Posted on 21st June 2023 at 06:47
The prostate is a small walnut-sized gland situated at the base of the bladder, surrounding the urethra. Its main function is to provide the prostatic fluid which, when combined with the sperm in the seminal vesicles, provides the semen for ejaculation.
It can be, literally, a pain in the arse. As men age, the prostate naturally enlarges (benign prostatic hyperplasia, BPH) and this can constrict the urethra, causing difficulty in passing urine and, at the worst, urinary retention. Fortunately, medication is available to help, although surgery in some form is still occasionally required.
The prostate can also become infected or inflamed. Treatment for this can be quite difficult, requiring prolonged antibiotics and pain management.
But the most important problem with the prostate is cancer (CaP). It is the commonest form of male cancer. It increases in frequency with age. It is less common in Asians, more common in Northern Europeans, and the highest incidence is in African-Americans. It often doesn’t cause symptoms until it has started to spread, invading local tissues, causing pain, blood in the urine or (when it has spread further) low back or other bone pain.
In the past, CaP would be diagnosed by internal examination (“per rectum” (PR) or digital rectal examination (DRE)). The discovery of the tPSA (total prostate specific antigen) test has improved our ability to make the diagnosis. However, it is not a good “screening” test as it is not specific or sensitive enough: NICE guidelines UK suggest 3 in 4 men with raised tPSA levels will not have CaP, and about 15% of men with normal tPSA do have CaP. 75% of men with a raised PSA level will have a negative prostate biopsy. They advise tPSA tests be restricted to those with suspected prostate cancer and men over 50 years. Surprisingly, they don’t seem to have a lower threshold to advise it in those with a family history of CaP, or even African/Caribbean men.
tPSA levels can be raised by: recent vigorous physical exercise (especially cycling): recent sex: and any urinary tract infection or invasive procedure within 6 weeks of test.
There is another test, the complex PSA (cPSA), which I think is more accurate and doesn’t seem to be affected by the factors in the previous paragraph. If it is normal, you can be reassured that your prostate is almost certainly healthy: if it is abnormal, there is something going on which needs further investigation (repeat test, prostate MRI with/out biopsy). It is more expensive, but I think is worth it. The sample has to be sent abroad so takes longer to come back, about 10 days. Please discuss with me when you attend.
Share this post: