As we all know, prevention is better than cure and being aware of ones own health from a preventive and health surveillance stance is always a good place to start. In this article, we will explore the intricacies of testicular and prostate health, what to look for if you’re worries and when to seek help.
What is the prostate gland?
The prostate is a small gland, located in the pelvis, between the penis and the bladder. It is part of the male reproductive organs that helps to generate prostatic fluid that is needed for healthy semen production.
How does the prostate start to misbehave and what do I look for?
Like any organ in the body, it can become infected and this can cause a condition known as prostatitis. This can be as a result of an infection tracking up the urine pipe or from a bladder/kidney infection or caused by a sexually transmitted infection. For these reasons, we always advise full sexual health screens every 6 months for sexually active patients, regardless of protected or unprotected sexual intercourse.
The prostate can also become enlarged and there are two main ways for it to happen. The first is as a result of a condition known as benign prostatic hyperplasia, which occurs as men get older normally in their 40s. Here the prostate becomes naturally enlarged.
The second way the prostate can become enlarged is through a cancerous process or tumour that forms in the prostate. The risk of this rises with age, with an increased risk of this forming in men generally in their 50’s and beyond.
What to watch out for
It is difficult to distinguish benign prostatic hyperplasia from prostate cancer, however, when the prostate becomes enlarged it places pressure on the bladder and urethra (the tube through which urine passes – see image below).
This can affect how you urinate and may cause one difficulty starting to urinate, as well as also causing urination to occur too frequently. Some may also complain of a difficulty in fully emptying their bladder.
Symptoms such as dribbling and poor urinary stream/flow could be signs of prostate enlargement. Coupling this, a cancerous process may also cause bleeding into the urine, tiredness and weakness, as well as unexplained weight loss or back pain.
How to I examine my prostate?
All the symptoms above should be investigated and do not hesitate to see your doctor should any occur. It remains very difficult to examine your prostate without medical input. There are two ways in which doctors examine the prostate gland, one is with a digital rectal exam, which is where the doctor will insert a gloved finger into the back passage to feel the prostate to check for natural enlargement or cancerous growth.
Although it may seem unpleasant, it is relatively painless and is the least invasive way to diagnose benign prostatic hyperplasia. The other is to arrange a simple blood test known as the prostate specific antigen or PSA test. It is important the prostate has not been examined within two weeks prior to organising the PSA test as this can alter results. The PSA is a generally seen as a very good test to look for prostate cancer, although it is not perfect.
We would always advise both tests to be carried out if you develop symptoms: one to look for benign prostatic hyperplasia and the other to look for cancerous changes. A routine PSA test is available on request and following counselling, because there are risks as well as benefits to having the test.
Is there any medication/treatment that’s recommended?
Depending on the outcome of the tests outline above, a high PSA reading requires a referral to a consultant urologist (specialist mens’ health doctor) for further treatment.
Benign prostatic hyperplasia can be treated with medicine obtained through your doctor. There are two types of medication: one that could potentially shrink the prostate and another which can widen the urine pipe.
If these medicines are struggling to have the desired effect, the next step would be a referral to a consultant urologist to arrange for an operation to shrink the prostate.
If you are ever in doubt or concerned about your health, or you begin to experience some of the symptoms above, you should see your doctor without delay.
Article by Dr. Amun Kalia MRCGP MbChB BCSc. (Hons) ECPC Dip OH
NICE (2010) The management of lower urinary tract symptoms in men (NICE guideline). National Institute for Health and Clinical Excellence. www.nice.org.uk
NICE (2013a) Lower urinary tract symptoms in men. Quality standard (QS45). National Institute for Health and Care Excellence. www.nice.org.uk