The Enlarged Prostate
The majority of men over the age of 50 will have an enlarged prostate and this is most commonly due to Benign Prostatic Hyperplasia (1) with symptoms, which can include:
- Difficulty starting to pass urine and a weak or interrupted stream
- Burning sensation or pain when urinating
- The need to strain to when pass urinating
- Feeling that the bladder hasn’t emptied fully after urination
- Frequent urination – especially at night, and an urgent need to urinate
- Blood in the urine
- Leaking or “dribbling” of urine
Understanding the prostate
The prostate is a walnut sized gland that forms part of the male reproductive system, which secretes fluid that carries sperm. With age and time the prostate enlarges causing pressure on the urethra, which causes problems with urination.
What is prostate cancer?
Prostate cancer is the most common form of cancer among men in the UK. There are more than 30,000 new cases each year and the lifetime risk for being diagnosed with prostate cancer is 1 in 14. The cancer develops from cells within the prostate gland. The majority of prostate cancers are slow growing and do not result in any noticeable symptoms. Consequently, many men are not aware that they have this cancer. However, prostate cancer can be treated effectively if diagnosed early, so it is very important that the disease is caught as soon as possible.
What are the symptoms of prostate cancer?
In the early stages of prostate cancer, there may be no symptoms. Symptoms which do occur may include any of the following:
- Frequent urination
- Pain, burning or weak flow of urine
- Dull pain in the lower pelvic area
- Blood in the urine or semen
- General pain in the lower back, hips or upper thighs
- Loss of appetite and weight loss
How is prostate cancer diagnosed?
Rectal examination and PSA tests are the standard means of assessing whether a patient is at risk of prostate cancer.
A consultant urologist examines the prostate gland to note any abnormalities in size, shape or consistency of the prostate. This is always combined with a PSA test.
The test measures the level of PSA, a substance produced only by the prostate and released into the bloodstream. If the prostate is healthy, very little PSA escapes from a healthy prostate into the bloodstream. However some conditions of the prostate cause larger amounts of PSA to leak into the blood. One possible cause of a high PSA level is benign enlargement of the prostate. Prostate cancer is another possible cause of an elevated PSA level.
It is important to realize that in most cases an abnormality in either test is not due to cancer but to benign conditions, the most common being benign enlargement of the prostate. In order to make a positive diagnosis of prostate cancer, a prostate biopsy must be carried out using ultrasound.
The ultrasound scan produces an image of the prostate, identifying any abnormalities in the prostate gland’s size and shape. The most common abnormalities are shadows which might signify the presence of prostate cancer. However, not all prostate cancers are visible. A device attached to the ultrasound probe will be used to remove small amounts of prostate tissue. These samples, or biopsies, will then be examined by a pathologist – an expert in examining human tissue – to confirm whether or not cancer is present.
A range of tests will be carried out in order to check whether the patient has cancer and to identify exactly any enlargement which has taken place and its impact upon the bladder.
- A PSA Test – a blood test to screen for prostate cancer
- A urine test is carried out to check whether the patient has bladder cancer
- A measurement of post-void residual volume (PVR), the amount of urine left in the bladder after urinating
- A urine flow study, a measure of how fast urine flows when a man urinates
- Cystoscopy – an examination of the urethra and/or bladder using a small flexible scope
- Urodynamic pressure-flow study that tests the pressures inside the bladder during urination
- Ultrasound of the kidney or the prostate
What treatment is available for me?
If you are diagnosed with benign prostate enlargement, you should discuss all treatment options with the Birmingham and Solihull Bladder Clinic. Together, you can decide whether medication or surgical treatment is best for you.