Over 3,600 new diagnoses of prostate cancer are made each year in Ireland with one in eight Irish men receiving this diagnosis before the age of 74.
Some prostate problems may not relate to cancer but because the symptoms are similar for both benign and malignant/cancerous conditions it is very important to tell your doctor about them, she says.
More minor problems
To understand the symptoms of the more minor – and more serious – problems related to the prostate we have to understand what the prostate is and what it does. Galway-based nurse Rachael Dalton explains the anatomy of it.
“The prostate gland is only found in men and lies below the bladder and in front of the rectum,” she says.
“Running through the prostate is a tube that carries the urine from the bladder out to the penis. That tube is called the urethra.
“The prostate gland function is to mix liquid with sperm, making semen more liquid, so it is an important gland in reproduction.” She details the less-serious problems that can develop with the prostate first.
Prostatitis
Prostatitis means that the prostate gland has become inflamed. It can be caused by an infection in the prostate gland and is often treated with antibiotics. It is not a form of prostate cancer. It can occur at any age but is more common in men aged between 30-50 years. Symptoms of prostatitis can include:
Testicular discomfort.Pain when passing urine.An uncomfortable feeling when sitting down.Prostate enlargement
Benign prostatic hyperplasia (BPH) is when the prostate gland grows larger. This can happen as a man gets older for no known cause. BPH is not cancerous but it may cause urinary tract symptoms. The treatment for BPH depends on the urinary symptoms causing you trouble and if there is any obstruction (blockage) caused by your enlarged prostate gland. The symptoms of BPH are:
Difficulty in passing urine. Feeling of incomplete emptying of bladder.Getting up to go to the toilet more at night.Treatment for BPH
“If men are experiencing difficulties passing urine and, following assessment, a diagnosis of BPH is made, their GP or urology consultant may first consider medication, the purpose of which is to shrink down the prostate.
“Secondly, they may offer, if medicines fail, a surgical intervention where an operation will be done to reduce the size of the prostate so that the flow of urine is freed up.”
Prostate cancer
In relation to prostate cancer she points out that there are no typical signs and symptoms solely related to it.
“Symptoms related to an enlarged prostate are also symptoms which may be evident in a man who has prostate cancer,” she says. “Indeed, over about 50% of men will not have any symptoms at all – this is why the PSA blood test is important.”
PSA blood test
PSA stands for prostate specific antigen. The PSA level can be raised in many different situations namely:
1 If the man has an enlarged prostate (benign prostatic hyperplasia).2 If there is any inflammation in the prostate gland. 3 If there are any cancerous or pre-cancerous cells in the prostate.If the PSA test is elevated it needs further investigation. Having a long chat with your GP about this test is very important, she believes, in order to understand it and the implications of having it.
“We encourage all men over 50 to have a talk to their GP about it. Men aged 45 who have had a brother or father diagnosed with prostate cancer should also talk to their GP about a PSA test,” says Rachael
Getting the results
If the levels are raised another PSA test is usually taken six weeks later, she states. But is six weeks not a long time to wait? Why is this?
“It’s because the first test result could be because of infection or inflammation so a second one is needed to decide on an appropriate course of action. Sometimes the level will have gone back down to normal again. If a man has had two elevated PSA tests they are referred to their nearest rapid access prostate clinic (RAPAC) and seen by a consultant urologist within 21 days of that referral. GPs may make this referral after one elevated PSA test and/or if a digital rectal examination is abnormal.”
But do men with ‘waterworks’ problems sometimes put off seeing their GP because of fear of/embarrassment around this digital rectal examination?
“They have the right to refuse it, but it is a very important test. It is one of the most beneficial tests for assisting in diagnosing prostate cancer in that abnormalities can be felt.”
Rapac
Patients, after review of the information sent in by their GP, will be either booked in for a review in the RAPAC clinic or for a biopsy.
The biopsy involves samples being taken from the prostate gland. This day procedure is talked through beforehand in detail and the procedure itself takes 10 or 15 minutes under ultrasound guidance by urology doctors. Those samples are then sent to the lab for analysis.
Plan of action
Depending on what the biopsy results show, a plan of action will be decided on. “If there is a prostate cancer present on the samples, we firstly look at how abnormal/aggressive the cancer cells identified are and then we book relevant scans to see how much prostate cancer is present,” Rachael explains.
While some cases may be classified “low risk” and only require surveillance, those men considered “intermediate” to “higher risk” will be offered several treatment options or combinations of treatments. These include:
Surgery – removal of the prostate gland and the seminal vesicles attached (this can be done robotically or by open prostatectomy).Radium treatment – where high-energy rays are used to kill cancer cells.Brachytherapy – where radioactive seeds are placed directly into the prostate gland.Hormone therapy – to reduce the amount of testosterone in a man’s body, slowing down or indeed stopping prostate cancer cells from growing. Individualised assessment
A lot of consultation takes place between patient and consultant in order to determine the appropriate course of action for the person, she says.
