Taken from the Times.......
Giiven that men are notoriously backwards at coming forwards with problems below the belt, health campaigners have welcomed the King’s decision to share that he will undergo a corrective procedure for a benign enlarged prostate next week. Visits to NHS online advice reportedly jumped 1,000 per cent in the wake of Buckingham Palace’s statement that Charles, 75, is being treated for the condition “in common with thousands of men each year”. Here’s what you need to know.
What are the most common prostate problems?
The prostate is a small gland that forms part of the male reproductive system, located under the bladder. The three most common prostate problems are inflammation (prostatitis), benign prostate enlargement (BPE) and prostate cancer. One does not lead to another, so having prostatitis or an enlarged prostate does not increase your risk of prostate cancer, but it is also possible for you to have more than one of these conditions at the same time.
According to Ben Challacombe, consultant urologist at The Prostate Centre, part of HCA Healthcare UK. the key is not to delay seeking help. “Men are less good at coming forward than women,” he says. Early intervention can postpone the need for further, more invasive treatment for some years.
Are they more likely with age?
Although the exact cause isn’t known, prostate enlargement is a very common condition associated with ageing, and believed to be linked to hormonal changes. Typically around the size of a walnut, the prostate can grow to three times that size, surrounding and pressing upon the urethra, the tube through which urine leaves the bladder. BPE affects some 50 per cent of men over the age of 50, jumping to 70 per cent of men over 60 and about 80 per cent of men over 70.
Besides age, “a genetic link, such as your father suffering from the condition, raises the likelihood of developing it yourself,” says Dr Jeff Foster, a GP and men’s health specialist.
What are the symptoms to watch for?
So-called “urinary emergencies” are common signs of an enlarged prostate, Challacombe says. These include “not having enough time to get to the loo before the urine starts coming; going quite quickly; or getting up at night more than just once”.
The Urology Foundation estimates that up to three million men in the UK have lower urinary tract symptoms associated with BPE. Mild symptoms are most likely to begin in your forties, Foster says. “These include hesitating before you pee; finding that your flow is so poor that you’re not able to empty properly; dribbling afterwards or finding that because you’re not emptying properly you’re having to go back again five minutes later.” There may also be greater likelihood of urinary tract infections, or urinary retention, when “you can’t pee at all because the prostate has got so large and the flow is obstructed”.
How can I get checked?
If you’re experiencing symptoms, the first port of call is to contact your GP, says Meg Burgess, a specialist nurse at Prostate Cancer UK, who advises “keeping a bladder diary for a few days” to show your doctor.
A urine sample may be taken to check for infection and a digital rectal examination (DRE) will likely follow, she says, in which “the doctor uses a gloved, lubricated finger in the back passage to feel the prostate, which sits on the other side of the rectal wall. This gives an idea of its size.”
They may also suggest a blood test to check your levels of prostate specific antigen (PSA), a protein produced by the prostate. High levels could indicate benign enlargement, infection or cancer. PSA tests are free on the NHS for over-50s; if you are under 50 and symptom-free but concerned, you would need to get a PSA test done privately.
If your GP refers you to a urologist, you may be asked to undergo a flow rate test, which measures the speed of your urine passing through a funnel, to ascertain the bladder’s ability to empty.
Can lifestyle changes help my prostate health?
Some simple lifestyle changes can help to relieve symptoms of BPE. Challacombe advises “increasing [consumption of] clear fluids, decreasing caffeinated and fizzy drinks, restricting fluids in the evening so you don’t get up [to pee] as much, and keeping the bowels loose”, as constipation can put pressure on the bladder. The NHS website also advises upping your intake of fibre (found in vegetables, fruit and wholegrain cereals) and avoiding artificial sweeteners, which can irritate the bladder and make urinary symptoms worse.
How are problems treated?
The “vast majority” of men experiencing urinary symptoms will be diagnosed with BPE, says Challacombe, for which there are two principle medical treatments if lifestyle changes don’t help. First are alpha blockers (such as tamsulosin and alfuzosin), which “work very quickly to relax the prostate, but they don’t change the size of it”. If these are insufficient to relieve symptoms, “prostate shrinkers (finasteride and dutasteride) gradually shrink the prostate, but can affect levels of testosterone, so are often used in older men”.
When is surgery necessary?
If medication doesn’t work, surgery to improve symptoms and relieve obstructions may be advised. Previously the most common was transurethral resection of the prostate (TURP), which Foster describes as “a quite aggressive procedure that almost corkscrews through the prostate” in order to ease urinary flow. Side effects include bleeding, infection and short-term incontinence.
Happily, Foster says, the past five or ten years have produced a range of new procedures “that are game-changers for prostate conditions”. The first is a GreenLight laser: a minimally invasive laser treatment to remove the part of the gland causing BPE. There is also water vapour treatment, in which a probe uses steam to remove prostate tissue, effectively “killing a layer of cells”. The UroLift system, meanwhile, “involves getting two little metal prongs either side [of the prostate], which hoik the prostate up away from the urethra”. The absence of scalpels significantly lowers the risk of infection, as well as minimising time patients need to spend in hospital.
How worried should you be?
“It’s important to stress that prostate enlargement is a different condition to prostate cancer,” Burgess says. “It isn’t caused by cancer, and it doesn’t increase the risk of cancer.”
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However, just as the risk of BPE rises in men over 50, prostate cancer does too, and can occur without symptoms. Besides age, the other main risk factors for prostate cancer are race — black men have double the risk of prostate cancer and develop it younger, according to Prostate Cancer UK — and a history of prostate cancer in the family. If you are concerned, visit prostatecanceruk.org/risk-checker for a 30-second online risk assessment, and see your GP.
