Three good reasons to seeadoctor—andtwo to go off and play golf
ROSTATE PROBLEMS include benign enlargement, prostatitis and cancer. James Gelister, consultant urologist at Spire Hospital Bushey, writes: Benign enlargement is common in men over 50 and can cause lower urinary tract symptoms (LUTS) such as slow urinary flow, difficulty starting, frequent urination, urgency, a sense of incomplete bladder emptying and dribbling. Occasionally benign enlargement causes complete inability to urinate (“urinary retention”). Prostatitis can cause discomfort with urination and in the pelvis, frequency and urgency and often affects men in their 40s. Blood in the urine (haematuria) is more likely to be from the bladder but can indicate a prostate or kidney problem. Early prostate cancer usually has no symptoms but can lead to LUTS. Advanced prostate cancer may cause weight loss and skeletal pain. What to do Problematic LUTS should be discussed with your GP, who can take a medical history and perform an examination, including a digital rectal examination. Blood in the urine — even a single episode — should always be reported and investigated urgently. LUTS tests start with a dipstick urine test to check for blood, infection and diabetes and a urine sample may be sent for culture. Blood tests for kidney function and PSA may be advised. PSA is a protein produced by the prostate and the test sometimes gives misleading results. Mild PSA elevation often accompanies benignenlargementand,lesscommonly, cancer can be present with a normal PSA. But a PSA progressively rising over time suggests prostate cancer. Scans Further assessment of LUTS is by ultrasound and urine flow testing, which are non-invasive and can indicate if the prostate is causing much blockage. If, following a rectal exam or PSA test, there is worry about cancer, an MRI scan is advisable. Prostate biopsies are recommended if the MRI is positive. Haematuria is usually investigated with CT scans and cystoscopy (a camera inspection of the bladder). Treatments Urinary problems caused by benign prostate enlargement can be alleviated with medications that relax or shrink the prostate and ease urination. More problematic benign enlargement may require telescopic surgery, by laser or electrocautery, to remove obstructing prostate tissue. Alternatively, the new Urolift device can be inserted to widen the channel through the prostate without removing tissue. Urolift uses tiny implants that hold the prostate lobes apart.
Prostatitis usually requires antibiotics and may be helped by prostaterelaxing “alpha blocker” drugs used for benign enlargement and by antiinflammatory painkillers. Urinary retention requires urgent insertion of a catheter tube to drain urine and telescopic surgery may well follow. Early prostate cancer can be treated by keyhole surgical removal using a robot, by radiotherapy or by (gland-preserving) focal treatments such as high-intensity ultrasound but sometimes it does not require any active treatment, in which case close surveillance is recommended. Advanced prostate cancer is treated with hormone drugs, chemotherapy and sometimes radiotherapy. A London Clinic surgeon has used a 3D printed model of patient’s prostate to optimise the outcome of robotic surgery, writes Martin Benjamin.
Professor Prokar Dasgupta successfully removed a prostate cancer tumour from a 65-year old, while holding an exact replica of the patient’s prostate, complete with tumour.
The 3D printed prostate is the brainchild of Dr Clare Allen, consultant radiologist at The London Clinic, and stands to revolutionise the way prostate surgery is carried out.
“One of the disadvantages of doing prostate surgery the way I do it, with robotics, is the lack of touch,” says Prof Dasgupta. “While you can see things better in 3D, HD, magnified 10x, you lose this crucial sense of touch. In this patient, I could feel the tumour in the 3D model and feel how close the tumour was to the surface.
“Normallyweplanwherethetumour is in our minds but here I held the model in my hand as I performed the procedure with the Da Vinci Robot, where I’m seated remotely at a console. The model allows for better planning and accuracy.”
From the patient’s MRI scan, Dr Allen was able to mark out where the tumour was and then, using software, generate the 3D model which was printed by Nuada Medical.
As Dr Allen explains: “The tumour in this case was in a very difficult location, very close to the muscle which provides continence — the sphincter muscle. The distancebetweenthetwowasonly1mm and we wanted to remove all the cancer successfully without disturbing the sphincter muscle.”
“The nerves for erections are on the sides of the prostate,” says Professor Dasgupta. “We have spared these nerves. The cancer has been removed successfully and additionally, the patient was continent straight away, with no reduction in his quality of life post-surgery.” Testicular cancer is relatively rare, accounting for one out of every 100 cancers diagnosed in men in the UK each year. And most testicular lumps are not cancer.
The earlier a cancer is picked up, the easier it is to treat and the more likely the treatment is to be successful. So go to your GP as soon as possible if you notice worrying symptoms. Be aware of what is normal for you and check from time to time, ideally after a warm bath or shower, when the scrotal skin is relaxed.
The most common symptom of a testicular cancer is a lump or swelling in part of one testicle. It can be as small as a pea or much larger. You may notice an unusual difference between one testicle and the other.
Hold your scrotum in the palms of your hands, so that you can use the fingers and thumb on both hands to examine your testicles.
Note their size and weight. It is common to have one testicle slightly larger, or that hangs lower than the other. But any noticeable increase in size or weight might mean something is wrong.
Gently feel each testicle individually. You should feel a soft tube at the top and back of the testicle. This is the epididymis, which carries and stores sperm. It may feel slightly tender. Don’t confuse it with an abnormal lump. You should be able to feel the firm, smooth tube of the spermatic cord which runs up from the epididymis.
Feel the testicle itself. It should be smooth with no lumps or swellings. It is unusual to develop cancer in both testicles at the same time. So if you are wondering whether a testicle is normal, compare it with the other.