TALK TO YOUR GP Symptoms of the lower urinary tract are very common and are, more often than not, due to non-cancerous causes.
Don’t procrastinate over your prostate
Dr Ronan Clancy
Having discussed polycystic ovary syndrome (PCOS) in my last column, in the spirit of gender equality I will cover some men’s health in this one!
Prostate disease has become a frequent media topic in the past years. The longstanding campaign has been to increase public awareness of prostate disease and to remove the taboos associated with the intimate nature of the problem and the examination. It is working, as more men than ever before are aware of prostate disease and are coming forward for assessment.
The prostate gland is a small gland that sits just below the bladder in men. In a normal male, it is about the size of a walnut and produces an alkaline fluid for healthy sperm. The prostate also produces a chemical called prostate specific antigen (PSA), which is traceable in the bloodstream and often rises with prostate enlargement and in prostate cancer.
With advancing age, it is common for the prostate to enlarge. When it does it compresses the urethra which is the tube that drains the bladder through the penis. Over time the bladder will need to contract or squeeze harder to expel urine through this narrow neck. The main symptoms of prostate enlargement relate to this narrowing.
Firstly the stream of urine may be slow to start and a man may feel himself strain to start, and maintain a poorer flow of urine than before. At the end of urinating there may be some dribbling or a sensation that the bladder has not fully emptied. Incomplete emptying of the bladder can increase the threat of urinary-tract infection or even kidney damage. Bed wetting at night may be a sign of severe retention of urine. ‘Need to go’ sensations may become more urgent and intense due to degenerative problems in the bladder muscles and control system. Alcohol effects on urinary habits do not apply!
The difficulty is that these symptoms, collectively called lower-urinary-tract symptoms (LUTS) may be present in approximately 30 percent of all men over 65 years of age.
Some will have simple age-related enlargement of the prostate and others will have an alternate diagnosis due to a non prostate-related condition. Others still may have prostate cancer, although prostate cancer may not cause any symptoms in its early stages.
Cancer is unusual in men under 50, but men with a first-degree relative have a higher risk of prostate cancer, as do African and Caribbean black men.
If you feel you have some of these symptoms or you just want to be screened for prostate cancer, you should visit your GP for an assessment. This will include an examination of the prostate, which is necessary to accurately complete the clinical picture. Depending on your symptoms, age, ethnicity and risks for prostate cancer, a PSA blood test may also be performed.
PSA tests can detect prostate cancer, sometimes at an early stage. The problem is that two out of three abnormal PSA tests are not due to cancer and may require prostate biopsy procedure to clarify things further. About two out of three biopsies will be negative for cancer and may occasionally even miss a cancer. Sometimes a very non aggressive (indolent) cancer will be found that would have otherwise caused no major problems but must then undergo treatment, which comes with difficult side effects as well as the emotional and psychological burden of a cancer diagnosis.
As you can see, there are definite benefits to PSA testing but also many potential limitations. Your doctor will discuss these with you if the need for PSA testing arises.
If your symptoms are being caused by normal prostate enlargement (benign prostatic hyperplasia) or non-prostate symptoms emanating from the bladder, your GP will manage these with specialist medications and lifestyle advice. Failing these measures, surgical procedures may be considered.
The take-home message here is that symptoms of the lower urinary tract are very common and are, more often than not, due to non-cancerous causes. Nevertheless, they should not be ignored or disregarded. Investigations for LUTS and screening for prostate cancer can pick up prostate cancers, sometimes early on, but may also lead to a limbo of unnecessary investigations and anxiety. Your GP is highly trained in the complex nature, investigation and treatment of these disorders, and will counsel you in deciding the best course of action.
For more information on PSA testing for prostate cancer, a useful patient information sheet can be downloaded at www.cancerscreening.nhs.uk/prostate.
> Dr Ronan Clancy is a GP at the newly opened Clancy Medical Practice, James street, Westport (www.westportgp.ie). He is in practice with Sarah Kavanagh, chartered physiotherapist.
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