What test is done to determine the size of a prostate

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HI guys,

Often on this forum , different options are discussed for BPH, and it would seem that prostate size and medium lobes are some of the things that determine what procedure may be effective .

My question is, what test reveals this information . To date i have several DrE's , PSA test , a bladder and renal ultrasound plus a urodynamics study ( which diagnosed a severe bladder obstruction). I have not been told what size my prostate is or any mention of a medium lobe .

I am due to have a cystoscopy later this month and hope to have a procedure after that, that does not result in RE.

Will the cystoscopy enlighten me with the prostate size etc ? so that i can make an informed decision on what procedure will be best for me.

Alpha blockers have stopped working for me and i am currently self cathing , which i do mot wish to continue with .

many thanks

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18 Replies

  • Posted

    My understanding is that MRI is the most accurate followed by TRUS. I have not had an MRI (can't get it approved, but might pay for it myself), but here are my results from various methods:

    DRE - 40 grams

    Transabdominal ultrasound (TAUS) - 145 grams

    Transrectal ultrasound (TRUS) - 99 grams

    Do not under any circumstance trust an estimate resulting from a DRE.

    Perhaps others can chime in regarding MRI. I think it needs or should be a 3T MRI, but I'm not sure if this is required for sizing. It is required if you want to pursue FLA.

    Good luck.

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  • Posted

    Get a pelvic ultrasound for prostate which would show size of prostate and any obstruction. You do not have to have a full bladder like the TRUS (Transrectal ultrasound).

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    • Posted

      Hi joseph

      Thank you for replying . I have had an ultrasound that checked kidney function , and bladder and i thought it looked at the prostate as well , i'll need to check that . Result was " no abnormalities " i did have a pelvic MrI 3 years ago plus a biopsy that turned up chronic prostatitis but i guess that was too long ago . what i find so so frustrating is different urologists suggest different things . After my utodynamics in march the UrO said if alpha blockers stop working then a BNi was my only option . Thats fine but causes RE.

      My latest URO, disagreed with that and hence the cystoscopy . With so many different surgical options out there with irreversible side affects i want to know the procedure is suitable for me . This forum is so helpful and my thanks for everyones help and replies

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  • Posted

    You are right the best is MRI or other CT scan and you don’t need a 3T MRI, which gives better images of soft tissue. Standard MRI scan (around $2000 in US) or CT scan with urography will give you the size of the prostate in 3D with accuracy of 1 mm approximately. The formula for calculating of the volume is 0.5abc cm^3 or g, where a,b,c -sizes of prostate in all three directions that radiologist reports after reading the images. Acuracy of this calculation is approximately 0.2a^2 and depends on the size of prostate a. Assuming a large prostate with size 6 cm, accuracy from a CT/MRI scan will 7-10 g. Many research papers show that TRUS is much less accurate than MRI calculations contrary to what most URO believe because Simmens wants them to buy expensive TRUS equipment. Cost of TRUS is around $2000 with radiologist readings. DRE is definitely the worst and shouldn’t be used at all in our day and time. Don’t trust your URO or GP who claims he has a magic calculator in his finger.

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  • Posted

    i agree the MRI gives the best results on size including the size of each lobe. It will also give you information on the bladder and the extent the medium lobe is pushing into the bladder wall. If you have contrast the image will also indication areas in the soft tissue that might be cancer as well as issues with the bladder wall and maybe the lower colon. The CT scan can give you a pretty good size estimate and with contrast show all the blood vessels which gives some additional information. I know nothing about the cost of CT scan, but I did research in Florida where I could have a 3T-MRI scan done. There are quite a few scan centers in Florida and self pay prices are all over the place. I settled on one in Sarasota, Florida. The cost for a 3T-MRI without contrast was 500 dollars and with contrast it was 700 dollars. The director of the center was the person reading the scans and he went over the scan with me two hours after with the results and I got a detail written report which included the size of each lobe. He showed me where my medium lobe was protruding into the bladder and the wall of the bladder was slightly thicker than it should be as well as other structures in that area. I had the scan done at my expense to determine locations where a biopsy would need to be focused. These prices are from a year ago.

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  • Posted

    The good thing about a cystoscopy is that it will show for certain if you have a median lobe or not. Median lobes tend to be the main culprit for BPH symptoms. 95% of men with BPH have median lobes and even if their prostate size is reasonable they can still not pee on their own due to this lobe blocking the bladder neck. In my case I have a 300 gm prostate but my cystoscopy showed I did not have a median lobe so I can still pee on my own but I still need to CIC every day to help my bladder.

    A cystoscopy also goes into your bladder and shows the condition of your bladder wall as well as any bladder stones and other issues. So it is a good test. It also shows the urologist the condition of your urethra and any strictures. It does not show the size of your prostate which is best done with just an abdominal ultrasound.

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  • Posted

    no the scope wont determine. get an mri for exact size. look at pae if youre larger than 90cc. no re or other side effects

    thanks

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  • Posted

    Get a 3 Tesla MRI with contrast. You can get size; and the density reading and this math can give you the PSA reading in line. My PSA was 7.4 and not high or out of line for my size and density. With MRI you can also be confident you have no cancer as they will see any lesions. Then if lesion detected, you can have a single needle focal biopsy done not that 12 needle random BullSh**. Also with this same MRI a specialized Interventional Radiologist can look at your bladder, and the whole prostate along with the condition of the urethra for any reasons (like stricture where pinched by tissue) for the restricted urine flow. And for the size of the median lobe and is it pushing into the bladder.

    Of course, the Urologist is NOT who does any of this with an MRI it is a Prostate specialist who is an I.R. M.D. and there are about 5 of these that specialize in the prostate. If you want some names I will get them to you with personal message.

    The one I use will not charge you for this if you go locally and get the 3 T MRI in your area. He allows you on his web site to up load the disc and then he would call you and walk you through what is your actual condition. In none of this do they insert anything into the penis. I loved that part of it. After you know exactly what you have, you can then look at the multiple of procedures that you may be able to use. Again, your urologist will not lead you this way. but it is the best and most conclusive. Insurance will cover the MRi if orders are call in correctly. But do insist on the 3TMRI with contrast and find someone who uses a pelvic coil not a rectal coil if you can. The rectal is not bad but the pelvic just lays across your pelvis like a blanket.

    There you go. You as for comment on options and I did this 2 years ago and then successfully treated my BPH after nine years of suffering.

    Knowledge is power.

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  • Posted

    Thanks everyone , some excellent advice and much appreciated

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  • Posted

    What alpha blocker and at what dose are you taking that no longer helped ? Hank

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