Issues with the prostate are extremely common, particularly as men get older, with prostate problems being one of the most common Men’s Health problems that doctors come across. For the last day of Movember, we summarise some of the most common causes of prostate problems as well as red flag symptoms you should contact your GP about.
What Is The Prostate?
The prostate is a gland about the size and shape of a walnut, which only exists in men. It sits just below the bladder, surrounding the urethra – the tube which carries urine from the bladder out of the body. It is also connected to the tube which carries sperm from the testes into the prostate and urethra (the Vas Deferens) and seminal vesicles, which produce fluid that makes up the semen, from behind.
The main function of the prostate gland is also to produce fluid that makes up semen.
The prostate gland sits just below the bladder in men, behind the public bone and in front of the rectum
Benign Prostatic Hyperplasia
As men get older, the prostate enlarges, this is called Benign Prostatic Hyperplasia or BPH. This is most common in men over the age of 50. The cause of BPH is unknown but it is thought to be related to changing levels of hormones as men age. BPH is not cancer and doesn’t increase your risk of developing cancer in the future.
BPH typically causes problems in passing urine due to the position of the prostate below the bladder and around the urethra. Common symptoms include:
- Weak flow of urine
- Difficulty stopping and starting to urinate
- Waking up in the night to pee (nocturia)
- Sudden urge to urinate
- Increased frequency of urinating
- A feeling that your bladder is not completely empty after urinating
- Prolonged dribbling after urinating
- Straining in order to pee
BPH is not a risk to your health, however some men experience severe symptoms which can have a big impact on their quality of life. It is important to contact your GP if you are experiencing these symptoms, firstly to confirm it is BPH and secondly to offer advice and treatment if symptoms are troublesome.
In order to diagnose BPH, your GP may want to perform a physical examination as well as urine and blood tests.
If your symptoms are mild, the GP may advise you to limit caffeine and alcohol consumption as these may worsen your symptoms.
If your symptoms are severe, your GP may offer you some medication in addition to lifestyle advice to improve your symptoms. If medication fails to improve your quality of life, surgical options are available.
Prostatitis is inflammation of the prostate. This can be caused by an infection, but often the cause is unknown. Prostatitis can occur at any age, although it most commonly occurs in men aged 30-50 years old.
- Pain, in the pelvis, genitals or lower back
- Pain in the perineum (the area between the anus and genitals), particularly after sitting down
- Pain on urination
- Pain on ejaculation
- Difficulty starting to urinate
- Frequent need to urinate
- Joint and muscle pain
If you experience any of these symptoms you should contact your GP. They may prescribe some antibiotics if an infection is likely, or painkillers to help manage your symptoms.
Prostate cancer is the most common cancer occurring in men. The exact cause of prostate cancer is unknown however the risk of developing prostate cancer increases with age, particularly over the age of 65. The risk of developing it is also increased in men with a first-degree relative with prostate cancer and those of Afro-Caribbean ethnicity.
The prognosis for prostate cancer is relatively good as it is a particularly slow growing cancer. It doesn’t always require treatment and men are often found to die with prostate cancer rather than dying from it.
What Are The Signs & Symptoms of Prostate Cancer?
Symptoms for prostate cancer are similar to symptoms of BPH, including:
- Difficulty starting to urinate
- Straining to urinate
- Weak flow of urine
- A feeling that your bladder isn’t empty after urinating
- Having the urge to pee more frequently
- Waking up to pee at night (nocturia)
- Erectile dysfunction
- Unintentional weight loss
- Lower back pain
It is important to see your GP if you experience any of the above symptoms, even though BPH is much more likely to be causing urinary symptoms.
How Is Prostate Cancer Diagnosed?
Your doctor will discuss your symptoms with you in full as well as doing a physical examination, known as a digital rectal exam. This is where the prostate is examined, by the doctor inserting a finger up the anus.
A PSA blood test (prostate specific antigen) is recommended next, raised PSA can be caused by various conditions including prostate cancer. A raised PSA therefore is not a prostate cancer diagnosis but further tests are warranted to investigate the possibility of cancer.
A biopsy is the only way to confirm a cancer diagnosis. This involves sampling a piece of the prostate and looking at the cells under a microscope to check for cancer cells. A prostate biopsy is commonly done using a transrectal ultrasound-guided biopsy. This procedure is carried out with local anaesthesia.
Biopsies of suspicious prostate glands are studied under a microscope for cancer cells
Magnetic resonance imaging (MRI) or computerised tomography (CT) scans are recommended if there is a high chance of cancer as these scans will show if the cancer has spread anywhere. An isotope bone scan may also be done to see if any cancer has spread to the bones in particular.
Prostate Cancer Treatment
Prostate cancer is usually a slow growing cancer, treatment will depend on the staging of the cancer. In some cases, treatment is not necessary at all, and close monitoring is all that is needed.
A multidisciplinary team (MDT) of specialists including a cancer surgeon, oncologist, radiologist and specialist nurse will come up with a treatment plan, although the decision surrounding your care is ultimately yours.
If the cancer is in early stages, surgery or radiotherapy to the prostate may be curative. More advanced cancers may require a combination of surgery and radiotherapy as well as chemotherapy and sometimes hormone therapy to kill cancer cells.
With the increased awareness of Men’s Health problems, owing to campaigns such as Movember, there is no excuse for symptoms of concern to be swept under the carpet and ignored. Guys, if you’re experiencing any of the above mentioned symptoms, one quick GP appointment may be all is required for reassurance or to get the ball rolling for further investigation. With same-date appointments available across all eight of our clinics, you can seek the appropriate medical advise without delay!
By Anna Kessler