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Prostate

Your prostate, prostate problems, prostate cancer and it’s diagnosis

The prostate gland is only found in men, it’s main job is to help make semen – the fluid that carries sperm. The prostate is usually the size and shape of a walnut and grows bigger as you get older. It sits underneath the bladder and surrounds the urethra – the tube men urinate (pee) and ejaculate through.

Common prostate problems are:

Prostatitis is thought to be caused by an infection or inflammation of the prostate, it can affect men of any age, but is most common in men between 30 and 50. Prostatitis causes a wide range of symptoms which can vary between men, the most common symptoms are problems urinating or pain/discomfort around the testicles, back passage or lower abdomen.

Enlarged prostate, benign prostatic enlargement (BPE) or benign prostatic hyperplasia (BPH), hyperplasia means an increase in the number of cells. An enlarged prostate is common in men over 50, but not everyone will get the symptoms but as the prostate enlarges it presses in on the urethra (the tube that urine and semen travels along) causing it to narrow. When this happens, it can slow down or sometimes even stop the flow of urine. This can cause:

A weak flow rate when you urinate
A feeling that you’re not emptying your bladder completely
Difficulty urinating
Dribbling urine when you finish urinating
Need to urinate more often, especially at night
A sudden urge to urinate, sometimes you may leak before you get to the toilet

An enlarged prostate is not caused or linked to:

Prostate cancer can develop when cells in the prostate start to grow in an uncontrolled way, it often grows slowly to start with and may never cause any problems. This is referred to as localised or early prostate cancer. Some men might have some mild urinary problems that develop over years and could also be a sign of benign prostate problems.

However, some men have prostate cancer that is more likely to spread outside the prostate if left untreated. 1 in 8 men in the UK will get prostate cancer but it is more common in men over 50, men with a family history of prostate cancer and black men.

A transperineal (the area of skin between your testicles and anus) prostatic biopsy can find out whether any of your prostate cells have become cancerous or, if you have pre-existing cancer, whether the cancer has changed. The prostatic biopsy can also be taken transrectally (through the rectum) but has a higher risk of infection. Prostate cancer that is diagnosed early can be cured. Most men will have evidence of prostate cancer by the time they reach their 80’s, at this stage any treatment is aimed at controlling the cancer rather than curing it.

It is critical to determine the aggressive potential for the cancer to spread outside of the prostate.

Prostate cancer indicators:

A routine health screen, lower urinary tract symptoms or erectile dysfunction which may also include a digital rectal exam (DRE) which indicates an abnormal feeling prostate.

An abnormally elevated PSA blood test for your age:
40 - 49 years > 2.5 ng/ml
50 - 59 years > 3.5 ng/ml
60 - 69 years > 4.5 ng/ml
70 - 79 years > 6.5 ng/ml

 

There is a significant increase in the standard PSA level over time (PSA velocity). An increase of more than 20% per annum would be suspicious.

A prostate MRI scan suggests the presence of a visible abnormality within the prostate considered suspicious for prostate cancer.

Dealing with the diagnosis
 

The diagnosis of prostate cancer can be terribly emotive and have a major impact upon relationships and family. An element of depression and stress is a common feature of the normal response to the diagnosis and it is absolutely crucial that you take time to reflect upon your treatment options as explained to you. Decisions should not be taken too quickly and a focused, reasoned, and calm attitude will be an asset in dealing with the pressures you will face.

Remember - if a particular treatment doesn't feel right for you, then it probably isn't suitable for you. If a treatment feels right, then it probably is. Keep asking questions until you are satisfied. After studying all your options, speak to the appropriate specialists, use the knowledge gained and trust your instincts.

Be realistic - If a man is not generally in good health, surgery may not be the best option. Surgery of any kind is hard, and recovery is easiest when a person is in good shape. If a man has bowel or bladder problems already, radiation of any kind may make them worse. Fortunately, there are a number of other options, including various forms of radiation therapy and hormone therapy, or a combination of treatments, which may still result in a successful outcome.

The ideal treatment - for early prostate cancer would both provide an excellent chance of cure (over 90% of the time) and minimal side effects with regard to urinary continence (leakage) and potency (erectile function). Unfortunately, the ideal treatment does not exist (if it did then there would be no question about the benefit of prostate cancer screening), they all have significant side effects and an individual’s options are very dependent upon a number of interrelated factors:

The PSA level at diagnosis
The Clinical Stage ¬ local extent of disease based on DRE and imaging.
The Gleason score ¬ the pathological grade of the tumour.
The age and physical wellbeing of the patient (co morbidity).
The presence or absence of significant lower urinary tract symptoms.
The current quality of erectile function (potency).
An individual’s preference for a particular treatment.

 

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