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Treat all your prostate patients like the King

One in three men over the age of 50 will experience symptoms of an enlarged prostate, but what is a prostate and what should you know about it?
Prostate cancer in its early stages does not cause any symptoms

Recently it was announced that the King was receiving treatment for an enlarged  prostate. Subsequently, His Majesty has been diagnosed with a separate form of cancer, which is said to have been found early.

One in three men over the age of 50 will experience symptoms of an enlarged prostate, but what is a prostate and what should you know about it?

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Men, trans women, non-binary people who were assigned male at birth and some intersex people have a prostate. It is a small, walnut-sized organ which sits below the bladder and surrounds the urethra. The job of the prostate is to make semen.

As the person ages, the prostate grows which can put pressure onto the urethra and bladder, causing symptoms. The main symptoms of an enlarged prostate include a reduced urinary flow, difficulty starting the flow, feeling of incomplete emptying, frequency of urination, nocturia, intermittency of the stream, urgency and dribbling at the end of the stream. Men can also have haematuria, but this is rare. Most men put these symptoms down to old age, but they can really affect a man’s quality of life, even preventing him from leaving his home in some cases. It can also cause anxiety and mental health conditions such as depression.

Prostate cancer in the early stages does not cause any symptoms. This is because it affects the outer part of the prostate, away from the urethra. There are no links between having an enlarged prostate and prostate cancer, but men can have both at the same time.

Primary care nurses are best placed to discuss prostates; even a simple blood pressure check could include asking about any urinary problems. With constant time pressures and demands, it may feel difficult to ask men, in fear of opening a can of worms which would then delay the clinic. But, by giving men an IPSS (International Prostate Symptom Severity Score) sheet to fill in whilst they wait could help them to discuss any problems they might feel embarrassed to mention, and offering a follow up consultation to discuss in more detail would prevent this.

Lots of men are worried about mentioning urinary problems due to embarrassment,  and the thought of a digital rectal exam (DRE) can be off-putting. NICE guidance states that a physical examination should be offered at the initial assessment, however, there is some controversy with DREs as they can be subjective.

At the initial assessment, men should be offered advice on PSA blood testing, and time to make their decision. All men over the age of 50 (45 if higher risk) are entitled to a PSA blood test as long as they understand the pros and cons of the test.

The publicity from the King’s recent treatment may lead to more men seeking testing. Let’s seize the moment to improve diagnosis