A Patient Journey for Prostate Health

The prostate is a small gland which surrounds the urethra (the tube which carries urine out of the body). The prostate is found only in men and can be found just below the bladder and the opening of the vas deferens (the tube which carries the sperm up from the testicles into the urethra). The gland also produces a thick, white fluid which mixes with sperm and allows sperm to live longer.

Most normal, healthy prostates are around the size of a walnut. However it is very common for the prostate to become larger with age. It is thought around a third of men over 50 (and three quarters of men over 70) will experience symptoms of prostate enlargement at some point. The most common reasons for a man to experience symptoms of prostate enlargement are a non-cancerous enlargement of the prostate gland called benign prostatic hyperplasia or BPH (you may also hear it referred to as benign prostate enlargement or BPE), Prostatitis (a swelling of the prostate gland sometimes caused by an infection) or more seriously prostate cancer.

BPH prostatitis and prostate cancer share a number of symptoms. These include:

• needing tourinate often, especially at night
• difficulty starting to urinate
• straining to urinate or taking a long time to finish
• pain when urinating or during sex
• leaking urine

Other less common symptoms include:

• pain in the lower back
• blood in the urine

If you begin to feel any of these symptoms  you should make an appointment to visit your doctor. Although BPH and Prostatitis are rarely serious conditions, your doctor will want to rule out the potential of prostate cancer. Prostate cancer is the most common cancer among men in the UK with 30,000 new cases each year.

When visiting your doctor with prostate-related symptoms he/she will want to talk through your symptoms and check whether they may relate to other health issues such as kidney and bladder infections or diabetes. Your doctor will be interested to know how long your symptoms have been affecting you (for example weeks or months), whether the symptoms you are experiencing have become worse over time and how your symptoms are affecting your quality of life.  You may find it useful to keep a diary of your symptoms. Your doctor may also physically examine your stomach and penis - this should not be painful. You may be asked to give a urine sample to check for signs of infection.

A key factor in diagnosis in most cases is digital rectal examination (DRE) where the doctor or nurse will insert a gloved and lubricated finger into your back passage. The doctor or nurse will be able to feel the prostate through the wall of the rectum, and may be able to feel the changes associated with your prostate, such as the prostate becoming harder and ‘bumpy’. This procedure will often be uncomfortable, but should not be painful. It is also worth remembering that the doctor or nurse will have performed this procedure many times and you should try not to be embarrassed by the process.

Very often, your doctor will also ask to carry out a blood test in order to check your Prostate-Specific Antigen level (PSA). PSA is a protein produced by the prostate, and a higher level tends to indicate an increase in the size of the prostate, and may also indicate prostate cancer as this is known to cause levels to rise in some men. However the PSA blood test is not a specific test for prostate cancer with around 65% of men who have increased levels of PSA testing negative for cancer. If, based on the results of the tests mentioned above, your doctor suspects that you might have prostate cancer; you will be referred to a specialist for further testing. The most common test at this stage is the transrectal ultrasound-guided biopsy (TRUS), in which an ultrasound machine (a machine which uses harmless sound waves to build a picture of the insides of the body) is inserted into your back passage. This allows the doctor to guide a needle through the wall of the rectum and take a small sample of tissue which will be looked at under a microscope (this may also be referred to as a biopsy). This procedure can sometimes be painful, and patients may be given a local anaesthetic. The specialist may also use imaging tests such as Magnetic Resonance Imaging MRI scans (a machine which uses string magnetic fields and radio waves to produce detailed images of the inside of the body) or Computerised Tomography CT or CAT scans (a machine which uses x-rays and a computer to take detailed images inside the body). Both forms of scanning are painless and safe procedures.

Treatment varies considerably with a prostate-related diagnosis. Most cases of prostatitis are acute (rather than chronic), meaning that they will get better within a few weeks – the most common course of treatment in these cases is a course of oral antibiotics for up to four weeks. Chronic prostatitis, however, cannot be cured, and treatment focuses on limiting the impact of symptoms. Many cases can be effectively handled with painkillers; if everyday painkillers such as ibuprofen and paracetamol do not help to ease symptoms your doctor may be able to prescribe you a stronger painkiller.

Treatment for BPH, similarly, varies with the severity of the condition. Where symptoms are mild, a doctor may encourage ‘watchful waiting’ – a careful monitoring of your symptoms until they require further treatment. A number of lifestyle changes may also help to ease symptoms such as reducing your consumption of alcohol and caffeine, avoiding drinking before going to bed and becoming more active. If such changes prove ineffective, a number of medicines may help. The most common are:

• Specific Enzyme Inhibitors - They block the effects of a hormone called dihydrotestosterone (DHT)on the prostate gland, which can reduce the size of the prostate and improve your symptoms. It is important to wear a condom if you are sexually active as both medications can affect the sperm and if you get a woman pregnant there is a high risk of birth defects. Other side effects can include impotence (trouble maintaining an erection) and little or no sperm when you ejaculate.
• Alpha blockers – They work by relaxing the muscles in your bladder making it easier to pass urine. Side effects of these medications are uncommon but can include dizziness, headaches, weakness and little or no sperm when you ejaculate.

There are also a number of surgeries that can be used in cases where symptoms become severe: transurethral resurrection of the prostate (TURP), for example, is a procedure where excess prostate tissue is removed; transurethral incision of the prostate (TUIP) involves the widening of the urethra to ease the passing of urine. Some may also want to treat complications such as urinary incontinence – for example by using catheters (a procedure used to drain the bladder and collect urine). A small tube called a catheter is inserted into the urethra and the urine is drained through the catheter into a drainage bag.

Treatment for prostate cancer, again, depends on individual circumstances. Anyone with prostate cancer should, as such, receive care and support from a multidisciplinary team (MDT), who will develop a personalised treatment plan for each patient. Since prostate cancer tends to be slow to develop, many cases will be carefully monitored for developments instead of being treated right away, and many never progress to the stage where they require treatment. Cases in which the cancer becomes more developed may be treated with surgery, radiotherapy (where doses of targeted radiation are used to kill the cancer cells), chemotherapy (in which drugs are used to kill the cells), hormone therapy (in which hormones are used to control the growth of the prostate), steroids, or a number of other treatments.

There are a number of UK charities offering information and support for men with prostate issues. talkhealth suggests Prostate Cancer UK, Prostate Action, Bladder & Bowel Foundation and Tackle Prostate Cancer. There are also great resources on some general men’s health charities such as Orchid (which deals with all forms of male cancer) and the Men’s Health Forum. You can also find support among the talkhealth community – you can post any questions you have or interact with others affected by prostate related issues in the prostate disease and prostate cancer section of our forums.

Every year we hold an online clinic which focuses on those affected with or by prostate health issues – the online clinic gives our community the opportunity to ask questions to our panel of experts who will do their best to answer you. Take a look at our previous clinics on Prostate Health and don’t forget to set yourself a reminder for our upcoming clinic in November.

Sources used in writing this article are available on request.

_{Last revised: 2 September 2016}

_{Next review: 2 September 2019}