Mr B Dev SarMah, MBBS, FrCSeD, Consultant Urological Surgeon/Honorary Senior Clinical lecturer at HEFT (Heart of England Foundation Trust) with special interests in all aspects of prostate disease, bladder cancer and urinary calcular (stone) diseases.
Mr Sarmah consults and operates weekly at Spire Parkway Hospital, Solihull.
What is the prostate?
The prostate gland is a funnel shaped organ that surrounds the neck of the urinary bladder in a man and sits in the midline at the lowermost part of a male pelvis. It also supports the bladder neck but the bladder can function quite normally after surgical removal of the prostate gland. The prostate gland conducts urine and adds nutritional substances to sperm to produce seminal fluid after ejaculation. The prostate gland enlarges with age and certainly after the age of 40 it begins to get bigger slowly. 70% of men in their 70’s and 80% of men in their 80’s will have what is called BPH (Benign Prostatic Hypertrophy). Men could develop symptoms relating to an infection of the prostate gland (Prostatitis), an enlargement of prostate (BPH) and prostate cancer. Infection of the prostate gland is commonly seen in men in their 40’s and 50’s. BPH symptoms are usually seen from the age of 60 onwards and increases with age. Prostate cancer, on the other hand, can be diagnosed in any age group after the age of 50 although the vast majority is diagnosed in men in their 60’s.
What symptoms might I be experiencing?
Men are certainly more health conscious now compared to say 10 years ago and this is a very good thing. Symptoms caused by an infection in the prostate can vary from individual to individual. These range from simple burning in passing urine to severe annoying pain/discomfort in the perineal area (area behind the scrotum and the back passage). Symptoms caused by an enlarged prostate can also vary between men. Predominantly, men experience weaker urinary flow, hesitancy, incomplete emptying of bladder and delay in urinating. Unfortunately, a lot of men even now, ignore these symptoms and decide to put up with symptoms, accepting it as a part of the ageing process.
What should I do if I am experiencing problems?
As the enlargement of the prostate continues, the amount of residual urine in the bladder increases which results often in daytime frequency, nocturia (having to get up at night frequently) and urgency (having to dash to the toilet even at the first urge to urinate). All of these symptoms can be assessed adequately at the doctor’s surgery with basic investigations carried out and initial treatment started with medications. These comprise of Alpha-blockers that act very quickly within days of starting treatment and 5-Alpha reductase inhibitors that work much slowly but the latter do reduce the prostate gland size to 30% after six months of therapy.
Men can also be referred to specialists, i.e. urologists who can assess further with flow rate measurements/ultra sound scan etc and then discuss what specialist treatment one may be suitable for. When medical treatment fails, then men can be guided towards surgical treatment with either Green Light KTP laser, Prostatectomy or TURP(trans-urethral resection of prostate). These procedures are carried out endoscopically through the urethra (water pipe) under suitable anaesthesia. PSA (Prostate Specific Antigen) is a simple blood test which has been around for about 14-15 years. Urologists are certainly relying on age specific PSA results these days. PSA can be raised in men with an enlarged prostate, infection of the prostate and in prostate cancer. The acceptable PSA values are Age 40 – 49=2, 50-59=3, 60-69=4 and 70-79=5. The vast majority of men with a PSA value within these parameters can certainly be reassured that their prostate gland is healthy. Furthermore, the specialist can examine the prostate gland from the back passage (DRE-Digital Rectal Examination) as further reassurance.
The testing of PSA has certainly allowed prostate cancer to have overtaken lung cancer as the most common male cancer in the U.K. Those men with suspicion of prostate cancer get further evaluated with trans-rectal ultrasound guided biopsy (TRUS). Those with diagnosed cancer are counselled either for active treatment (radical prostatectomy, radiotherapy or brachytherapy) or active surveillance in selected men.