The recent sad news regarding Sir Chris Hoy will no doubt trigger a few thoughts amongst men about whether they should get their prostate checked. I have a particular interest in Mens Health and would like to share some information regarding prostate issues, prostate cancer symptoms and what we can offer you at Courtfield Private Practice.

What is the Prostate?

The prostate is a small gland about the size of a walnut that is in the male body just above the area between the scrotum and the anus. The gland’s role is to produce fluid that is released with the sperm when men ejaculate to support the sperm.

In the U.K., 1 in 8 men will get prostate cancer in their lifetime and 144 are diagnosed every day. It is the most common male cancer.

Currently there is no national screening program for prostate cancer. The guidelines doctors use in the NHS suggest that if there are none of the cancer’s symptoms, they can only offer the PSA test*. This test is only available when men specifically ask for it and are over 50 or deemed at higher risk.

*The PSA (Prostate Specific Antigen) blood test looks for a protein released by the prostate gland which can give an indication as to it’s size and if anything sinister may be going on. It is not perfect but currently the best option we have.

Who has increased risk of developing Prostate Cancer?

You may have an increased risk of developing prostate cancer if;

• you are over 50.
• You have a close family member who has had Prostate, Ovarian or Breast cancer.
• You have Black ethnicity.

An excellent website run by the Prostate UK explains this further and is a great resource.

Prostate Cancer Symptoms

For most men, the early stages of prostate cancer don’t usually cause any symptoms. Depending on where the problem is, within the prostate, and its progression, it may produce symptoms such as;

• Going to the loo to pass urine more often, which is usually more noticeable at night, perhaps getting up to do a pee 3 or more times.
• The flow may not be as strong as it used to be, no more knocking a fly off the urinal wall, more a dribble on the shoes.
• Difficulty getting started to pass urine – so called ‘Stage Fright’
• Little or no advanced warning that you need to go for a pee – urinary urgency.
• Erection issues
• Blood in the semen or urine

The above symptoms do not mean you have prostate cancer. They are likely the result of another medical issue, but it important to discuss these with your doctor.

Most often, changes to how men pass urine are a result of a naturally enlarging prostate which is very common with age. The largest I have seen was the size of a tennis ball. This occurs as unfortunately male bodies are not quite perfect in design. The urine tube from the bladder to the penis runs through the middle of the prostate, like the core of an apple. This means sometimes, when the prostrate enlarges, it can put pressure on this urine tube, which – like stepping on a hose – can produce urinary symptoms.

How do we test for prostate cancer

The test we can offer is a simple blood test looking at the level of PSA (Prostate Specific Antigen). The results for this test usually come back the next day.

Should I have a test?

It is a personal choice. However, if you are above 50 and if you have a family history or symptoms you are worried about, we would encourage you to discuss this with us.

Do I need a rectal exam?

The quick answer to this is NO.

Until last year it was always recommended to have a rectal exam. This is where a lubricated gloved finger is inserted into the rectum for a few seconds to feel the size and nature of the prostate. Most who have had it done felt it was not nearly as concerning as it sounds.

Now, to the relief of many patients, the guidance has changed. Suggesting the blood test alone is sufficient, as they feel it is very unlikely a problem will be detected with the prostate on rectal examination without there being an increase in the PSA blood test level.

At Courtfield Private Practice, if you are willing, I still feel there is benefit from an examination. As you gain more information and there is an opportunity to check for other rectal problems at the same time.

However; the bottom line (excuse the pun) is to have a blood test. The rectal physical examination is, of course, entirely optional.

Is there anything I need to do to prepare for the test?

It is important not to ejaculate for 48 hours before the test. It is best to avoid long cycle rides for a couple of days before as it may inflame the area. You do not need to fast.

How often should I have a test?

Assuming the test is negative, once yearly is thought to be sensible.

It is worth noting that the PSA’s general trend is also important. If you have a PSA level which has increased significantly since last year, even though it may still be in the normal range, it may warrant further investigation. After all; the whole point of screening is to catch any issues early on to make any treatment required as simple and as effective as possible.

What if my test is positive?

Often the first step is to simply repeat the blood test and rule out obvious causes such as a urinary infection.

If the test remains positive, the usual step is to have a painless MRI scan (an image like 3D  X-Ray, but with no radiation) of the prostate to look at it more closely. Alongside a consultation with a Urologist (Prostate specialist) to see if anything further is required.

Options at Courtfield Private Practice for prostate cancer testing

1. Book a consultation to discuss further. If you decide to go ahead with a PSA test, we can take the blood during the appointment and call you the next day to discuss the results.
2. Book in for a full Male medical which is a much more comprehensive consultation with full blood panels and additional cancer screening including PSA testing. See our website or call for more information.

Dr. Russell Ward