Drs John Coffin and David Acorn
Family Medical Practice
0844 477 3088

Men's Health

Prostate Problems

What is the prostate?

The prostate is a gland at the bottom of the bladder, that makes part of the semen. The tube that carries the urine to the penis (the urethra) passes through the middle of the prostate.

If the prostate gets bigger it also tightens up round the urethra and starts to restrict the flow of urine. 

It may be difficult to pass urine and the flow rate is slow. Some men find that when they need to pass urine they have to rush to the toilet to avoid an accident, this symptom is called "urgency".

If the symptoms are ignored, pressure builds up in the bladder which gradually gets bigger, and then the pressure also begins to affect the kidneys. If it is still ignored the kidneys can stop working.

The bladder never empties properly so it reaches full capacity sooner, so you have to pass urine more often, even getting up in the night.

If it gets very full, eventually it can't take any more, and so you may leak urine (overflow incontinence).

What can go wrong with the prostate?

The commonest problem is benign hypertrophy of the prostate (BPH)

• benign means it's not cancerous
• hypertrophy means it's grown bigger

It affects about half of all men older than 45. Around one in five men over 60 have symptoms bad enough to need treatment.

Symptoms are

• difficulty starting to pass urine
• poor flow of urine
• having to pass urine frequently
• having to rush to the toilet to pass urine
• getting up at night more than once to pass urine
• dribbling after passing urine
• when you think you've finished passing urine you have to go again

Do come and see us if you get these symptoms. We need to make sure the problem is benign, and also organise some treatment. Initially this may be tablets. Sometimes we have to refer you to a specialist to see if an operation is needed.

Cancer of the prostate is commoner than is realised
In fact one third of all men  over 50 have it but most will not have any symptoms or die from it. It is said that prostate cancer is often "something you die with rather than die from".

Symptoms are

• none, in a lot of men
• similar to benign hypertrophy
• change in bowel habit
• incontinence
• impotence
• blood in the urine or semen
• pain in the bones of the pelvis, lower back or legs
• weight loss
• feeling generally unwell

If you get these symptoms do come and see us

Is there any screening programme for prostate cancer?

No, not yet.
Although there is a blood test (the PSA test), it's not yet known if detecting prostate cancer early actually makes men live longer. Until this has been proven the NHS is reluctant to start a mass screening programme.

There are problems with the PSA test, depending on the cut off point chosen for a "normal" test, up to two thirds of men with a raised PSA don't actually have cancer. Some men with PSA results below this cut off point will have prostate cancer.

PSA screening of men without any symptoms would mean that a lot of men would need further tests such as scans and biopsies, though many of them would be found to be free of cancer.

This would cause a lot of anxiety and the extra workload for the hospitals could stop more urgent cases being investigated as quickly as needed. 

However, if despite reading this you still want to have a PSA test we would be unlikely to refuse you.

What if my PSA test is raised?

This doesn't necessarily mean you have cancer.

Up to two thirds of men with a raised PSA don't have cancer of the prostate. Other conditions can elevate the PSA test.

• BPH
• infection of the prostate
• sex in the 48 hours before the blood test 

However we will probably have to arrange other tests including an ultrasound scan of the prostate and possibly prostate biopsies.

On this page

• What can go wrong with the prostate?
• Is there a screening programme for cancer of the prostate?
• What if my PSA test is raised?

See also

• For further information try this website www.prostate-cancer.org.uk

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