by Richard Brierley
Have you noticed that you’re having to rush to the loo more often and when you get there you have to stand and wait for ages for it to start, and when it does, it trickles out slowly, and then 5 minutes later you’re desperate to go again? Are you getting up 2 or 3 times a night to pass urine when you used to sleep right through undisturbed?
Lots of men get problems with their waterworks and often simply put it down to getting older, but it may be something more serious and it’s worth considering getting things checked out properly.
Most of the problems that men get with their bladder function is related to the prostate gland, a “ring doughnut” shaped piece of tissue that sits around the bladder’s drainage tube (urethra). As you get older the prostate gland slowly enlarges and if you can imagine a doughnut swelling up, the hole in the middle gets gradually smaller, and this stops the bladder from emptying as efficiently as it should.
This is known as benign prostatic hypertrophy (BPH) and is very common. It doesn’t necessarily need treating if it is mild but if bothersome, it will often respond to tablets, either to relax the muscle tissue in the prostate or to actually shrink the prostate tissue, both of which lead to that hole in the middle getting larger and improving the urine flow. In severe cases where there is a risk of the hole closing up altogether, a transurethral resection of the prostate (TURP) can be carried out, which is a surgical procedure where a thin tube with a camera is inserted into the end of the penis and up to the prostate where tissue is removed either with a thin hot wire or with a laser.
However what most men are worried about when it comes to their prostate gland is prostate cancer, especially as the symptoms of BPH and prostate cancer are very similar and there is much confusion and disagreement, both amongst doctors and the general public about how prostate cancer should be tested for and treated. It is the commonest cause of cancer in men in the UK being diagnosed in about 1 in 8 men, usually after the age of 65. Most are slow growing and have no effect on life expectancy, but some can be life threatening and need treating rapidly and aggressively.
Generally, if you have noticed changes in your waterworks it’s worth booking in to see your GP. They will need to examine your prostate which I know puts a lot of people off. The prostate sits just in front of the rectum and can be felt easily with a finger inserted through the anus. It’s a very routine examination that GPs do all the time and doesn’t hurt at all. It’s often possible to feel a cancer as a hard craggy lump but the examination is usually followed up with a blood test to measure the PSA. This is a chemical from the prostate gland that rises in the blood if there is a prostate cancer however it can also rise with other conditions so doesn’t give a complete answer in itself. If cancer is suspected, even in the slightest, an urgent referral is arranged to see a urologist who can carry out further tests such as scans and biopsies.
Something I am very frequently asked about is screening for prostate cancer. This subject has been quite controversial and there is no complete agreement amongst doctors. The problem is that the PSA blood test is positive for lots of reasons, and prostate cancer, even if it’s there, is often not threatening and can sometimes be left alone with with no treatment.
When I am asked by a patient if they can have a blood test for prostate cancer despite not having any symptoms, I will say “Yes, but I don’t recommend it”. The reason for this is because studies on screening have revealed some very interesting data. If you compare 1000 men without symptoms who all have a PSA test, to 1000 similar men who don’t have a test you get these results. For the men who are not screened, 68 will be diagnosed with prostate cancer and 7 will die of it. For those who are screened 88 will be diagnosed with prostate cancer but interestingly still only 7 will die of it. So the bottom line is that screening doesn’t save lives and results in 20 in every thousand men having unnecessary and potentially harmful treatment. They would have been better off not knowing.
Bear in mind that this is only relevant to men who don’t have any bladder symptoms. Remember if you have noticed a change in those waterworks, get on the phone and make that appointment.
Richard Brierly is a freelance GP who works in the Eastbourne area.
Richard is married with three sons, and is particularly interested in the natural world; he loves spending time out in the beautiful Sussex countryside.
Richard and his family live in Eastbourne, East Sussex.