Frequently asked questions

Benign prostatic hyperplasia (BPH) is the result of non-cancerous changes in the prostate that causes the middle portion of the prostate to enlarge. As the prostate enlarges, it squeezes the urethra, which reduces the flow of urine from the bladder. 

We are still to identify what triggers BPH, but we do know that testosterone is involved in some way. It is likely the female hormone oestrogen has a role too. Research data suggests that men in the Far East are protected to some extent against the risks of BPH by tiny amounts of oestrogen-like substances in their diet. Soya beans are a good example of this. This raises the question whether dietary supplements taken regularly could protect against BPH. Again, more research is needed.

Most men living with BPH who do not receive treatment will experience only a gradual deterioration in symptoms. However, as the prostate continues to enlarge, the muscular wall of the bladder has to work harder to push urine through the urethra. This extra work makes the muscles of the bladder wall thicker and stronger. The pressure inside the bladder also increases and this causes diverticula to form within the bladder walls. Occasionally, the pressure is great enough to result in kidney problems. Bladder stones can also develop. If BPH isn’t treated, it can lead to acute urinary retention or chronic urinary retention. Both of these conditions require hospital admission. Acute urinary retention is a medical emergency.

BPH is most commonly treated with drugs or surgery. However, many men with mild symptoms of BPH opt for active surveillance of their condition in addition to simple lifestyle changes. For more information on treatment options, please visit our BPH treatment options page.

5-alpha-reductase inhibitors are drugs that work by blocking the conversion of testosterone to another substance: DHT. DHT is known to have a key role in prostate growth. The two most commonly used 5-alpha-reductase inhibitors are finasteride and dutasteride. These drugs do appear to reverse benign prostatic hyperplasia (BPH) to some extent. This is particularly true of significantly enlarged prostates, but it can take at least six months to be effective.

The use of 5-alpha-recutase inhibitors may reduce the likelihood of developing complications and the requirement for surgery.

Some medications do not alter the size of your prostate but do help decrease your symptoms. Alpha blockers work by helping to relax the muscles in the neck of the bladder and in the prostate. This reduces pressure on the urethra, which leads to better urine flow. Symptoms are improved by 20-50% and flow rates by 20-30% within six weeks.

Some studies have shown that combining both these classes of medication may be more effective in some patients than either drug taken on it’s own – this is known as combination therapy, and is particularly useful in older men with large prostates and more severe symptoms.
 

Retrograde ejaculation is where semen passes backwards into the bladder during orgasm, rather than out through the penis. This is not harmful – you pass the semen mixed up with urine the next time you urinate –and most men do not find it a problem. Retrograde ejaculation may reduce your fertility, though it does not make you sterile.

TURP stands for transurethral resection of the prostate and is the commonest operation for men with benign prostatic hyperplasia (BPH) who have not responded to medical therapy or who have developed complications. It is usually carried out under a general anaesthetic but can be performed with local anaesthesia too. The procedure involves passing a surgical instrument up through the penis and urethra. This instrument is then used to remove the middle of the prostate in small pieces. These pieces are sent to the laboratory for analysis to confirm benign prostatic hyperplasia (BPH).

TUIP is transurethral incision of the prostate and is for men who are experiencing obstruction problems and have a relatively small prostate. It is a quick procedure to perform, usually taking around 20 minutes. You will be given either a general or epidural anaesthetic. As with a transurethral resection of the prostate (TURP), an instrument will be passed up through the penis.

A TUIP differs from a TURP, as the aim of the operation is to make one or two small cuts in the neck of the bladder and in the prostate. This allows the bladder neck to spring apart and urine to flow more freely.

This is called acute urinary retention and is a potential complication of BPH. It is usually, but not always, preceded by symptoms of prostatic obstruction. If you find that you cannot pass urine at all, contact your doctor or go to your nearest Accident & Emergency Department.  

