“I think I have a prostate problem”

Enlarged prostate

Important questions and answers about your prostate:

  1. Where is it? The prostate is a small gland found beneath the bladder and surrounding the urethra (water pipe)
  2. What is it for? It is probably important in improving the fertility of male sperm. Later in life it has no important functions as far as we know
  3. I am passing urine more often do I have a prostate problem? Not necessarily. There are many reasons why men pass urine more frequently at times, however it is always worth telling your general practitioner.
  4. How do I know if my prostate is enlarged? Your doctor will examine your prostate by inserting a finger into the back passage. The prostate is easily felt here. The procedure is called “digital rectal examination”.
  5. Does an enlarged prostate mean I have prostate cancer? In general this is not the case. The prostate enlarges throughout life in most men, some at a greater rate than others. This is known as benign prostatic enlargement. As it enlarges, it can put pressure on the bladder and urethra which is why symptoms can occur.
  6. What symptoms suggest benign prostate enlargement? Apart from increased frequency of passing urine, patients may notice urgency to pass urine, slowness to start (hesitancy), a weak flow, interrupted stream, and a feeling that the bladder has not fully emptied. Patients may have some or all of these symptoms.
  7. What can be done about this? Your general practitioner may suggest you see a urologist. After some simple tests it is possible to tell if the prostate is the cause and how severe the problem is. In some cases nothing more than reassurance is required. In most patients a trial of medication is recommended which helps in over 50% of people. Less commonly, an operation may be advised.
  8. I have been told I need prostate surgery. What does this involve? Patients with severe symptoms, and those in whom medication has not helped, are often advised to have surgery. There are several techniques available, but all aim to remove the prostate tissue that is obstructing the flow of urine from the bladder. The procedure is usually performed by a urological surgeon who passes a telescope along the urethra and can then see the inside of the prostate. The prostate tissue is removed either with electrical current (known as a”TURP”) or with a laser.
  9. What are the side effects of benign prostate surgery? In the short term, you may pass blood in the urine, and you may still pass urine frequently. These usually settle within 2 to 6 weeks after treatment. Patients can be concerned about the effects of the operation on their sex-life. Generally, this is not affected but your urologist will need to talk in detail about this before surgery. Patients also worry that they will not be continent afterwards. In the first few days after surgery, it is advisable to remain near a toilet as there is little warning of the need to pass urine. However, this settles quickly and very few patients have poor control of their urine afterwards.
  10. I have heard that a Laser prostate operation is best. Is this true? There is no evidence that laser prostate removal is better in the long term than the more conventional TURP. However, there may be less blood loss and potentially a shorter hospital stay with laser treatment. The safest answer is to ask your surgeon in which procedure he or she is most experienced and decide yourself which you would prefer.
  11. My doctor has asked if I would like a PSA test. What is this? PSA stands for Prostate Specific Antigen. It is measured in a blood test and gives an indication about whether a patient has prostate cancer. An abnormal result needs interpretation by a urologist and in the majority of patients it can be explained by conditions other than prostate cancer. It is not advisable in a man under 50 years of age as the risk of prostate cancer is very low. In older men it is something to consider carefully particularly if you already have some urinary disturbance.
  12. How would I know if I had prostate cancer? In many cases, there are no symptoms with early cancers which is why doctors rely on the PSA test as a guide.
  13. My urologist has advised a prostate biopsy because of an abnormal PSA test. What does this involve? This procedure is performed to confirm whether there may be prostate cancer. It involves passage of a probe into the rectum to visualise the prostate and several small samples are taken. This is performed as an outpatient under local anaesthesia. In over 85% of cases your urologist will be able to confirm whether cancer is present or not.
  14. I have been told I have “localised’ prostate cancer”. How is this treated? This is a difficult question and cannot be answered in a simple way. There are currently many potentially equivalent treatments that can cure a patient with prostate cancer. Surgery, radiotherapy or even watching closely are advocated. The decision is based on detailed discussions with your urologist and a doctor specialising in radiotherapy treatments.
  15. I am nearing retirement. Should I be worried about my prostate? Not necessarily. But it is well known that men take less care of their health than women and are more reluctant to see their doctor. Early detection of any urological condition gives more opportunity for treatment and a happy retirement!

Advanced laser technology brings relief to men

Consultant urologists are increasingly offering men requiring surgery for benign prostatic enlargement the newest laser therapy.

Benign prostatic hyperplasia (BPH) is the non-cancerous enlargement of the prostate affecting more than half of all men over the age of 60. The GreenLight Laser procedure, also called PVP, uses laser energy to vaporise and remove enlarged prostatic tissue, leaving an open channel for urine to flow through. Patients experience rapid symptom relief and a significant improvement in urinary flow. The GreenLight procedure is less invasive and has a better side effect profile compared to conventional transurethral resection of the prostate (TURP) or open prostatectomy. Blood loss tend to be non existent or minimal and hospital stay is usually less than 24 hours.

Consultant surgeon Mr Pieter Le Roux, who introduced this procedure at Epsom and St Helier NHS Trust in Surrey and also performs the GreenLight operation at St Anthony’s Hospital, Cheam, has been very pleased with the results. “An audit of our initial series of 25 cases has been very encouraging. The vast majority of patients went home on the first postoperative day without a catheter. Patient satisfaction levels are high and we have seen only very minimal side effects. Conventional TURP is associated with more bleeding, a higher incidence of complications and a longer hospital stay of 3 or 4 days.

Most men develop an element of BPH in their lifetime. Not all require treatment. Symptoms include difficulty in urinating, a reduced urine stream, straining to urinate, frequency of urination, and a feeling of incomplete bladder emptying. The GreenLight laser system delivers immediate relief of symptoms and dramatic restoration of urine flow. Almost all patients with BPH who require a surgical solution to their problems are suitable for the Greenlight procedure. As with any procedure there are risks associated with GreenLight Laser Therapy, however the most common side effects tend to be mild and short lived. Patients are discharged within 24 hours and can return to normal non-strenuous activities within days.

For more information:
w: www.stanthonys.org.uk

Q&A by Mr Nick Watkin MA MChir FRCS, Consultant Urological Surgeon
t: 020 8337 6691
f: 020 8335 3325

Laser treatment by Mr Pieter J le Roux FRCS, FCS(SA)UROL, MMed(UCT)
contact Janice Roberts (PS to Mr le Roux):
t: 020 8335 4676 / 7
f: 020 8335 4637
e: JaniceRoberts@stanthonys.org.uk