Diffuse changes in prostatic parenchyma: signs, treatment

Pathological disorders in the prostate tissue can be detected only when it is visualized during ultrasound examination, and they are defined as diffuse changes in the prostate gland.

According to the nature of these changes, taking into account the presence of symptoms, one or another disease of the male genitourinary system is diagnosed.

[1], [2], [3]

Epidemiology

According to the information provided by the American National Institutes of Health, 5-10% of men face prostatitis, and cysts - often as a result of prostatic inflammation - are detected in 10-20% of patients.

According to the European Association of Urology, diffuse changes in the prostate gland with calcifications are found in about 25% of men aged 20-40 years. According to other data, calcification is present in almost 75% of middle-aged men, as well as in 10% of patients with benign prostatic hyperplasia (adenoma). This disease is diagnosed at the age of 30-40 years in one patient out of 12; about a quarter of 50-60-year-olds and three men out of ten are 65-70 years older. Clinically significant adenoma occurs in 40-50% of patients.

The risk of prostate cancer is threatened by 14% of the male population. In 60% of cases, oncology is defined in men who have crossed the 65-year-old line, and rarely at the age of 40. The average age at the time of diagnosis of prostate cancer is about 66 years.

[4], [5], [6], [7], [8], [9], [10], [11]

Causes of the diffuse changes in the prostate

The main causes of diffuse changes in the prostate gland are associated with long-term inflammatory processes in the parenchyma caused by urogenital infections (chlamydia, gonococcus, ureaplasma, Trichomonas, etc.).

To the development of diffuse changes of glandular, fibrous or muscle tissues of the prostate are also implicated:

• violations of intracellular metabolism;
• deterioration of blood circulation in the prostate and trophism of its tissues;
• replacement of glandular tissues fibrous in the process of age-related gland involution with the development of  sclerosis of the prostate;
• Malignant neoplasms and  metastases to the prostate.

Calcifications in the degeneration of prostate tissue with the formation of calcified (calcified) sites in it according to the results of ultrasound are defined as diffuse changes in the prostate gland with calcinates. And when visualizing cysts formed due to increased secretion and stasis, ultrasound diagnostics detect diffuse focal changes in the prostate gland.

Distinguish such types of morphological diffuse changes in the prostate gland, as:

• atrophy - a limited or widespread decrease in the number of cells and volume of the gland with a decrease in its secretory and contractile function;
• hyperplasia - an increase in the total number of cells due to their proliferation;
• dysplasia - abnormal modification of tissue with a violation of the phenotype of cells.

Atrophic processes occur for a sufficient long time and can look like diffusively heterogeneous changes in the prostate gland.

Benign prostatic hyperplasia or prostate adenoma is an age-related disease in which there is an increase in the number of stromal and epithelial cells, which leads to the formation of large isolated nodules, most often localized near the passing urethra. And this can be determined in the description of the ultrasound image as diffusely nodal changes in the prostate gland. More in the publication -  The causes and pathogenesis of prostate adenoma

The most unfavorable option is dysplasia, and such diffuse changes in the structure of the prostate gland - depending on the degree and stage of changes at the cellular level - are divided into mild, moderate and severe. The first two types, as a rule, indicate a prolonged inflammatory process -  chronic prostatitis, which is accompanied by swelling of the tissues and can lead to an abscess, but can also regress under the influence of therapy. But a significant modification of prostate cells oncologists are regarded as a precursor of the development of basal cell carcinoma or  adenocarcinoma of the prostate gland.

[12], [13], [14],

Risk factors

Risk factors for diffuse changes in the prostate gland include inflammatory urogenital infections; injuries of testes (testicles); alcohol abuse; parasitic diseases; pathology of the thyroid gland and pituitary gland; chemotherapy and radiation therapy of oncology of any localization; the use of certain pharmacological drugs (anticholinergic, decongestants, calcium channel blockers, tricyclic antidepressants).

There are data confirming the relationship of prostatic hyperplasia with the metabolic syndrome: obesity, type 2 diabetes, high blood triglycerides and low-density cholesterol, as well as hypertension.

But the main risk factor experts call age and associated testicular atrophy and lower testosterone levels - produced by testicles male sex hormone. The age-related decline in testosterone production begins at 40 years-about 1-1.5% per year.

[15]

Pathogenesis

The pathogenesis of diffuse changes in the prostate gland in prostatitis is caused by the infiltration of prostate tissues with lymphocytes, plasma cells, macrophages and products of inflammatory tissue decay. A purulent melting of the areas of inflamed glandular tissue leads to the formation of cavities filled with necrotic masses, and their subsequent scarring, that is, the replacement of normal fibrous tissue.

