Know your prostate

This walnut sized organ is situated at the base of your bladder. It functions to provide prostatic secretions to your seminal fluid and give motility to your spermatozoa. As you age, it can become a source of two medical conditions which can adversely affect the quality of your life. Benign prostatic enlargement and prostatic cancer are conditions all in the turaga mould need to be aware of.

Benign hypertrophy prostrate and prostate cancer are conditions we can develop as we age. Some of the signs of these conditions include:

* Frequency of urination;

* Reduced stream when we strain at urination;

* Incomplete emptying of bladder;

* Urinary infections; and

* Urine retention

The diagnosis of benign hypertrophy prostrate or cancer is made by your doctor. The doctor undertakes a clinical rectal examination and correlating this with your symptoms, signs and a blood test. More recently ultrasound scanning also has been utilised in the diagnostic process but this may not be warranted invariably.

For the additional diagnosis of cancer the prostate needs biopsy.

Rectal examination

The physician undertakes, a digital examination of the front wall of the rectum to determine enlargement. The texture, size and contour are assessed. The examination can be minimally uncomfortable at most but some men feel uncomfortable with doctors and that is understandable.

Don’t forget we men, are from Mars!

The blood test

The blood test is utilised to compliment the clinical examination and/or provides an alternative for those men who are concerned about their modesty.

The prostrate gland produces a specific chemical called prostrate specific antigen (PSA). Elevation of the PSA level indicates benign hypertrophy and in much higher levels indicates prostatic cancer. The assay of the PSA levels help monitor the disease and any treatment subsequently offered for both conditions.

The good news is that PSA can be assessed in all the private laboratories in Fiji at a nominal cost.

Treatment available

1. Medical option.

There are a range of medical treatments on offer. Various medications are now in vogue for benign hypertrophy. However medications are not full proof and not without side-effects too. Treatment is also life-long.

2. Surgical option.

Surgery can be contemplated by various approaches. The transurethral route is the least traumatic. Then there are the classical transvesical and perineal approaches too, in individual cases. The patient diagnosed with prostatic cancer may need to consider surgery and/or a combination with radiotherapy or chemotherapy dependant on the stage of the disease. Follow-up with regular PSA assessment will need to be undertaken.

In cases of prostate cancer specific anti-androgens may need to be considered. These can be available as oral medication or the other option is to undertake a bilateral orchidectomy. This is not an easy decision but the quality of life issues, medication costs are variables one needs to factor in.

A common side effect of surgery for both the benign and cancer patient is erectile dysfunction. The topic of erectile dysfunction has been covered in a previous issue of Turaga magazine

Who needs screening

The following individuals will benefit from screening.

1. If there is a family history of prostate disease in a first degree relative.

2. Individuals of Caucasian and Negroid descent.

3. All males over 50 years with symptoms of urine dysfunction.

4 All males with a positive clinical examination and/or an elevated PSA level.

Can I do something to reduce my risk of prostate disease?

Unfortunately there is very little we can offer by way of prevention. However tocopherols as in carrots and tomatoes have been suggested as good prophylactics in the aging game. Antioxidants such as these help but the final medical evidence is lacking at this point in time. Likewise using that “erection” well may be something to consider for your “< 50 year wallahs”.

Concluding word of reassurance

Many men will have some enlargement of their prostate. They will live a long and productive life without any clinical concern about their prostate. Some will even develop cancer of a slow growing nature and will die of other causes without a concern about their prostate. This is one end of the scale.

On the other hand some men want to know that they will not develop a rapidly progressive condition which will take them to an earlier grave after a painful terminal cause. These are the men who need to be screened especially if their risk quantification is high. There are treatment options available. The quality of your life and existence is paramount.

* Dr Neil Sharma is a former minister for health. The views expressed are his and not of this newspaper.

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