What is the prostate?
The prostate is present in all males. It is a walnut-sized gland that sits at the base of the bladder and surrounds the waterpipe (urethra). The urethra transports urine from the bladder out through the penis. The primary function of the prostate is to produce fluid that carries sperm during ejaculation.
What can happen to the prostate?
The prostate grows to its normal adult size in a man’s early twenties. It then begins to grow at varying rates from the mid-forties. This non-cancerous growth is often referred to as benign prostatic enlargement (BPE) and can cause obstruction to urinary flow. It is very common, with over 50% of men over fifty suffering from it. An inflamed prostate, known as prostatitis, may cause similar symptoms.
Does an enlarged prostate mean I have prostate cancer?
No. It is important to recognise that BPE does not mean you have prostate cancer and does not increase the risk of developing it. The symptoms caused can be similar and it is therefore important to seek advice from a urologist, who can help differentiate between the two. It should be noted that it is possible for prostate cancer and BPE to co-exist.
What symptoms can prostate enlargement cause?
The symptoms can be varied and not all need to be present. Typical complaints are an inability to commence urination, a weak flow, stopping and starting, the sensation of incomplete bladder emptying and passing urine frequently either in the day or night. These symptoms can have a significant impact on your quality of life, with over 50% of men saying it interferes with at least one aspect of their normal life. It is also known to contribute to sexual problems in 50% of men.
Are there any risk factors?
Yes. It is generally related to aging and often associated with a family history. Heart disease, diabetes and being overweight may also increase your risk of developing it.
What investigations are needed?
It is important that you are seen by a consultant urologist. Assessment is commenced with a thorough medical history, including the use of validated questionnaires. A full physical examination will be undertaken, which will involve evaluation of the prostate via a rectal examination. A urine sample and blood tests are sent for analysis to detect the presence of blood in the urine, infection or kidney dysfunction. A prostate-specific antigen (PSA) blood test will be checked, which will help to identify prostate cancer and also guide treatment for BPE. Your urinary flow rate will be measured, and ultrasound imaging used to assess for adequate bladder emptying. Subsequent investigations e.g., prostate and kidney scans, biopsies and a camera inspection of the bladder may be necessary depending on the initial findings.
Do I definitely need treatment?
No. In some men with mild symptoms, behavioural and dietary modifications may be all that is required. These include reduction of fluid intake at certain times of the day, avoidance/moderation of caffeine and alcohol consumption, bladder retraining, and a review of other medications being taken.
Are there any risks?
Yes. Without early intervention, you may stop passing urine, this is called acute urinary retention requiring an emergency insertion of a catheter to drain the bladder. If the obstruction is longstanding, it can lead to progressive bladder dysfunction and incomplete emptying. This can in turn increase the risk of urinary infections, bladder stones and kidney dysfunction.
What are the treatment options?
In men who require active intervention, first-line treatment is with the use of oral medical therapies. There are two commonly used medications that can be started in isolation or combined. They work to increase the calibre of the urethra as it travels through the prostate by relaxing some of the muscles involved (tamsulosin) or by reducing its size (finasteride).
For men who have ongoing symptoms despite oral medication, there are multiple options for surgery. The majority are minimally invasive procedures performed under a general, spinal or local anaesthesia. The choice of surgical intervention depends on various factors e.g., the size of the prostate, patient age and personal choice.
The most common procedure is a transurethral resection of the prostate (TURP). This involves a telescope passed down the urethra with the prostate gland cored out from within to relieve the obstruction. Hospital stay is typically one to two days and long-term success rates are excellent. Side effects include a small risk of needing a repeat treatment, urinary incontinence, and sexual dysfunction.
Other treatment modalities include enucleation of the prostate with a laser, typically performed in men with very large prostates. Prostatic urethral lift ( UroLift ® ) represents a novel approach whereby the obstructing prostate is held open with permanent suture-based implants. The prostate tissue can also be destroyed with a new steam therapy (Rezūm). Early results from these treatments suggest a good short-term improvement in symptoms, along with the benefit of reducing the risk of impact on sexual function.
Finally, surgical removal of the prostate via a keyhole approach with a surgical robot is an emerging treatment modality, suitable in select cases.
Urology Clinics Manchester offers all of these treatment options.
Consultant Urological and Robotic Surgeon
Consultant Urological Surgeon
This information does not replace a doctor’s opinion and if you suffer any of these problems, always see your GP.
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