Although prostate cancer affects 1 in 12 men during their lifetime, 1 in 2 men will develop benign enlargement of their prostate. Consequently most men who experience urinary symptoms associated with prostate enlargement will not have cancer. The symptoms to look out for include frequent visits to the toilet, or getting up at night to pass urine and having to rush to get there; and a period of pause before starting to pass urine, having a slow flow of urine and dribbling at the end. If you have a family history of prostate cancer then your own risk of having prostate cancer is increased and you should seek medical advice whether or not you should be tested. You should not be concerned as there are good treatments available for all prostate diseases and prostate cancer is curable if detected early.
EUS-European Division at the Specialist Medical Group. Gibraltar.
Men and the prostate gland, what can go wrong?
The most common problems of the prostate are:
1. An enlarged prostate – most common problem
2. Inflammation or infection of the prostate
3. Prostate cancer
Not all men with a diseased prostate will have symptoms. It maybe found if they are offered a PSA test and undergo a digital rectal examination for other conditions, either of which might highlight the problem.
Common urinary symptoms include:
- Poor stream
- Increased frequency of urination
- Poor bladder emptying
- Nocturia (getting up at night to pass urine)
There are recognized risk factors for prostate cancer:
- Age – prostate cancer rare in men under the age of 40, its incidence increases in men aged 45 to 64 and is considered the commonest cancer among men aged 65 and above.
- Men who have had a close family member (father/brother) diagnosed with prostate cancer at younger age (under 55) can be at increased risk by 3 folds, or due to inherited genes that are faulty
- Men who have an increased family risk of prostate cancer, may wish to have regular screening once they are over the age of 40 or 50, to monitor against the potential onset of the disease.
Sometimes men have symptoms that relate to prostate cancer cells being spread to other parts of the body (metastases), such as back pain or pain in the bones that does not change or go away with simple painkillers.
Prostate Specific Antigen (PSA) Test
PSA is a protein produced by the prostate gland, its level can be checked by a blood test. It is useful in telling doctors which treatment may benefit patients with benign prostate disease and malignant prostate cancer, and also help in monitoring treatment for prostate cancer.
PSA can detect prostate cancer at an early stage, before any other symptoms develop, but not all men with a raised PSA level will have prostate cancer. If prostate cancer is diagnosed, PSA test is very useful in monitoring response to treatment.
Raised PSA test can be due to various causes, such as:
- Benign prostate growth
- Prostate cancer
- Urinary tract infection
- Significant level of cycling (more than 10miles/day on regular basis)
- Inspection of bladder (cystoscopy)
What happens if my PSA test is abnormal?
If the PSA test comes back elevated and or digital rectal examination shows an abnormal texture of your prostate gland, you will be advised to undergo a prostate biopsy.
Prostate biopsy is a day-case procedure under local anaesthesia. An ultrasound probe is placed into the back passage using a lubricant jelly. This is moved around to scan the prostate, take various size measurements and allow injection of the local anaesthetic prior to taking biopsies (small samples of prostate tissue). After the biopsy, it is common to see some blood when passing urine and also from the back passage. This usually clears after a day or so. Once the report comes back from the laboratory, usually around couple of weeks or so, we will be in touch with the result and discuss further management accordingly.