The prostate gland is an organ dependent on androgenic steroids. With age, the activity of aromatase enzymes and 5-alpha-reductase increases, with the participation of which the transformation of androgens into estrogen and dihydrotestosterone (DHT, more potent than its predecessor, testosterone). Metabolism of hormones leads to a decrease in testosterone levels, but increases the content of DHT and estrogen, which play a key role in the growth of prostate cells.

In elderly men, the pathogenesis of diffuse changes in the parenchyma of the prostate gland is associated with the replacement of glandular connective tissue with the formation of single and multiple fibrous nodes, as well as with the pathological proliferation of the stroma of the prostate acinus.

Diffuse changes in the prostate gland with calcifications appear due to tissue degeneration and the deposition of insoluble fibrous proteins (collagens) and sulfated glycosaminoglycans in them. Calcinates can also be formed because of the deposition of the secretion of the prostate in the parenchyma. Calcification is noted in a third of cases of atypical adenomatous hyperplasia and in 52% of cases of adenocarcinoma of the prostate gland. A later stage of calcification is the formation of stones that can be asymptomatically present in healthy men.

Diffusive focal changes in the prostate gland in cysts are detected by chance and, according to urologists, the mechanism of their appearance is associated with atrophy of the prostate gland, its inflammation, obstruction of the ejaculatory duct and neoplasia.

[16], [17], [18], [19], [20]

Symptoms of the diffuse changes in the prostate

According to experts, it should be understood that the symptoms of diffuse changes in the prostate gland can be manifested only as a symptom of those diseases in which they were detected during an ultrasound examination.

In most cases, the first signs of prostatitis, in which ultrasound can be detected moderate diffuse changes in the prostate gland, manifested by chills and more frequent urination. Very quickly urination becomes painful - with a burning sensation or a cut; patients are forced to go to the toilet at night, and the pain begins to seize the groin, lumbar and pubic area. Frequent symptoms are general weakness, increased fatigue, as well as joint pain and myalgia.

In the case of diffuse changes in the prostatic parenchyma associated with prostate adenoma, urination in the first place is also impaired, with imperative urges (including at night) increasing, in spite of the considerable tension of the abdominal muscles, the urine is removed with difficulties (the decrease in the muscular pressure on the muscle of the bladder affects) , and the process of urinary excretion does not bring the expected relief. No less unpleasant symptom is enuresis.

According to doctors, diffuse changes in the prostate gland with calcinants usually do not cause symptoms, and many are not even aware of their presence. Stones become problematic and can lead to prostatitis, if they are a source of repeated inflammation. Even if the patient takes antibiotics, the obstruction of ducts in the gland remains, and thus the inflammatory process continues and can lead to the appearance of symptoms of prostatitis.

[21]

Complications and consequences

All of the above diseases with diffuse changes in the prostate gland can cause effects and complications in the form of:

• chronic ishuria (urine retention);
• cystitis and / or pyelonephritis;
• an abscess with a risk of developing sepsis;
• fistula formation;
• protrusion of the wall of the bladder (diverticulum);
• urolithiasis;
• atrophy of the renal parenchyma and their chronic insufficiency;
• problems with erection.

[22], [23], [24], [25]

Diagnostics of the diffuse changes in the prostate

In fact, the diagnosis of diffuse changes in the prostate gland is the detection of pathologically altered tissues with the help of  transrectal ultrasound, which allows to evaluate the structure and dimensions of this organ, as well as homogeneity / heterogeneity, density and degree of vascularization.

A correct diagnosis of prostate diseases is impossible without a visual display of the state of its tissues, determined on the basis of their different acoustic density (echogenicity) - the degree of reflection of ultrasonic waves directed by a pulsing ultrasonic signal.

There are certain echoes of diffuse changes in the prostate gland.

Absence of pronounced diffuse changes is defined as isoechoinality, which appears in the echographic image in gray.

The inability to repel ultrasound, that is, anaehogenicity, is inherent in the cavity formations, in particular, the cysts: on the echogram there will be a uniform black spot in this place. The same will be the "picture" in the presence of an abscess, only in combination with a weak reflection of ultrasound - gipoehogennostyu (giving dark gray images).

In most cases, gipoehogenicity is evidence of inflammatory processes, as in acute inflammation of the prostate gland. Also, diffusively heterogeneous changes in the prostate gland with hypoechoence zones are visualized if there is swelling of the tissues, calcification or replacement of the glandular tissues with fibroids.

But the hyperechoic state - clearly reflected by the equipment reflection of ultrasonic waves in the form of white spots - gives grounds to diagnose stones or chronic prostatitis.

It should be remembered that the criteria for ultrasound diagnosis can not unequivocally confirm or refute the diagnosis: they only inform the doctor about the structural and functional state of the prostate gland. Correct diagnosis includes rectal examination of the prostate (palpation); blood tests (general, biochemical, prostate cancer), urine, seminal fluid.

