What does the prostate gland do?
The prostate gland lies just beneath the bladder and is normally about the size of a chestnut. The urethra (water pipe) runs through the middle of the prostate. The main function of the prostate is during your reproductive life. It produces fluid containing chemicals which nourish sperms to help with fertilisation.
What should I do if I have prostate symptoms?
If you have difficulty starting or stopping your urine flow, a weak stream, a feeling that you do not empty your bladder completely, increased frequency and urgency of urine passage by day or night and a tendency to dribble after you have finished, you should contact your GP for further advice
Your GP will normally review you initially and may supply you with a symptom questionnaire and/or a bladder diary to complete before your appointment.
Download the International Prostate Symptom Score (IPSS)
Download a bladder diary
Referral to a urologist is only indicated if:
- your symptoms are severe;
- your urine flow is very poor;
- your blood tests (e.g. PSA) are abnormal; or
- there are any complications of the condition (e.g. chronic retention, urinary infection, bladder stones).
What are the facts about prostate symptoms?
- By the age of 65 years, 50% of men will experience benign enlargement of the prostate. At the age of 90, 90% of men have prostatic enlargement;
- An enlarged prostate alone does not always cause symptoms;
- The severity of the symptoms is not related to the size of the prostate;
- 1 in 3 men will suffer prostatic symptoms during their life;
- 1 in 10 men will require surgical treatment for their symptoms;
- Not all urinary symptoms in men are due to an enlarged prostate - incontinence, pain or blood in the urine may be due to other conditions;
- The risk of prostate cancer is not increased by having benign enlargement of the prostate. You are no more likely to develop prostate cancer than a man without benign prostatic enlargement;
- 30-40% of men with prostatic symptoms do not experience worsening of their condition with time and may not require any treatment;
- If treatment is indicated, this usually involves with drugs which relax the muscle in and around the prostate and/or drugs which shrink the glandular component of the prostate;
- If symptoms are severe, if there is no response to medical treatment or if there are complications of prostatic enlargement, surgical treatment may be indicated; and
- The risk of acute, painful retention of urine is small (approximately 1 in 100) and it is not always preceded by prostatic symptoms. Acute retention usually requires surgical treatment.
What could have caused my prostate to enlarge?
In general terms, we know very little about why the prostate gland enlarges with increasing age but hormone imbalance within the gland itself probably plays a part as well as certain genetic factors.
There is some evidence that hormones and certain growth factors may work together to cause the prostate gland to enlarge. There also seems to be an inherited tendency in approximately 10% of men (1 in 10).
What treatments are available for this problem?
No treatment is likely to clear all your symptoms completely but they can be greatly improved so that the degree of "bother" is minimal; your symptoms can then be monitored regularly to see whether changes in treatment are needed
5-alpha-reductase inhibitors (e.g. finasteride, dutasteride) shrink large prostate glands (>40 grams) and may be used together with alpha-blockers if your PSA is more than 1.5 (an indication that your prostate is significantly enlarged). They can cause ejaculatory problems. They take at least 6 months to have maximum effect and do not work well if your prostate is small. They also reduce your PSA level by up to 50%.
With larger prostates, a combination of both types of drug has been shown to be better than either type used alone, to reduce the risk of complications (especially retention) and the need for surgery.
Surgical treatment is usually recommended if symptoms are severe, medical treatment has failed or if there are complications (e.g. a large residual urine,. retention of urine, infection, bladder stones).
Open surgery on the prostate is rarely performed nowadays but may be necessary if the prostate is very large.
Conventional telescopic surgery (TURP) involves resecting the central part of the prostate using a telescope passed into the bladder through the penis (transurethral resection or TURP). There are risks to this procedure so other techniques, such as electrical vaporisation and laser surgery, have been developed which also give good results with less risk.
Sometimes, when the prostate is small, the muscle at the neck of the bladder can be cut telescopically without actually removing the prostate (bladder neck incision or prostatotomy); normally, the surgeon can only decide if this is appropriate after looking inside the bladder.
Less invasive alternatives to surgery
An indwelling catheter or intermittent self-catheterisation relieve symptoms but should be regarded as temporary measures. More recently, the UroLift procedure has proved promising; this is performed by inserting a "hitching" stitch through the prostate to reduce its constrictive effect on the urethra.