“It is a very individualised assessment and it depends on numerous different factors like what stage the prostate cancer is at, what their MRI scan shows, what their past medical history is, their age or any other co-morbidity problems they may have. All these play a role in the decision-making process.”
But do men usually shy away from surgery? “Men receive very good consultations from each treatment specialty before making a decision, so they are very much prepared for what it means to have an operation or radiation treatment and what the side effects of having an operation are.”
Temporary side effects
Side effects can include temporary urinary incontinence and sexual function issues.
“When we remove the prostate gland, because of where it is positioned, it can affect initially how a man controls the flow of urine,” she says, “so we need to appropriately counsel men on this before they have their operation. We do that by providing education sessions on pelvic floor exercises instruction, delivered by physiotherapists before and after surgery.”
Surgery and sexual function
Surgery may affect a man’s sexual function also, however. “When you take out the prostate, you need to peel back or remove some nerves from the prostate gland. Those nerves are important in sexual function so it can have an effect on a man’s sexual function after their surgery. Sometimes, in removing the cancer, surgeons can’t save the nerves as the main priority is removing the cancer,” Rachael says.
She outlines, however, that there are survivorship clinics and sexual dysfunction clinics within UHG to support men with the issues above after treatment.
“In UHG, for example, we have a sexual medicine specialist and clinic for prostate cancer patients.”
Radiotherapy
The second treatment option for prostate cancer is radiotherapy treatment and there are two options within this.
“One is external-beam radiotherapy treatment where the man would attend hospital Monday to Friday and radiation beams being delivered to the prostate gland to target any cancer cells,” Rachael explains. “This can take place over four to seven weeks. Hormone medicine may also be given with this treatment. Men may also be offered a brachytherapy treatment where radiotherapy seeds are implanted into the prostate. That’s a one-day procedure. All these treatments may be given in combination, again it is an individualised treatment assessment. Everyone is different.”
Radiotherapy may affect sexual function and also urinary control and frequency. It may also cause inflammation in the bowel or bladder. This is discussed with the patient in detail when they meet the radiation oncology consultant, she adds.
Every man has their own story when it comes to what the most appropriate treatment option is for them. In relation to side effects the extent and duration of each issue is different from man to man.
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Over 3,600 new diagnoses of prostate cancer are made each year in Ireland with one in eight Irish men receiving this diagnosis before the age of 74.
Some prostate problems may not relate to cancer but because the symptoms are similar for both benign and malignant/cancerous conditions it is very important to tell your doctor about them, she says.
More minor problems
To understand the symptoms of the more minor – and more serious – problems related to the prostate we have to understand what the prostate is and what it does. Galway-based nurse Rachael Dalton explains the anatomy of it.
“The prostate gland is only found in men and lies below the bladder and in front of the rectum,” she says.
“Running through the prostate is a tube that carries the urine from the bladder out to the penis. That tube is called the urethra.
“The prostate gland function is to mix liquid with sperm, making semen more liquid, so it is an important gland in reproduction.” She details the less-serious problems that can develop with the prostate first.
Prostatitis
Prostatitis means that the prostate gland has become inflamed. It can be caused by an infection in the prostate gland and is often treated with antibiotics. It is not a form of prostate cancer. It can occur at any age but is more common in men aged between 30-50 years. Symptoms of prostatitis can include:
Testicular discomfort.Pain when passing urine.An uncomfortable feeling when sitting down.Prostate enlargement
Benign prostatic hyperplasia (BPH) is when the prostate gland grows larger. This can happen as a man gets older for no known cause. BPH is not cancerous but it may cause urinary tract symptoms. The treatment for BPH depends on the urinary symptoms causing you trouble and if there is any obstruction (blockage) caused by your enlarged prostate gland. The symptoms of BPH are:
Difficulty in passing urine. Feeling of incomplete emptying of bladder.Getting up to go to the toilet more at night.Treatment for BPH
“If men are experiencing difficulties passing urine and, following assessment, a diagnosis of BPH is made, their GP or urology consultant may first consider medication, the purpose of which is to shrink down the prostate.
“Secondly, they may offer, if medicines fail, a surgical intervention where an operation will be done to reduce the size of the prostate so that the flow of urine is freed up.”
Prostate cancer
In relation to prostate cancer she points out that there are no typical signs and symptoms solely related to it.
“Symptoms related to an enlarged prostate are also symptoms which may be evident in a man who has prostate cancer,” she says. “Indeed, over about 50% of men will not have any symptoms at all – this is why the PSA blood test is important.”