In addition, other instrumental diagnostics are also used: mikrozionnaya US-cystourethroscopy, uroflowmetry, dopplerography,  computed tomography of the prostate, MRI.

[26], [27], [28], [29], [30]

Differential diagnosis

Based on the results of transrectal ultrasound and a set of all studies, differential diagnostics is carried out, because with the identity of the clinical manifestation, it is necessary to distinguish the same chronic form of prostatitis from adenocarcinoma, bladder cancer or a neurogenic bladder in Parkinson's disease or multiple sclerosis.

Treatment of the diffuse changes in the prostate

Once again, we are not treating the diffuse changes in the prostate gland, but the diseases diagnosed with ultrasound and the resulting echographic images.

That is, the treatment of prostatitis, benign prostatic hyperplasia (adenoma), sclerosis of the prostate, adenocarcinoma, etc. Is prescribed. Medications used in the treatment of prostate inflammation are described in detail in the publication -  Treatment of chronic prostatitis, as well as in the material -  Tablets from prostatitis

With benign prostatic hyperplasia, the main drugs include α-adrenoblockers Tamsulosin (Tamsulide, Hyperprost, Omsulosin, etc.), Doxazosin (Artesin, Kamiren, Urokard), Silodozin (Uorek). As well as anti-androgenic drugs Finasteride (Prosteride, Urofin, Finpros), Dutasteride (Avodart) and others, which reduce the activity of 5-alpha-reductase,

Tamsulosin is prescribed for one capsule (0.4 mg) - once a day (in the morning, after eating), if there are no problems with the liver. Among the side effects are weakness and headache, increased heart rate, tinnitus, nausea, intestinal disorders.

The drug Finasteride (in tablets of 5 mg) should also be taken once a day - on a tablet. There may be side effects in the form of a depressive state, temporary erectile dysfunction and allergic skin reactions.

Doctors recommend Vitaprost (tablets and rectal suppositories) and  Palprostes  (Serpens, Prostagut, Prostamol), containing the extract of palm fruits Sabal serrulata.

Uses this plant and homeopathy: it is part of the multi-component Gentos (in the form of drops and tablets), take it for two to three months three times a day - one tablet (under the tongue) or 15 drops (inside). The main side effect is increased saliva.

If prostate cysts do not cause inflammation, then monitor the patient's condition and recommend taking vitamins. But, if the size of the cyst is such that urination is impaired, the procedure for sclerosing is shown.

How is prostate cancer treated, read in  Prostate Cancer

In the presence of inflammation or adenoma of the prostate can improve the condition of physiotherapeutic treatment: UHF, rectal electrophoresis, ultrasound and magnetotherapy, massage.

Surgery

In diseases of the prostate gland, in particular prostate adenoma, surgical treatment can be used in cases of ineffectiveness of drug therapy. Surgical methods used include laparoscopic transurethral (through the urethra) resection of the prostate and laparotomic adenomectomy with access through the bladder.

Minimally invasive endoscopic methods include radio wave needle ablation (transurethral), laser prostate encolement, electro- or laser vaporization, microwave thermocoagulation.

Alternative treatment

Perhaps the most well-known alternative treatment for prostate pathologies is the use of pumpkin seeds containing a complex of vitamins with antioxidant properties, omega-6 fatty acids, and lignans, which stimulate the synthesis of hormones.

Among the effective natural remedies are turmeric, green tea, as well as lycopene-rich tomatoes and watermelon.

On the means of complementary medicine, recommended for benign prostatic hyperplasia, read -  Alternative treatment of prostate adenoma

It will help to reduce the intensity of some symptoms with the treatment of herbs: infusions and decoctions from the roots of the nettle, daisy flowers of the chemist's and calendula officinalis, yarrow herbs and sypetroid spray.

[31], [32], [33], [34],

Prevention

To date, the prevention of prostatitis and other diseases in which diffuse changes in the prostate gland are not developed. Although general provisions for a healthy lifestyle (without alcohol, smoking, lying on the couch and obesity), no one has canceled.

Also, studies conducted in China, confirmed the assumption of the influence of protein foods on the development of prostate adenoma. Among men over 60 who live in rural areas and consume more plant products, the percentage of prostate gland diseases is much lower than among urban dwellers of the same age who consume a lot of animal proteins (red meat) and animal fats (including dairy products).

[35], [36], [37],

Forecast

The prognosis of the visualized diffuse changes in the prostate gland depends entirely on the success of the treatment of diseases in which these changes were detected on ultrasound.

It should be borne in mind that the risks of malignancy and the occurrence of oncology in hormone-dependent organs are much higher.

[38], [39], [40]