Prostate Health

The prostate is a gland about the size of a walnut and is located around the urethra – the tube that runs from the bladder to the penis. Its function is to manufacture substances in the fluid that make up semen. If the gland becomes inflamed, this is referred to as prostatitis. This can lead to pain and often requires treatment with antibiotics.  The prostate commonly enlarges in later life, leading to a condition called benign prostatic hypertrophy (BPH).

BPH

Benign prostatic hypertrophy (BPH) is caused by enlargement of the prostate gland and is a common disorder in men over 50. By the age of 55, about 50 per cent of men will notice problems with their “waterworks”. Symptoms may include frequency of urination, the urge to urinate with little warning and waking at night to empty the bladder. Difficulty starting a urine stream, decreased force or dribbling and complete urinary obstruction may also occur.

When the prostate gland enlarges, it squeezes the urethra, making it difficult for urine to pass through. Diagnosis of the condition is usually made by digital rectal examination (DRE) – a physical examination of the rectum to see if the gland is enlarged. An assessment of urine volume and force, blood tests and other tests may also be needed. You will also be asked about alcohol intake and any other medication you are taking.

There are a range of treatments for bothersome BPH. However, about one in three sufferers manage their condition with medication and lifestyle changes, such as avoiding fluids for at least three hours before bedtime and emptying the bladder completely when you go. There is no proven way to prevent prostate enlargement. Medical treatment options include drugs that improve the flow of urine – some, such as finasteride and dutasteride help shrink the enlarged gland; other drugs called alpha blockers relax the smooth muscle of the prostate and the neck of the bladder, thereby relieving obstruction. Surgical options include a transurethral resection of the prostate (TURP) where some or all of the gland is removed.

If the symptoms of BPH are ignored for some time, you may develop a painful condition called acute urinary retention, the only treatment for which is to have a urinary catheter inserted to release the trapped urine.

Prostate cancer

Prostate Cancer is the most common cancer in men in Ireland if skin cancer is excluded. Each year, more than 3,000 men are diagnosed with prostate cancer in this country. One in eight men will get prostate cancer at some point in their lives. The chances of getting prostate cancer increase as you get older. A blood test called prostate specific antigen (PSA) is used to identify those at greater risk of prostate cancer. However, PSA levels may also be elevated in a man with BPH and other conditions.

The causes of prostate cancer are unknown. However, a number of factors can increase your risk of developing the condition.

  • Most cases develop in men aged 50 or older.
  • For reasons not yet understood, prostate cancer is more common in men of African-Caribbean or African descent, and less common in men of Asian descent.
  • Men who have a father or brother affected by prostate cancer are at slightly increased risk of developing the disease.

There is no single test for prostate cancer. All the tests used to help diagnose the condition have benefits and risks. The most commonly used screening tests for prostate cancer are blood tests and a physical examination of your prostate (a DRE).

The PSA blood test may help detect early prostate cancer. Men are not routinely offered PSA tests to screen for prostate cancer as results can be unreliable. This is because the PSA blood test is not specific to prostate cancer. PSA can be raised due to BPH, a urinary tract infection or inflammation of the prostate as well as prostate cancer. Raised PSA levels also cannot tell a doctor whether a man has life-threatening prostate cancer or not. This means that a raised PSA can lead to unnecessary tests and treatment.

A dilemma for doctors is that while it is important to diagnose high-risk cases within the window of curability, many men with low-risk prostate cancer do not need aggressive treatment.

For many men with prostate cancer, treatment is not immediately necessary. If the cancer is at an early stage and not causing symptoms, a policy of “watchful waiting” or “active surveillance” may be adopted. This involves carefully monitoring the condition. Some cases of prostate cancer can be cured if treated in the early stages. Treatments include surgically removing the prostate, radiotherapy and hormone therapy. All treatment options carry the risk of significant side-effects, including erectile dysfunction and urinary incontinence.

Prostate cancer is one of a number of tumours linked with obesity, so having a healthy diet and remaining active are helpful in terms of prevention.

Useful Resources

The Irish Cancer Society is a valuable resource for information on prostate cancer. National cancer helpline 1800 200 700