As they get older, men are more likely to experience problems relating to the prostate gland, the gland at the outflow of the bladder. It slowly enlarges and sometimes causes pressure on the outflow tube, resulting in a slower stream and often a need to go to pass urine more frequently, including during the night. This condition is known as benign prostatic hypertrophy. Occasionally men develop cancer of the prostate, which causes similar symptoms, but this is rarer and one does not necessarily lead on to the other.
Diagnosis
Your doctor will want to know more about any change in the flow or stream of urine, frequency by day or the need to get up at night, and regarding any difficulty starting or stopping when passing urine.
He will want to examine the prostate gland, which means examining, with a gloved finger, up the rectum. This will give a clue as to the size of the prostate and any possible evidence of cancer.
Other tests include a blood test to check on kidney function and a special blood test (PSA) to check for biochemical evidence of prostate cancer. PSA stands for prostate specific antigen, and is a substance from the prostate gland which is present in the blood of all men. As men get older the amount that is in the blood slowly rises.
In prostate cancer the PSA test usually shows a higher concentration in the blood than would be expected. If the test shows a normal result this is reassuring, and if the result is high it is likely that your specialist will wish to embark on further tests and treatment. There is a level which is just above the normal range, but not yet high, which might lead to your doctor repeating the test after a few months. As with all tests, the PSA is considered by your doctor in conjunction with their other findings and test results.
It may well be that your doctor will also organize a urine test to check for infection, and a flow test to assess the speed at which the urine leaves the bladder. There may also be an ultrasound examination (rather like sonar is used to detect submarines underwater, and how babies are examined during pregnancy).
Treatment
After these tests it may be apparent that the problem lies elsewhere (for example irritable bladder wall), or that there are varying degrees of obstruction due to the prostate. If there is severe obstruction, or any suspicion of cancer, your doctor will refer you directly to a specialist kidney and bladder surgeon (urologist). If there are lesser degrees of prostate obstruction, in the absence of evidence of cancer, your doctor may suggest some tablets which might be to help the muscle wall of the outflow tube to open more or to slowly shrink the prostate gland.
There is a natural remedy that some men may wish to try, having had the preliminary tests, as an alternative to the prescription medications. This is a berry extract known as saw palmetto, which has been shown to be safe and effective, at least in mild to moderate cases. If it does not help you, however, you should be willing to consider the medication from your doctor, as back-pressure on the kidneys from the prostate can eventually lead to poor kidney function.
Should you require surgery, this is most frequently done via the penis and does not involve an external scar. It consists of reaming out the protruding center of the gland, thus leaving a larger passage. Occasionally a more major operation is required which does involve a scar, usually above the pubic bone.
Further information
Books
- The Man Manual: 120,000BC to present day, by Dr Ian Banks
- From the publishers of a well known series of car owner workshop guides! Written by a British family doctor.