PSA blood test
PSA stands for prostate specific antigen. The PSA level can be raised in many different situations namely:
1 If the man has an enlarged prostate (benign prostatic hyperplasia).2 If there is any inflammation in the prostate gland. 3 If there are any cancerous or pre-cancerous cells in the prostate.If the PSA test is elevated it needs further investigation. Having a long chat with your GP about this test is very important, she believes, in order to understand it and the implications of having it.
“We encourage all men over 50 to have a talk to their GP about it. Men aged 45 who have had a brother or father diagnosed with prostate cancer should also talk to their GP about a PSA test,” says Rachael
Getting the results
If the levels are raised another PSA test is usually taken six weeks later, she states. But is six weeks not a long time to wait? Why is this?
“It’s because the first test result could be because of infection or inflammation so a second one is needed to decide on an appropriate course of action. Sometimes the level will have gone back down to normal again. If a man has had two elevated PSA tests they are referred to their nearest rapid access prostate clinic (RAPAC) and seen by a consultant urologist within 21 days of that referral. GPs may make this referral after one elevated PSA test and/or if a digital rectal examination is abnormal.”
But do men with ‘waterworks’ problems sometimes put off seeing their GP because of fear of/embarrassment around this digital rectal examination?
“They have the right to refuse it, but it is a very important test. It is one of the most beneficial tests for assisting in diagnosing prostate cancer in that abnormalities can be felt.”
Rapac
Patients, after review of the information sent in by their GP, will be either booked in for a review in the RAPAC clinic or for a biopsy.
The biopsy involves samples being taken from the prostate gland. This day procedure is talked through beforehand in detail and the procedure itself takes 10 or 15 minutes under ultrasound guidance by urology doctors. Those samples are then sent to the lab for analysis.
Plan of action
Depending on what the biopsy results show, a plan of action will be decided on. “If there is a prostate cancer present on the samples, we firstly look at how abnormal/aggressive the cancer cells identified are and then we book relevant scans to see how much prostate cancer is present,” Rachael explains.
While some cases may be classified “low risk” and only require surveillance, those men considered “intermediate” to “higher risk” will be offered several treatment options or combinations of treatments. These include:
Surgery – removal of the prostate gland and the seminal vesicles attached (this can be done robotically or by open prostatectomy).Radium treatment – where high-energy rays are used to kill cancer cells.Brachytherapy – where radioactive seeds are placed directly into the prostate gland.Hormone therapy – to reduce the amount of testosterone in a man’s body, slowing down or indeed stopping prostate cancer cells from growing. Individualised assessment
A lot of consultation takes place between patient and consultant in order to determine the appropriate course of action for the person, she says.
“It is a very individualised assessment and it depends on numerous different factors like what stage the prostate cancer is at, what their MRI scan shows, what their past medical history is, their age or any other co-morbidity problems they may have. All these play a role in the decision-making process.”
But do men usually shy away from surgery? “Men receive very good consultations from each treatment specialty before making a decision, so they are very much prepared for what it means to have an operation or radiation treatment and what the side effects of having an operation are.”
Temporary side effects
Side effects can include temporary urinary incontinence and sexual function issues.
“When we remove the prostate gland, because of where it is positioned, it can affect initially how a man controls the flow of urine,” she says, “so we need to appropriately counsel men on this before they have their operation. We do that by providing education sessions on pelvic floor exercises instruction, delivered by physiotherapists before and after surgery.”
Surgery and sexual function
Surgery may affect a man’s sexual function also, however. “When you take out the prostate, you need to peel back or remove some nerves from the prostate gland. Those nerves are important in sexual function so it can have an effect on a man’s sexual function after their surgery. Sometimes, in removing the cancer, surgeons can’t save the nerves as the main priority is removing the cancer,” Rachael says.
She outlines, however, that there are survivorship clinics and sexual dysfunction clinics within UHG to support men with the issues above after treatment.
“In UHG, for example, we have a sexual medicine specialist and clinic for prostate cancer patients.”
Radiotherapy
The second treatment option for prostate cancer is radiotherapy treatment and there are two options within this.
“One is external-beam radiotherapy treatment where the man would attend hospital Monday to Friday and radiation beams being delivered to the prostate gland to target any cancer cells,” Rachael explains. “This can take place over four to seven weeks. Hormone medicine may also be given with this treatment. Men may also be offered a brachytherapy treatment where radiotherapy seeds are implanted into the prostate. That’s a one-day procedure. All these treatments may be given in combination, again it is an individualised treatment assessment. Everyone is different.”
Radiotherapy may affect sexual function and also urinary control and frequency. It may also cause inflammation in the bowel or bladder. This is discussed with the patient in detail when they meet the radiation oncology consultant, she adds.
Every man has their own story when it comes to what the most appropriate treatment option is for them. In relation to side effects the extent and duration of each issue is different from man to man.
Read more
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