WATERWORKS PROBLEMS
MALE
Benign Prostatic Hypertrophy.
The prostate is a gland situated at the base of the penis. It surrounds the urethra (water pipe) where it leaves the bladder. As men get older it tends to enlarge although the rate and extent varies between individuals. Probably all men would run into prostate problems if they were to live long enough - it can start to cause problems from the 40's onwards. The first thing you tend to notice is that your bladder takes longer to empty and there may be some dribbling afterwards. Then initiation of the stream may be delayed. Passing water at night may be more frequent. Occasionally you may get a water infection - normally uncommon in men. Presence of these symptoms needs checking out and the assessment will include, most probably, a test of kidney function and a PSA test (which is often raised in this condition but not to the level it sometimes gets to in prostate cancer) and a DRE (where the doctor inserts a finger into the back passage to directly assess the prostate - both size and whether it feels benign or malignant). Initial treatment may be with drugs - two types exist: alpha-blockers relax the muscles around the water pipe and hormone blockers reduce the hormonal stimulation to the prostate itself which allows a slight reduction in size. Eventually surgical treatment may be necessary to remove some prostate. Untreated this condition may deteriorate to the point where there is a sudden blockage (acute urinary retention) often precipitated by holding onto urine after the urge to pass water is felt (as in a long car journey) or an intake of a large amount of fluid in a short space of time (as in a night on the beer). Patients with prostate problems would be well advised to avoid these two situations. Before going into complete retention there may be some impairment of kidney function so we tend to monitor this from time to time in prostate patients with a simple blood test.
Prostate Cancer
Not to be confused with hypertrophy of the prostate. This is becoming one of the commonest cancers though it is often a chance finding at operation or post mortem. It's still a relatively uncommon cause of death though it may genuinely be on the increase. Quite often it grows very slowly and causes few problems for many years - the patient dying of something else entirely - though occasionally it is much more aggressive. Hormonal treatments are often very successful as the cells are are very sensitive to the balance of male and female sex hormone radical surgery is also used.
Initial symptoms may be similar to the ones described above for hypertrophy of the prostate - indeed both conditions may be present in the same patient. Rarely secondary spread of the cancer (to the bones, often the spine) may be the first thing that the patient notices with severe unremitting back pain. On DRE (see above) the doctor may find that the prostate feels hard and irregular - quite different to hypertrophy. The PSA test may be very high. Initial response though to modern treatment is often very good.
Screening for this condition is currently controversial. The official NHS position is not to do it in patients without symptoms and we currently subscribe to that point of view. The reasoning behind what may at first seem a negative viewpoint is that there is currently not thought to be any gain from starting treatment before symptoms appear (in contrast to cervical screening in women where there is a curable pre-cancerous condition). However some employers and some private health screening organisations do carry out screening with the PSA blood test. Unfortunately there is a large grey area of borderline results between what is clearly normal and what is clearly abnormal. If you are offered screening through your employer or health screener please bear in mind that you may not get a clear result and even if you get a positive there is no reason to think that knowing that will extend your life expectancy, unfortunately. New treatments and more refined tests in the future could change this advice of course.
Blood in the Urine (haematuria) Go to page5.