PROSTATE PROBLEMS

[Benign Prostate Enlargement]     [Prostate Cancer]    [PSA]    [Screening]
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Prostate problems are very common in men. Uncommon before the age of 50, both benign prostate enlargement and prostate cancer become increasingly common with increasing age. There is no connection between the two conditions - benign enlargement does not progress to cancer.

BENIGN PROSTATE ENLARGEMENT (BPH)
Benign prostatic hyperplasia (BPH) is a condition in which the central glandular tissue of the prostate gradually increases in volume, causing symptoms of partial or complete obstruction to the outflow of urine from the bladder. Around 50% of men over the age of 60 have some symptoms related to prostatic bladder obstruction - by their mid to late 70's, 80% of men have symptoms.
It is estimated that up to 30% of men will require surgical treatment for this condition.
SYMPTOMS include :
Hesitancy (difficulty beginning to void), reduced urine stream, dribbling of urine after voiding and a feeling of incomplete bladder emptying. There may also be a need for frequent voiding and getting up several times a night, urine urgency and some urge incontinence ( can't make it to the toilet in time).
*At times there can be sudden onset of complete urine obstruction - a very uncomfortable situation requiring urgent medical attention. Acute "retention" can be brought on by a number of things including :
-"holding on too long" - e.g. on long journeys
- alcohol excess
- certain medications, including Sudafed and some antidepressants and antihistamines
- getting excessively cold
- constipation
TREATMENT is required when symptoms become a problem and affect lifestyle. While certain medications may be of benefit early, when more severe symptoms are present, some form of surgery is usually required to relieve the obstruction. There are a number of new surgical methods being developed, including laser, microwave and ultrasound techniques.

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PROSTATE CANCER
Prostate cancer is the most common internal malignancy in Australian men. The incidence of the disease increases with age and is uncommon before age 50. Around 1 in 18 men will develop clinical prostate cancer, and a quarter of these will die from the disease. While common, prostate cancer is often quite slow growing, particularly in older men, and may take many years to cause problems - patients often dying from unrelated conditions.
Prostate cancer normally develops in the outer capsule of the gland and is not related to benign prostate enlargement (BPH).
There is an increased risk of developing prostate cancer if a first degree relative has had the disease, particularly before the age of 60 years. Prostate cancer tends to be a more aggressive disease in younger men (before 60).

TREATMENT methods depend on how advanced the cancer is at he time of diagnosis, the age of the patient and their other medical conditions. Radical surgery or radioactive implants may be used in younger men where the disease has not spread. In other patients treatment is usually in the form of some very effective hormone treatments and radiotherapy.

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PSA TESTING
Prostate Specific Antigen (PSA) is a chemical produced by the prostate, which can be detected in blood. In normal men PSA levels increase with age - at age 59 a level up to 3.5 is normal, while at 79 a level of 6.5 is normal.
PSA levels are elevated in many prostate problems - levels are often very high with prostate cancer and prostate infection.
PSA testing is controversial because of its relative inaccuracy.
FALSE POSITIVES - only 25% of men with a PSA between 4 and 10 have prostate cancer - the rate is higher with higher readings.
FALSE NEGATIVES - around 25% of men with prostate cancer have a normal PSA reading. However 50% of men with prostate cancer and a PSA greater than 10 have disease too advanced to be cured by radical treatment.
This inaccuracy of the PSA test causes the controversy about its use in screening - combining a PSA test with a rectal examination, improves the accuracy of screening from around 34% to 50%.

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SCREENING FOR PROSTATE CANCER
Because of the inaccuracy of screening methods and the potential complications of prostate biopsy where abnormal PSA tests are found in otherwise normal men, screening for prostate cancer needs to be done with care, making certain men are fully aware of the inaccuracies and the consequences of abnormal PSA readings.
However, there is evidence accumulating which suggests that there are probable benefits in screening men between the ages of 50 and 70 on an annual basis.
Screening should be definitely considered where
- there is a family history of prostate cancer, especially before age 60
- symptoms of prostate problems are present
SCREENING should ALWAYS include both PSA and a rectal examination.
Where there is a strong family history, screening from age 40 may be of value.