PCA3 is a new type of test that may help to diagnose prostate cancer. PCA3 is short for Prostate Cancer gene 3.  Prostate cells have PCA3 genes that make the cell produce a small amount of a particular protein.  Prostate cancer cells make much more of this protein than normal cells.  When the level of PCA3 protein is high, it leaks into the urine.  

Researchers are checking whether they can use PCA3 protein to diagnose prostate cancer. More research is needed to answer this question and this test is therefore not currently available on the NHS.

A prostate biopsy is a diagnostic test that collects samples of prostate tissue to look for prostate cancer cells.

An ultrasound probe is inserted into the rectum, which guides an automated needle to the prostate. You may be given a local anaesthetic to reduce any discomfort during the biopsy. You may feel a sharp needle prick as 8-12 tiny samples of prostate tissue are taken. These samples are sent to a laboratory for examination under a microscope. You will be given antibiotics before and after the procedure and told to continue taking the prescribed antibiotic for several days afterwards.

A prostate biopsy is performed under a local anaesthetic, but you may still feel some discomfort. For several weeks after the biopsy, you may notice blood in your urine, semen and/or bowel motions. Urinary infections can sometimes occur after a biopsy. You should contact your doctor if you feel unwell, have shaking attacks and/or a fever, or are having problems urinating.

The Gleason System is used to measure and grade your prostate cancer. The grade measures how aggressive your cancer is by looking at the tissue samples taken during your prostate biopsy. Prostate cancers range from slow-growing tumours which are unlikely to spread and cause problems to fast-growing tumours which can spread quickly. The higher the Gleason score, the more aggressive the prostate cancer.

You may have multiple tumours in your prostate, which can have different individual grades on the Gleason score. If this is the case, the two most prominent areas are graded and added together, e.g. a Gleason score of (3 + 4). The maximum Gleason score is 10.

These diagnostic tests will show whether the cancer has spread outside the prostate. A Computerised Tompography (CT) and Magnetic Resonance Imaging (MRI) scan will help identify whether the prostate cancer has spread to the immediate surrounding areas and local lymph nodes. A bone scan will show whether the prostate cancer has metastasised and is present in the bones.

This is a question to ask your doctor. It depends on a number of factors, including your own personal choice. Your doctor will suggest a form of treatment depending on the grade and stage of your prostate cancer. They will inform you of the risks and benefits of the treatment they suggest and other care options available to you depending on your situation. Only with this information will you be able to make a fully informed choice.

Active surveillance can be an option for men with a very early and slow-growing form of prostate cancer. Active surveillance involves regular check-ups, usually taken every three months to carefully monitor your prostate cancer. These tests include

·         A prostate specific antigen (PSA) blood test.

·         A digital rectal examination (DRE).

·         Repeated scans.

·         Biopsies when necessary.

If the test results show any signs of the prostate cancer progressing, then your doctor will suggest further treatment options aimed at curing the cancer.

·         Brachytherapy is not usually suitable for men with high grade or more aggressive prostate cancer.

·         If you have a large prostate, you will have an increased risk of getting urinary side-effects from the brachytherapy, so you may be deemed unsuitable on this ground. Pre-treatment with prostate-shrinking drugs such as LHRH analogues can sometimes make brachytherapy suitable for men with larger prostates.

·         If you have received a transurethral resection of the prostate (TURP) you will not be eligible for brachytherapy. The radioactive seeds which are placed into the prostate cannot be sited correctly in men who have had this procedure.

Side-effects of radiotherapy include

·         Tiredness.

·         Occasional skin soreness.

·         Bowel changes – some diarrhoea and soreness in the rectum.

·         Frequency and stinging when passing urine.

The side-effects of radiotherapy all start to improve a few weeks after the treatment is finished. Some men have long-term or permanent side-effects which can occur many months after the radiotherapy has finished. These can include sexual problems and occasionally permanent problems with the bowel.

Your surgeon will usually tell you what he thinks within 24 hours, but will wait for a few days for the laboratory report to confirm the result.  If the laboratory report suggests that some prostate cancer cells have escaped from the prostate into the surrounding tissue, a positive margin, then the surgeon may recommend a course of radiation therapy. This is usually very successful.

