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By James Allan and Paul Hughes (Consultant Urologists at theurologyclinic.gi)

So you have eventually decided to bite the bullet and come and see us with your waterwork issues. The most important fact is that the vast majority of men that come along to see us can be greatly helped with relatively little fuss and you will have a diagnosis and a treatment plan very quickly. 

The first step is for us to listen to you and your story so that we understand your symptoms, the bother it causes you and the infringement on your lifestyle. The balance between ‘obstructive’ and ‘irritative’ symptoms that we mentioned last month is established. We ask you to fill in a validated questionnaire, called an IPSS score, which allows us to objectively assess the severity of your problem. We will ask you lots of questions to make sure you don’t have any ‘red flag’ symptoms, have you had any bloody or red urine, any waterwork infections and if there is any history of prostate cancer in your family. 

We may get you to pee into a clever bucket that records how quickly you wee and then scan your tummy to see if you are absolutely empty. You’ve never had this much fun and it’s all evidence to base our treatment on!

And yes, we will examine you! Men are notoriously bad at engaging with healthcare and yet they have so much to gain by taking advice, minimising symptoms that compromise your lifestyle, living the best quality of life you can and spotting problems earlier to maximise prognosis. So we pop a finger into your tail end and feel your prostate through your rectum. We are looking to assess the size and consistency of your prostate to make sure we don’t think it is worrying or feels suspicious!

Once this is done, we will look at your blood tests to make sure that your kidneys work well and if you have had your Prostate Specific Antigen or PSA done. PSA is a controversial test that your GP will probably have chatted to you about and then perhaps done. It is not a perfect test and has weaknesses and strengths This week we will concentrate on gentleman with normal PSAs.

So we have listened to your story, examined you, assessed the severity of your symptoms and now it’s all about making you better. Most men are hugely relieved to be told that they don’t have prostate cancer. Even though you don’t verbalise the anxiety, it’s the elephant in the room and until we look you in the face and reassure you that we are simply dealing with an older bigger prostate, you and your loved ones will worry.

We classify symptoms into mild, moderate and severe. There is a ladder of treatment and we start on the bottom rung with simple advice about lifestyle issues and education. The simplest treatment is try some tablets which may help you quite a lot. There are two groups of tablets for prostate problems: one relaxes the muscle in the prostate and is called an alpha blocker, the other group shrinks the prostate and block one of your male hormones. If your prostate is one of the larger ones we may use both drugs together to have the optimum result. If you have ‘irritative’ symptoms with a naughty bladder secondary to the blockage from your prostate we give a drug to dampen down the bladder’s irritability. 

After a couple of months, we meet again to see if you are happier. If the drugs worked then great, stay on them and stay away from a surgeon! However, if they didn’t or if you had side-effects then we need to start talking about operations and the risk-benefit equation. The skill of surgery is getting this right.

Luckily there have been some huge improvements in minimally invasive prostate treatments that have radically changed the risk benefit equation for men. Probably the most important is ‘The UroLift’ …and that’s what we are going to discuss next month! 

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