Prostate Health: Fast Facts

We all know September is Prostate Health Awareness Month, but what exactly is it that you are supposed to be aware of? To answer that, let me first tell you a bit about Prostate Cancer (and if you just can’t wait then go ahead and skip to the end!).

Causes

As is typical with most cancers, we don’t tend to know exactly what causes an individual case of prostate cancer. What we do know is that the risk of developing it is associated with:

• Age – uncommon under 50.
• Family history – particularly in first degree relatives who are diagnosed <60 years old.
• Ethnicity – most common among Black men; least common among Asian men.
• Self-destructive or aggressive behaviour.
• Being overweight tends to be associated with the more aggressive forms of prostate cancer.

Symptoms

Prostate cancer can occur without any symptoms. Any symptoms that do occur can be variable and can be hard to distinguish from those you get with a ‘normal’ enlargement of the prostate that happens as you get older (also known as Benign Prostatic Hyperplasia, or BPH). Symptoms of both, with some associated medical terms for reference include:

• Needing to wee more often, or ‘polyuria’ (including getting up in the night to wee, or ‘nocturia’)
• Difficulty getting the flow of urine started – ‘hesitancy’.
• An interrupted flow.
• Reduced flow strength (if there was an actual contest, you wouldn’t be able to wee as far as you used to).
• Increase in dripping after finishing, ‘terminal dribbling’.
• Feeling like the bladder hasn’t emptied completely afterwards.

Other symptoms that are unlikely to be due to a benign enlargement itself:

• Blood in the urine, ‘haematuria’. This might be easily visible or only picked up if a urine sample is tested for another reason. Invisible blood in the urine is actually very common in people over 50 and can be caused by a urinary infection amongst other things. When it is found, it is advisable to repeat the urine sample after 2 weeks to see if it has resolved. If it persists, please speak to your GP or us about whether further investigations are appropriate as it can be a sign of something more serious.
• Blood in the semen, ‘haematospermia’. This also can be caused by other things but is always worth speaking to a doctor about (which, to be fair, most people do!).
• Symptoms that suggest advanced cancer in general, such as weight loss, bony pain eg in the spine, and fatigue.

Diagnosis

If you do have any of the above risk factors or symptoms, or you are concerned about possible risks of prostate cancer, please get in touch with us (checkuphealth.co.uk) or your NHS GP.

If a doctor is concerned about possible prostate cancer, there are usually two initial tests to consider:

• A ‘Digital Rectal Examination’ or DRE: Unfortunately the ‘digital’ here is referring to the doctor’s examining finger, not an online remote examination. While it is undoubtedly uncomfortable, as the prostate is easily felt through the wall of the back passage, there is a lot to be gained from this simple procedure. The size and shape and general feel of the prostate can be assessed and give a significant indication as to how serious any issues are likely to be. As the surgeons all like to tell medical students, “If you don’t put your finger in it now, you’ll put your foot in it later”.
• Family history – particularly in first degree relatives who are diagnosed <60 years old.
• PSA (Prostate-Specific Antigen) testing: Perhaps one of the most controversial subjects since the man-bun (so low maintenance on one hand… on the other, still a man-bun), PSA testing has some important caveats to consider before having this done:
  -Pros: Can pick up prostate cancer earlier than otherwise.
  Especially useful when looking at changes with time (less so with one-off readings).
  -Cons: Can be falsely reassuring and come back normal despite cancer being present.
  Or can go the other way and make it look like there is a cancer, leading to painful further testing and procedures when in actual fact the prostate is completely healthy. (There are multiple cause for a raised PSA that have nothing to do with cancer, eg a urinary tract infection.)

If there is cause for concern then typically the next step is seeing a Urologist. They are likely to arrange a scan (MRI) and then potentially a biopsy. This can be done by going through the back passage (rectum), the perineum, or when another test with a camera inside the bladder (cystoscopy). See here for more info on these different approaches: https://www.nhs.uk/conditions/prostate-cancer/diagnosis/

If prostate cancer is found, the next step is to assess how severe it is, which is called staging. See the fantastic breakdown at Stages, types and grades | Prostate cancer for details about this.

Treatment

As far as cancers go, prostate cancer is generally one of the slower-growing types. However, the sooner it is caught, generally the better the outlook. Specific treatment options depend on the stage of the cancer (see link above) as well as your own health and preferences of course. The options tend to include watchful waiting, surgery, radiotherapy, hormone therapy or a combination of options. See https://www.cancerresearchuk.org/about-cancer/prostate-cancer/treatment for a more detailed breakdown on what each of these options entail.

The answer is…

I asked at the beginning of this article, what is it exactly that you should be aware of when it comes to prostate health? Hopefully you’ve read through this informative and (*ahem*) well-written article and found the answers. If you’ve cheated and skipped to the end, then please make sure you can answer the following questions:

• Are you at increased risk of prostate cancer? (Hint: If you’re unsure, read the bit under ‘Causes’
• What are the symptoms of prostate cancer? (You’ll never guess which heading this is under…)
• What are the options for assessing one’s prostate health? And the follow up question for extra credit, which option is comparable to the man-bun?

Helpful Links

I referenced a few of these in the article but they are also worth exploring in full if you’d like to learn more:
https://www.cancerresearchuk.org/about-cancer/prostate-cancer
https://prostatecanceruk.org/
https://www.nhs.uk/conditions/prostate-cancer/

If you’d like to chat to one of us private GPs about your prostate health or any other issue, download the CheckUp Health app now and book a video or audio call, daytime or evening, 7 days/week.