Diffuse changes in the parenchyma of the prostate gland: signs, treatment

Pathological disorders in prostate tissue can only be detected by visualizing it during an ultrasound examination, and are defined as diffuse changes in the prostate gland.

Based on the nature of these changes, taking into account the presence of symptoms, a particular disease of the male genitourinary system is diagnosed.

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Epidemiology

According to the American National Institutes of Health, prostatitis affects 5 to 10% of men, and a cyst – often as a consequence of inflammation of the prostate gland – is detected in 10-20% of patients.

According to the European Association of Urology, diffuse changes in the prostate gland with calcifications are present in approximately 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; in about a quarter of 50-60-year-olds and in three men out of ten over 65-70 years. Adenoma becomes clinically significant in 40-50% of patients.

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

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Causes diffuse changes in the prostate gland

Urologists associate the main causes of diffuse changes in the prostate gland with long-term inflammatory processes in its parenchyma caused by genitourinary infections (chlamydia, gonococci, ureaplasma, trichomonas, etc.).

The development of diffuse changes in the glandular, fibrous or muscular tissues of the prostate is also associated with:

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

Calcifications during degeneration of prostate tissue with the formation of calcified (calcified) areas in it are determined by ultrasound results as diffuse changes in the prostate gland with calcifications. And when visualizing cysts formed due to increased secretion production and its stagnation, ultrasound diagnosticians state diffuse focal changes in the prostate gland.

There are the following types of morphological diffuse changes in the prostate gland:

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

Atrophic processes occur over a fairly long period of time and may appear as diffusely 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 urethra passing through it. And this can be defined in the description of the ultrasound image as diffuse nodular changes in the prostate gland. More details in the publication - Causes and pathogenesis of prostate adenoma

The most unfavorable variant is considered to be 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 long-term inflammatory process - chronic prostatitis, which is accompanied by tissue swelling and can lead to an abscess, but can also regress under the influence of therapy. But significant modification of prostate cells is regarded by oncologists as a harbinger of the development of basal cell cancer or adenocarcinoma of the prostate gland.

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Risk factors

Risk factors for diffuse changes in the prostate gland include genitourinary infections that cause inflammation; testicular injuries; alcohol abuse; parasitic diseases; thyroid and pituitary pathologies; chemotherapy and radiation therapy for oncology of any localization; use of certain pharmacological drugs (anticholinergics, decongestants, calcium channel blockers, tricyclic antidepressants).

There is evidence that prostate hyperplasia is associated with metabolic syndrome: obesity, type 2 diabetes, high blood levels of triglycerides and low-density cholesterol, and arterial hypertension.

But experts say that the main risk factor is age and the associated testicular atrophy and decreased levels of testosterone, the male sex hormone produced by the testicles. Age-related reduction in testosterone production begins at age 40, by approximately 1-1.5% per year.

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Pathogenesis

The pathogenesis of diffuse changes in the prostate gland in prostatitis is caused by infiltration of prostate tissues by lymphocytes, plasma cells, macrophages and products of inflammatory tissue decay. And purulent melting of 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 tissue with fibrous tissue.

The prostate gland is an organ dependent on androgenic steroids. With age, the activity of aromatase and 5-alpha-reductase enzymes increases, with the participation of which androgens are transformed into estrogen and dihydrotestosterone (DHT, more potent than its predecessor testosterone). The 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 tissue with connective tissue with the formation of single and multiple fibrous nodes, as well as with pathological proliferation of the stroma of the prostate acini.

Diffuse changes in the prostate gland with calcifications appear due to tissue degeneration and deposition of insoluble fibrous proteins (collagens) and sulfated glycosaminoglycans. Calcifications can also form due to sedimentation of prostate secretion in the parenchyma. Calcification is observed in one third of cases of atypical adenomatous hyperplasia and in 52% of cases of prostate adenocarcinoma. A later stage of calcification is the formation of stones, which can be asymptomatically present in healthy men.

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

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Symptoms diffuse changes in the prostate gland

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

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

With diffuse changes in the parenchyma of the prostate gland associated with prostate adenoma, first of all, urination is also impaired: imperative urges become more frequent (including at night), despite significant tension of the abdominal muscles, urine is excreted with difficulty (the decrease in micturition pressure on the bladder muscle affects), and the process of excreting urine itself does not bring the expected relief. No less unpleasant symptom is enuresis.

