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Prostate Assessment

The prostate gland is located just below the bladder in front of the rectum. It wraps around the urethra, the tube that carries urine and semen out of the body. A normal prostate weighs around 20 to 30 grams and is approximately the size of a large walnut. It tends to grow with age, weighing up to 100 grams. The prostate secretes a fluid that makes up around 20 to 30 per cent of semen. It also has muscles that help to expel the semen during ejaculation. The prostate gland can be affected by several conditions, including prostatitis, benign prostate hyperplasia, and prostate cancer.

Benign prostatic hyperplasia (BPH)

Benign prostatic hyperplasia, or benign prostatic enlargement, is a common condition in men as they age. The prostate is enlarged but not cancerous. As it enlarges, it may cause difficulty passing urine with a slow flow, frequency and a feeling of incomplete emptying of the bladder. If the symptoms are not too bad, treatment may not be necessary. Medication can help shrink the prostate or relax muscles near your prostate to ease symptoms if the symptoms are bothersome.

If medication hasn’t worked, minimally invasive surgery may be required to improve the urine flow, such as prostate artery embolisation (PAE), Urolift, Rezum, laser surgery or transurethral resection of the prostate (TURP). There are advantages and disadvantages to all these procedures, and we can guide you to select the most appropriate option.

Chronic prostatitis

Chronic prostatitis is a common problem. It can cause pain in the perineum, lower back, or groin. Treatment may require a combination of antibiotics, anti-inflammatories and lifestyle changes.

Prostate Cancer

To determine if prostate symptoms are caused by cancer, a prostate evaluation will involve taking a thorough history, including your family’s medical history and a physical examination of the prostate, called a digital rectal examination (DRE).

A prostate-specific antigen (PSA) blood test may be performed if appropriate. PSA levels can be raised in men with an enlarged prostate, prostatitis, or with prostate cancer.

If the PSA level is high or the DRE is abnormal, we may recommend a Multi-Parametric MRI scan of your prostate to look for signs of prostate cancer. This is performed by our specialist uro-radiologist.

If the MRI scan shows that you might have cancer, we may recommend transperineal prostate biopsies. Prostate biopsies are usually performed under local anaesthetic as a quick day-case procedure. A bone scan or PET-CT scan may also be required to determine whether the tumour has spread beyond the prostate.

Treatment for prostate cancer depends on whether the cancer is confined to the prostate or has spread to other parts of the body. It also depends on your age and overall health. There are various treatment options available, including active surveillance, surgery (open/ laparoscopic/ robotic), radiotherapy, brachytherapy, hormone therapy, and other newer or experimental treatments. There are advantages and disadvantages of all of these options, and treatment should be tailored to each individual. Our specialist multi-disciplinary team will help guide you to the most appropriate treatment.

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