The prostate is a small chestnut sized gland which lies just underneath the bladder in men and surrounds the urethra (water pipe).
The prostate produces a thick fluid containing chemicals which nourishes the sperm and along with other fluid from the seminal vesicles they all form the semen. During ejaculation, the prostate squeezes the semen forcefully into the urethra which is then expelled outwards. The prostate also produces a protein called Prostate Specific Antigen (PSA).
BENIGN PROSTATIC ENLARGEMENT OR HYPERPLASIA (BPH)
This is a non-cancerous enlargement of the prostate gland which is very common after the age of 50.
The enlarged prostate can interfere with the passage of urine through the urethra causing a number of symptoms such as difficulty in starting urinary flow, urinating with a weak and interrupted flow, dribbling of urine towards the end of the stream, needing to pass urine more frequently both day and night and often with a distressing sensation of urgency.
BPH can lead to a number of problems if untreated including acute retention of urine, which is a sudden and painful inability to pass urine. Other problems include passing blood in the urine, formation of bladder stones, urinary tract infections, bladder weakness, incontinence and reduced kidney function.
What are the treatment options for BPH?
Mild to moderate cases of BPH can be successfully managed with lifestyle changes and possibly medications such as alpha-blockers and 5-alpha reductase inhibitors. More severe cases require surgery and the surgical options offered include bipolar transurethral resection of the prostate (TURP) and Urolift.
Prostate cancer is the most common type of cancer in men, with around 1 in 8 men getting the disease at some point in their lifetime. Early prostate cancer generally does not cause any symptoms as commonly the cancer starts in the outer part of the prostate away from the urethra. Some men may have symptoms similar to symptoms of prostate enlargement (BPH), other symptoms may include passing blood in the semen or urine, back or hip pain, problem getting an erection and unexplained weight loss.
What are the causes of prostate cancer?
The exact causes are unknown; however there are some factors which increase the risk of developing prostate cancer:
Age: prostate cancer is rare in men under the age of 50 and the risk goes up as men get older.
Family history: men are more likely to get prostate cancer if they have a close relative who has prostate cancer such as a father or a brother, in particular if the relatives were under the age of 60 when they were diagnosed, or if more than one relative has prostate cancer. The risk of getting prostate cancer may also increase in men if their mother or sister has breast cancer.
Ethnicity: prostate cancer is more likely to develop in black men compared to others.
Patients who are concerned about having prostate cancer should talk to their GPs or a specialist and may be offered a PSA blood test.
What is PSA?
PSA is a protein that is produced by prostate cells and the majority is secreted in the semen to help keep the semen in a liquid form. However, a small amounts of PSA also leaks into the bloodstream and this can be measure by a simple blood test. High levels of PSA in the blood may indicate prostate cancer; however, many other conditions can also increase PSA level.
Causes of high PSA level
Urinary tract infection.
Prostatic inflammation (prostatitis).
Ejaculation (within 48hrs before the test).
Vigorous exercise especially cycling (within 48hrs before the test).
Rectal examination of the prostate raises PSA slightly.
Procedures or investigations of the bladder and prostate including insertion of urinary catheter, prostate biopsy or cystoscopy (within 6 weeks before the test).
Prostate stimulation and receptive anal intercourse.
Men with an elevated PSA level are advised to undergo a comprehensive assessment with a full medical history, digital rectal examination of the prostate and a urine test to rule out infection. Further investigations will be dependent on individual circumstances and may include a multi-parametric MRI scan, a prostate biopsy, and additional scans.
Treatment of prostate cancer
There are a number of treatment choices for prostate cancer depending on cancer details, overall health and personal preferences. These may include: active surveillance, watchful waiting, surgery, radiotherapy, brachytherapy, hormone treatment, chemotherapy or steroids. Suitable treatments will be discussed with patients to help them choose the right option for them.
Prostatitis means inflammation and swelling of the prostate gland, it is not a serious condition and does not cause prostate cancer. Prostatitis can affect men of all ages but tends to be more common in men younger than 50.
Symptoms of prostatitis include burning sensation when passing urine, pain in the genital area or lower back, pain during ejaculation, increased frequency of urination both during the day and night and urgency. There are two main types of prostatitis:
Acute prostatitis: caused by a bacterial infection and the symptoms tend to start suddenly and are often associated with a fever.
Chronic prostatitis: this is the most common type, and is rarely caused by bacteria with the exact cause still being unclear. The symptoms are generally mild, come on gradually and often come and go. The symptoms can be vague and therefore men should undergo a full assessment to rule out other conditions which cause similar symptoms.
Treatment of prostatitis
Acute prostatitis is treated with a 2-4 week course of appropriate antibiotics and pain killers, and severe cases may require hospital treatment. The aim of treatment of chronic prostatitis is to control the symptoms and the options include pain killers and alpha-blockers.