Impotence (also known as ‘erectile dysfunction’) is a possible side-effect of prostatectomy. Your doctor will discuss the side-effects of treatment with you before you consent to treatment. There are a number of options for men who find it difficult to achieve/maintain an erection after treatment, including medications such as Viagra, Vacuum pumps and penile implants. For more information, see our page on your sex life.

Impotence is also a potential side-effect following radiotherapy and hormone therapy.

Typically, most men can expect to return to normal activity in one month for laparoscopic surgery and two months for open surgery. If you enjoy intensive sports, such as climbing or weight-lifting, then it may take longer.

Even if you are very active and fit, you may experience a degree of tiredness after the operation, which can last for a number of months.

Exercise is an important part of recovery, but it’s best to start gently. Talk to your medical team about your exercise routine and ask their advice. They will be more than happy to advise you.

The male hormone testosterone is produced in the testicles and stimulates prostate cancer growth. Hormone therapy works by blocking the effect of testosterone. This reduces the size of the tumour and delays its growth.

Hormone therapy can be given alone to slow down the progression of your prostate cancer or in combination with radiotherapy. There are several different types of hormone therapy, including LHRH analogue therapy, anti-androgen therapy and oestrogen therapy.

Oestrogens are female hormones. Oestrogens can reduce prostate cancer growth and also seem to damage prostate cancer cells directly. Potential side-effects include blood clots and heart attacks, so you may need to take additional medication to offset these risks. These factors mean that oestrogens are not usually the first choice of treatment.

No, in fact, prostatitis most commonly affects men in the 30-50 year old age range. At this time, no one is sure why prostatitis affects some men and not others.

This depends on many factors, not least of which is your diagnosis. If your prostatitis is deemed to have a bacterial origin, you will be prescribed antibiotics.

If your prostatitis is inflammatory, you may be prescribed with anti-inflammatory medication such as diclofenac.

For more information on the treatment options available for prostatitis, please visit our prostatitis treatment options page.

Prostatitis can be frustrating for patient and doctor alike. Here is a list of advice that you may find helpful. Don’t hesitate to talk to your doctor if you feel your symptoms are getting too much to deal with.

Useful advice

·         Avoiding substances that irritate the bladder may relieve symptoms. Examples include alcohol, caffeine, citrus and hot or spicy foods.

·         Empty your bladder frequently and completely. This may help to decrease symptoms of urinary urgency.

·         Research indicates that tension in the pelvic floor muscles may be the cause of some chronic pelvic pain. Relaxation techniques such as yoga or pilates may help relax your pelvic floor muscles, although there is currently no scientific evidence to support this therapy.

·         Maintain good hygiene. Bacterial prostatitis is caused by bacteria moving up the urethra into the prostate. Thorough hand-washing after a bowel movement and prior to handling the penis may prevent bacteria transfer. If you have anal intercourse, wearing a condom will prevent bacterial infection.

·         Avoid activities like cycling. It may increase your symptoms.

·         Warm baths may help to relieve pelvic pain.

·         There are reports of acupuncture, meditation, massage therapy and chiropractic treatment helping improve symptoms of individuals. This has not yet been confirmed by research.

The likelihood of prostatitis returning is relatively high. If you do notice your symptoms returning, visit your doctor immediately. Prompt treatment can help to stop the infection or inflammation taking hold.

The best advice at present is to avoid the risk factors of prostatitis. If you have symptoms of a urinary tract infection (a known risk factor in prostatitis), such as a burning sensation when urinating or cloudy, smelly urine, make sure you visit your doctor and complete any prescribed course of antibiotics. This will limit the risk of developing repeated urinary tract infections, which is a risk factor in prostatitis.

Maintaining a healthy lifestyle, having a diet low in saturated fats and taking plenty of exercise is advisable. Practicing good hygiene and safe sex will also help prevent the spread of bacteria.