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

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Complications and consequences

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

• chronic ischuria (urinary retention);
• cystitis and/or pyelonephritis;
• abscess with the risk of developing sepsis;
• formation of fistulas;
• protrusion of the bladder wall (diverticulum);
• urolithiasis;
• atrophy of the renal parenchyma and their chronic failure;
• problems with erection.

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Diagnostics diffuse changes in the prostate gland

In essence, the diagnosis of diffuse changes in the prostate gland is the identification of pathologically altered tissues using transrectal ultrasound examination, which allows one to assess the structure and size of this organ, as well as homogeneity/heterogeneity, density and degree of vascularization.

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

There are certain echo signs of diffuse changes in the prostate gland.

The absence of pronounced diffuse changes is defined as isoechoicity, which appears as grey on the echographic image.

Inability to reflect ultrasound, i.e. anaechogenicity, is inherent in cystic formations, in particular, cysts: on the echogram in this place there will be a uniform black spot. The same "picture" will be in the presence of an abscess, only in combination with weak reflection of ultrasound - hypoechogenicity (giving dark gray images).

In most cases, hypoechogenicity is evidence of inflammatory processes, as in acute inflammation of the prostate gland. Also, diffusely heterogeneous changes in the prostate gland with hypoechogenic zones are visualized if there is tissue edema, calcification, or replacement of glandular tissue with fibrous tissue.

But hyperechogenicity – a reflection of ultrasound waves clearly recorded by equipment in the form of white spots – provides grounds for diagnosing stones or chronic prostatitis.

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

In addition, other instrumental diagnostics are used: micturition ultrasound cystourethroscopy, uroflowmetry, Dopplerography, computed tomography of the prostate, MRI.

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Differential diagnosis

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

Treatment diffuse changes in the prostate gland

Let us repeat once again that it is not diffuse changes in the prostate gland that are being treated, but diseases diagnosed using ultrasound and the resulting echographic images.

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

In benign prostatic hyperplasia, the main drugs include α-blockers Tamsulosin (Tamsulide, Hyperprost, Omsulosin, etc.), Doxazosin (Artesin, Kamiren, Urocard), Silodosin (Urorek). As well as antiandrogen agents Finasteride (Prosteride, Urofin, Finpros), Dutasteride (Avodart), etc., which reduce the activity of 5-alpha-reductase.

Tamsulosin is prescribed one capsule (0.4 mg) - once a day (in the morning, after meals), if there are no problems with the liver. Side effects include 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 - one tablet. There may be side effects in the form of a depressive state, temporary erectile dysfunction and allergic skin reactions.

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

This plant is also used in homeopathy: it is part of the multi-component remedy Gentos (in the form of drops and tablets), it is taken for two to three months three times a day - one tablet (under the tongue) or 15 drops (internally). The main side effect is increased salivation.

If prostate cysts do not cause inflammation, then the patient's condition is monitored and vitamins are recommended. However, if the size of the cyst is such that urination is impaired, a procedure for its sclerosis is indicated.

How prostate cancer is treated, read in the article Prostate Cancer

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

Surgical treatment

In prostate diseases, and in particular prostate adenoma, surgical treatment can be used in cases where drug therapy is ineffective. The 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 enculation of the prostate, electro or laser vaporization, and microwave thermocoagulation.

Folk remedies

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

Effective natural remedies include turmeric, green tea, and lycopene-rich tomatoes and watermelon.

For complementary medicine recommended for benign prostatic hyperplasia, read – Traditional treatment of prostate adenoma

Herbal treatment can help reduce the intensity of some symptoms: infusions and decoctions of stinging nettle roots, chamomile flowers and calendula officinalis, yarrow herb and fireweed.

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Prevention

To date, prevention of prostatitis and other diseases that cause diffuse changes in the prostate gland has not been developed. Although general provisions regarding a healthy lifestyle (without alcohol, smoking, lying on the couch and obesity) have not been cancelled.

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

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Forecast

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

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

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