Benign prostate problems ( benign prostatic enlargement – non cancerous enlargement of the prostate)

The prostate is an accessory sex gland in the male. It produces secretions which form part of the seminal fluid which carries sperm. In most men the prostate starts to grow from the age of 40.

The prostate can enlarge through a normal process called benign prostatic hypertrophy and treatment is only necessary if the man develops symptoms passing urine or if he has bleeding from the prostate, retention or blockage of urine, urinary infection or formation of bladder stones.

prostate enlargement

Prostate enlargement

Men can also develop prostate cancer although this is most common in men in later years.

The treatment will depend on the symptoms however in benign disease the treatments may include

  1. Observation only – if minimal urinary symptoms
  2. Medical treatment with medication
  3. If medical treatment fails a surgical approach may be necessary.

There are many different surgical techniques ranging from less invasive such as Urolift, I Tind, Rezum, Aquablation to Turp (transurethral resection of the prostate), holmium laser / green light laser of the prostate, open prostatectomy. Although Dr Raza does not perform all of these procedures he will discuss the most appropriate procedure for youand refer you to an appropriate specialist if he does not perform the surgical procedure you opt for.

TURP

Turp

Other experimental techniques include embolisation of the prostate.

Prostate cancer treatment is dependent on the age, fitness of the patient, stage and grade of disease at time of diagnosis and wishes of the patient.

Treatment can involve

  1. Observation / active surveillance
  2. Medical Treatment
  3. Radiotherapy
  4. Surgical removal of the prostate gland
  5. Less invasive techniques  (Focal therapy) such as cryotherapy, brachytherapy, HIFU.

Dr Raza will again discuss your case with Specialist colleagues at a Multidisciplinary meeting and with you and your family if you wish at your visit and refer you to the appropriate Specialist for treatment depending on what treatment options are appropriate for you.

Prostate Cancer: Symptoms, Diagnostic Tests, and Treatments

Symptoms
Prostate cancer often develops slowly, and many men may not experience symptoms in its early stages. However, as the cancer grows, it may lead to:

  • Urinary Symptoms: Increased frequency, urgency, or difficulty starting/stopping urination. A weak or interrupted urine flow, or the feeling that the bladder isn’t emptying completely.
  • Hematuria or Hematospermia: Blood in the urine or semen.
  • Pain: Persistent discomfort or pain in the lower back, hips, or pelvis, which may indicate advanced disease.
  • Erectile Dysfunction: Difficulty achieving or maintaining an erection can sometimes be linked to prostate issues.
  • Advanced Symptoms: In metastatic cases, bone pain, especially in the spine, hips, or ribs, may occur. Unexplained weight loss or fatigue are additional signs of advanced disease.

Diagnostic Tests
Accurate diagnosis is essential for determining the best treatment plan. Tests include:

  • PSA Blood Test: Measures the level of prostate-specific antigen in the blood. Elevated levels may indicate prostate cancer, but they can also be caused by other conditions like benign prostatic hyperplasia (BPH) or prostatitis.
  • Digital Rectal Examination (DRE): A clinician palpates the prostate through the rectum to detect abnormalities in size, texture, or shape.
  • Imaging Studies:
    • MRI: Multiparametric MRI can help identify suspicious areas and guide biopsies.
    • Bone Scan: Checks for metastasis to the bones, which is common in advanced prostate cancer.
    • PSMA PET Scan: A highly sensitive imaging test that uses a prostate-specific membrane antigen tracer to detect cancer spread throughout the body.
  • Biopsy: Transrectal or transperineal ultrasound-guided biopsy involves removing small tissue samples for microscopic examination to confirm the presence and of cancer.

Treatments
Treatment options vary depending on the cancer’s stage, grade, and the patient’s overall health and preferences.

  1. Active Surveillance: Suitable for slow-growing cancers. Regular monitoring with PSA tests, MRIs, and biopsies ensures timely intervention if the cancer progresses.
  2. Watchful Waiting: A less intensive monitoring approach, often chosen for older men or those with other significant health conditions. Treatment is only initiated if symptoms arise.
  3. Surgery:
    • Radical Prostatectomy: Removal of the prostate gland and some surrounding tissues. This may be performed using open surgery, laparoscopic methods, or robotic-assisted techniques.
  4. Radiation Therapy:
    • External Beam Radiation Therapy (EBRT): Precisely targets cancer cells using high-energy X-rays or protons.
    • Brachytherapy: Implants radioactive seeds directly into the prostate.
  5. Hormone Therapy: Reduces or blocks testosterone, which fuels prostate cancer growth. Options include medications (like GnRH agonists or antagonists) or orchiectomy (surgical removal of the testes).
  6. Chemotherapy: Often used for advanced or hormone-resistant cancer, typically involving drugs like docetaxel or cabazitaxel.
  7. Focal Therapy: Minimally invasive treatments that target only the cancerous part of the prostate to preserve normal tissue. Options include:
    • High-Intensity Focused Ultrasound (HIFU)
    • Cryotherapy: Freezing cancer cells to destroy them.
    • Laser or Photodynamic Therapy: Using light-sensitive drugs and lasers to target cancer cells.
  8. Immunotherapy: Emerging therapies like sipuleucel-T, which boosts the immune system to fight cancer.

For men diagnosed with prostate cancer, discussing these options with a multidisciplinary team of specialists ensures a personalized approach that balances effectiveness with quality of life.

USEFUL LINKS

Use a prostate cancer risk calculator to work out your risk of prostate cancer – only for men aged over 55 years old:

https://riskcalc.org/PCPTRC/

For men diagnosed with prostate cancer please click on the link https://www.cancerresearchuk.org/about-cancer/prostate-cancer

Mcmillan Cancer Support website:

https://www.macmillan.org.uk/cancer-information-and-support/prostate-cancer