Benign Prostatic Hypertrophy

Very many men over 50 have symptoms of noncancerous enlargement of the prostrate (benign prostatic hyperplasia). These symptoms include hesitancy in starting the urinary stream, frequency in passing urine during the day, an urgent need to pass urine and getting up at night to pass urine. All are due to the enlarging prostate gland pressing on the base of the bladder and the beginning of the urethra to create narrowing and irritation of the sensitive tissue in the area.

It is impossible to tell whether or not this enlargement is cancerous without examining the prostate and doing a blood test. Should there be any doubt about benign enlargement, an ultrasound examination is necessary and any suspicious areas can be sampled (biopsied) for microscopic analysis.

Prostate Cancer Screening

Digital examination of the prostate by a doctor can identify an enlarged prostate and a hard nodule of cancerous tissue can sometimes be felt. Early cancers, however, were not distinguishable until the recent introduction of a sensitive test for prostate specific antigen (PSA), a chemical produced excessively by the cancerous cells.

If the PSA is elevated, further investigation is carried out by using the technique of transrectal prostatic ultrasound. The ultrasound machine emits high frequency sound waves from a small device introduced painlessly into the rectum. The echoes returning from the prostate gland are received by the machine, and are converted by its computer into a picture on a screen. Areas of possibly cancerous tissue can be identified and biopsied painlessly. These tiny fragments of biopsy tissue are then examined under the microscope to confirm the diagnosis.

The simple screening technique of digital examination and PSA estimation should be carried out annually on men over 45; at least this is what is recommended in the United States and Germany where it has been proved that 30 to 40 per cent more cancers can be identified than by digital examination alone. In Britain, the Government has refused to fund a large scale study to prove the point; health officials consider cancer of the prostate as a low funding priority as it only affects older men. Public awareness of the disease is low in the UK at present. It must be up to the individual to decide whether or not to screen annually, bearing in mind that early detection of prostate cancer in middle aged men undoubtedly saves lives.