one in a few weeks, that is why I want to know.
Lew
hank1953 lew82832
Posted
https://patient.info/forums/discuss/urolift-limitations-in-urinary-retention--682242
Urolift selling point is very low risk of sexual side effects. Other than that, it is minimally effective, therefore only good for patients with mild symptoms.
hank1953 rdemyan
Posted
Some one posted here that three out of four BPH sufferers have large median lobe. Is this is true or not ? Hank
Lvscott hank1953
Posted
No, median lobe is a small minority - not quite 50%
Lvscott rdemyan
Posted
Ya, cystoscopy is definitive way to detect this. Pelvic ultrasound can easily detect a median lobe as well, along with a TRUS.
glenn77 rdemyan
Posted
A flexible cystoscopy is the standard way. Ask the doctor whether they have a screen set up for easy viewing by the patient. My fist urologist had 50 year old equipment, with a small raster screen on a rolling cart about two ft beyond my head, so I had to painfully crane my neck to try to see it. My current urologist at Wake Forest Baptist Health in Winston-Salem has two large flat screens, one positioned for the patient to see.The procedure there was done in a manner that was totally comfortable.
uncklefester glenn77
Posted
Sounds like went to my first uro. To matters worse he tells me I can can watch on the screen behind my head. Then he says to his assistant the screen isn't on. She said, "It hasn't worked in weeks" I found a new uro after that episode
j12080 rdemyan
Posted
Just wrote you my 2 cents worth but it got stopped by moderator.
I would do the contrast. In fact I am doing my follow up MRI next week from my procedure 2 years ago.
If your doctor writes the order for the imaging center correctly, your insurance should cover it. If you have medicare now it will absolutely cover it.
Please consider if you do the MRI the Siemens Skyra 3T mri is the best on the market. You should also seek and find an imaging center that has and will use a body or pelvic coil (same thing) which is nothing more than a small blanket that lays over your lap while you are in the MRI. The other option is a rectal coil that is inserted into you for the 30 to 40 minutes on the table. Not near as comfortable and the rectal coil really is less accurate as it will touch and push against the gland which can and does distort the film. So the pelvic or body blanket coil is the best for both reasons.
I would send the results to a Interventional radiologist who is specializing in the prostate treatments for cancer and BPH. In my prior email I gave you the name but the moderator does not like that so I will have to email you. Your MRI can be uploaded from the CD they give you from you computer with the touch of one button on the web site that I sent you. This doctor does not charge to discuss or reveiw and evaluate the MRI. You do not have to commit to anything and there is know pushing on you for anything It is just education of your specific situation. Sorry the email did not make it but that's the way they are.
I will PM you the details for your consideration if you are interested. If you have questions, you are welcome to PM me back.
Good luck I know what your are going through and the 3T MRI is the best way to go if the right specialist is evaluating it you will gain a lot of data.
Lvscott j12080
Posted
You must be referring to Dr.K and FLA :"
emil54651 j12080
Posted
MRI 3 T is a very good thing to do, I agree. It helped me a lot when taking decisions about what to do. I definitely recommend it as well! Gives a lot of information!
j12080 Lvscott
Posted
yes i am