Prostatic symptoms are common in men over the age of fifty. The same symptoms can be caused by both benign enlargement of the prostate and prostate cancer, so it is important to seek an asessment. The cause of the majority of prostate symptoms is benign prostatic enlargement and associated bladder dysfunction, and small cancers localised to the prostate usually cause no symptoms.
- Common prostatic (lower urinary tract) symptoms include:
- Urinary frequency
- Difficulty in starting urination
- Difficulty postponing urination, or having to rush to the toilet
- Intermittent or poor urinary stream
- Pain when passing urine
- Getting up at night to pass urine
- Feelings of not emptying the bladder properly
An assessment of prostate problems involves detailed characterisation of the symptoms using validated questionnaires and a voiding diary, and a digital examination of the prostate by a urologist. After this a urinary flow rate measurement and ultrasound of the bladder after pasing urine may be performed to quantify how well the bladder is emptying. A discussion between the urologist and the patientshould then take place regarding the complex issues surrounding the PSA blood test, with the test only being performed after informed consent. Further investigations may or not then be recommended.
If the cause of the symptoms is benign prostatic enlargement the treatment varies from a conservative approach with patient specific advice given regarding how to minimise the symptoms, various medications, and lastly prostate surgery.
Prostate cancer affects a great many men but kills relatively few. We do not know precisely which cancers will cause a man problems and which are relatively indolent. There is no screening test for prostate cancer, and the more we find out about about the commonly performed PSA test the less reliable it appears to be as a marker for the disease.
New imaging MRI techniques are being developed and are available now, and it is likely that these will take over the role of PSA once fully evaluated. These very powerful MRI scanners enable detection of abnormalities in regions of the prostate not accessible by standard biopsy techniques, and in some patients are so unequivocally normal that prostate cancer can be reliably excluded without the need for biopsy. In others they can be used to guide the biopsy.
Despite the uncertainties surrounding prostate cancer, we can go a long way to quantifying the risks to an individual once it has been diagnosed, by analysing the cancer cells, performing various imaging studies and taking a number of patient characteristics into account.
A full discussion then needs to take place between the urologist and patient regarding the suitable treatment modalities, their effectiveness, and their side effects which can be considerable.
There are many treatments for prostate cancer and many variables to consider when deciding which one is most suitable for an individual. Furthermore, no one urologist is expert at the four possible techniques, and this might in theory influence a treatment decision. We have expert knowledge of the results of, and refer to, the most skilled practitioners in London of each treatment modality, and are able to provide a completely impartial patient centred opinion on the most suitable path to follow.
Prostatitis generally affects younger men than other prostate conditions, but can produce very similar symptoms. It causes urinary frequency and urgency and pain passing urine and on ejaculation. More research into prostatitis is needed and treatment can be prolonged. Initial assessment will involve a full evaluation of the symptoms and their history, including validated symptom scores. There will also be an examination of the prostate with a gloved finger, urine and sometimes blood tests. Further evaluation may involve specific cultures and ultrasound examination of the prostate and urinary system to exclude another cause for the symptoms. We have achieved very good results using a variety of powerful antibiotics in combination with anti inflammatory agents and those that relax the prostate ducts. At North london Urology we also have access to a prominent prostatitis support group and welcome patients with this difficult and uncomfortable problem.