Benign Prostate problems
What is
the prostate?
The
prostate is a sex gland found in men. In an adult male it is normally about
the size of a walnut. It sits under the bladder, at the base of the penis and
just in front of the back passage (the rectum). It makes some of the fluid in
semen. The prostate has a narrow hole through the middle. The tube (urethra)
that empties urine from the bladder passes through this hole on its way to
the end of the penis.
How do I
know if I have a prostate problem?
It is common
to have some problems with your prostate as you get older (over fifty). You
probably have some problems in passing urine. You may have some or all of
these changes:
·
Trouble getting started, especially when you are in a
hurry.
·
Trouble stopping the flow of urine.
·
Taking longer, because the urine stream is weak, or
it stops and starts.
·
Dribbling of urine after you have finished.
·
Going more often throughout the day, even though
there is not much urine to pass.
·
Getting up at night to go to the toilet, when you
used to sleep through. This can make you tired and cranky.
·
Needing to go urgently at any time.
·
Feeling you haven’t quite finished or that you need
to go again, even though nothing comes out.
·
Pain or burning feeling when you urinate.
·
Occasionally, blood in the urine. This should always
be checked by a doctor.
If you
have any of these problems, see your doctor about them. Don’t just accept
them as part of getting older—the right treatment can help you.
What causes
the problems?
In 90%
of cases when prostate problems are experienced it is because the prostate
has become enlarged which squeezes the urethra. This problem is called benign
prostatic hyperplasia or BPH and is caused by hormone changes in the prostate.
This affects about half of all men over fifty and is not cancer.
Sometimes
the swelling of the prostate can be caused by an infection called
prostatitis, which has similar symptoms to BPH but tends to affect younger
men.
Less than
one man in ten with prostate problems will have prostate cancer.
Remember—most
prostate problems are not cancer, and most can be treated.
What
will the doctor do?
First of
all, the doctor needs to find out what is causing the problem. This will
require some tests, which include:
Digital rectal
examination
The doctor inserts a gloved finger into your back passage (rectum) to feel
the size, shape and texture of your prostate.
Prostate specific
antigen test (PSA)
This is a blood test to look for PSA, which is produced by the prostate. If
there is a high level in your blood, you may have prostate cancer—but the
doctor needs to do more tests to be sure.
Biopsy
If your PSA test or digital rectal examination is abnormal your doctor may
refer you to a specialist (urologist). The urologist may recommend a biopsy,
which involves an ultrasound probe being placed in the rectum to find
abnormal areas of the prostate. Samples (usually six or more) of the prostate
are then taken and sent to a pathologist for further examination.
The procedure is not always done under anaesthetic. Your doctor will advise
you on this.
A biopsy is the only definite way to tell if you have prostate cancer. The
biopsy also indicates if it needs treating, how fast the cancer will grow and
how far the cancer has spread.
What are
the treatments for prostate problems and prostate cancer?
This
depends on what your problem is and how severe it is. Your doctor will choose
the best course of action for your particular situation. If you have an
enlarged prostate this doesn't mean you are more likely to get prostate
cancer.
Benign prostatic
hyperplasia (BPH)
This can be treated with medicines or surgery.
Medicines can change the hormone levels, or can relax or shrink the prostate so
that it doesn’t press on the urethra. You may need to take the medicines for
some months before your symptoms improve. You will need to keep taking them
until the symptoms are under control, and maintain checkups with your doctor.
Surgery may be used to remove part of the prostate, to stop it squeezing the
urethra. Laser and microwave treatments may also be used.
Prostatitis
This is usually treated with antibiotics. You may need to take the
antibiotics for several months. Some men may also need surgery to stop the
swollen prostate from pressing on the urethra.
Prostate
cancer
Sometimes prostate cancer does not need treating. ‘Watchful waiting’, where
the doctor does regular tests to check for any changes, is often the approach
that is chosen. Treatment may be advised at a later stage if the cancer
begins to grow.
Treatment depends on how far the cancer has spread, your age, and how healthy
you are. If the cancer has not spread, you may have surgery to remove the
prostate. Some men will also have radiotherapy or brachytherapy (internal
radiotherapy). If the cancer has spread, you may have hormone treatment to
stop the cancer or help slow it down.
You may want to get a second opinion before deciding on the type of treatment
that is best for you.
Are
there any complications of treatment?
Surgery
or radiotherapy for prostate cancer can have three main complications.
·
Some men can no longer get an erection (they become
'impotent'). This is because the nerves that bring about an erection pass
through the prostate. In some cases, it is impossible to avoid damaging these
nerves because of the position of the cancer.
·
Following surgery, some men may lose their ability to
control urine (they become incontinent) because of damage to the muscles
around the prostate.
·
Radiotherapy treatment sometimes affects the bowel.
This could mean diarrhoea during treatment or bowel damage requiring
treatment.
There is
help available for the complications of treatment. Talk to your doctor before
making a decision about treatment or call the Cancer Information and Support
Service on 13 11 20.
Should I
have a regular check-up or screening—even if I don’t have symptoms?
Making
an informed decision about testing for prostate cancer is a wise and
practical course of action if you are considering having a test.
For some
years now, there has been a lively and sometimes complex debate about the
issue of testing for prostate cancer. Some people believe all men over a
certain age should be regularly tested. Others believe it should be a matter
of individual choice based on a man’s informed consent.
Our view
is that men should find out all the information they need about testing.
Consider the issues. Talk to our counsellors at the Cancer Information and
Support Service on 13 11 20. Read our information booklets on prostate cancer
issues and treatment. Visit the prostate cancer website at
www.prostatehealth.org.au. Speak to men who have been through the prostate
cancer journey. Talk to your doctor.
There are many resources available and we are happy to help you get access to
the information you need.
At the
moment, we are not advocating routine testing for prostate cancer, because
there is no reliable evidence at this stage that this prevents men from dying
from prostate cancer. Nor can we be sure that routine testing is not
effective, so we don't advise against testing either. There is a great deal
of research underway that may answer this question in time.
It's a
decision for you to make up your mind about. All that we suggest is that you
get the best information you can.
For
further information call the Cancer Information and Support Service on 13 11
20.
Visit the Lions Australian Prostate Cancer website at
www.prostatehealth.org.au.
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