How common are prostate problems – and how do I know if I’m affected?

Written by: Mr Marc Laniado
Published: | Updated: 02/04/2019
Edited by: Nicholas Howley

Prostate problems are very common, particularly among older men. But can they affect younger men as well? Is it something that can run in the family? And how would you know if there was something wrong? Here to answer our questions is Marc Laniado ,  a highly-experienced prostate cancer specialist working in Harley Street, London.

How common are prostate problems?

Prostate problems are common: if you are white, you have about  one in 8 chance of getting prostate cancer and about the same number may have urinary problems from an enlarged prostate . Many men will have both issues. Overall about one in 24 white men will die from prostate cancer.

Age is the most significant risk factor for being diagnosed with prostate cancer. In the UK, the average age of diagnosis of prostate cancer is about 72, but you could be diagnosed from the age of 45 upwards if you have more risk than most. Black men are more likely to get (ie one in 4) or die (one in 12) from prostate cancer. Conversely, if you have an Asian ethnic background, you are less likely to suffer from prostate cancer.

You are more likely to be diagnosed with prostate cancer if your father, brother, or son, i.e. a first-degree relative, has it. Men with two or three affected first-degree relatives had a 5 to 11 times greater risk of prostate cancer, and the earlier they had it, the higher the risk.

Other risk factors for prostate enlargement and cancer include:

  • being overweight
  • eating a diet that promotes inflammation (i.e. red meat, saturated fat)
  • lack of exercise
  • smoking has been associated with a higher chance of dying from prostate cancer.

Can prostate problems affect younger men?

The answer is yes, but prostate cancer almost always occurs in men more than age 40. Prostate problems due to prostate enlargement or cancer often run in families and occur at a younger age than those without a family history. So, if you have a first-degree relative that needed treatment, it is much more likely that you will get a prostate problem too.

In fact, about 5 to 10% of all cancers develop because a man inherits a faulty gene that encourages the disease to grow. If you have a relative with a mutation in what is known as a cancer susceptibility gene, then you should consider getting specific advice on testing for that abnormality.

Your parents can pass on genes that make prostate cancer more likely. Specifically, the BRCA and HOXB13 genes can cause problems. The BRCA genes result in a more aggressive form of prostate cancer that needs comprehensive treatment.

Hereditary prostate cancer is more likely if you have:

  • two or more relatives with prostate cancer on the same side of the family
  • a first-degree relative who died of prostate cancer aged less than 60 years or was diagnosed with prostate cancer aged 55 years or less

Some men have a family history suggestive of the hereditary breast and ovarian cancer syndrome (BRCA). You might be at risk if you have a relative who:

  • who died from prostate cancer aged 60 or less or who has metastatic prostate cancer (ie prostate cancer that has spread)
  • who has high-grade prostate cancer and another family member with any of the following:
    • an instance of breast cancer less than 50 years old
    • a history of ovarian or pancreatic cancer (at any age)

How do I know if there is something wrong with my prostate?

If you have early prostate enlargement or cancer, usually you have no symptoms. If the prostate enlarges from benign overgrowth (BPH), you may get symptoms as the enlarging prostate squeezes the water pipe ("urethra"). As the urinary stream gets weaker, you may have to pass urine more often than before, as the bladder muscles contract more unpredictably. Often, these changes occur very slowly, and it is only by thinking back to your 20s that you may realise that there may have been some significant changes.

In contrast, if you have early and usually curable prostate cancer, you have no symptoms as a result of cancer. You start noticing symptoms only when cancer has become large. This is often late and when the tumour is quite extensive, making it less curable by simple treatments.

You should think about seeing a health professional If you are bothered by the following:

  • needing to urinate more often during the day and at night
  • an urgent feeling to pass urine and leaking before reaching the toilet
  • standing for a prolonged period before urine begins to pass
  • straining or taking a long while while urinating with a weak or slow flow
  • the feeling that your bladder has not emptied fully after going to the toilet

Please remember these symptoms do not necessarily mean you have cancer , as you may also get these symptoms when your prostate enlarges without cancer. If you have these symptoms, your doctor may have a prostate examination with a finger, blood test (PSA) and an enhanced MRI known as multiparametric MRI.

Sometimes, you may also get the following symptoms with prostate cancer:

  • pain passing urine
  • pain on ejaculating
  • blood in the urine or semen
  • difficulty with erections

When prostate cancer spreads away from the prostate, you may:

  • lose weight unintentionally
  • get new and persistent aches and pains in the back, pelvis or hips, or
  • notice that one or both of your legs have begun to swell.

These symptoms are particularly worrying, and the doctor should evaluate them, as there may be an important and treatable reason.

If you have any of the symptoms described above, and want to be evaluated further, you need to see your doctor to have a blood test (PSA) and sometimes a multiparametric MRI. Some doctors do a urine test known as SelectMDx , which has only become available privately. It is not a replacement for the other tests but may help to decide if you are likely to have serious prostate cancer.

By Mr Marc Laniado
Urology

Mr Marc Laniado offers men with prostate enlargement or early prostate cancer treatments that benefit with less chance of side-effects. He uses the most advanced techniques that have a consistently better success rate. These are personalised to the individual needs and values of each man he sees.

 

Prostate cancer:

  • highly accurate diagnostic tests with the least side-effects (enhanced MRI, transperineal prostate biopsies, and genomic testing)
  • treatments for early prostate cancer that can preserve bladder control and erections more consistently than conventional treatments (focal therapy by HIFU, Retzius-sparing prostatectomy with nerve-sparing (NeuroSAFE), and seeds, a.ka. brachytherapy)
  • active surveillance: close monitoring for men who do not need immediate treatment

Prostate Enlargement (BPH):

  • minimally invasive treatments for small to medium-sized prostate that can improve urinary symptoms and maintain erections & ejaculation (Rezum and UroLift)
  • treatments for large prostates that improve urinary symptoms with a faster and more comfortable recovery (Aquablation, laser prostatectomy, HoLEP)
  • assessment for Prostate Artery Embolisation (PAE) 

 

He is a highly experienced urologist and works full time in the direct clinical care of men with prostate problems. Annually, he performs about 100 Retzius-sparing prostatectomies, as well as HIFU,  and 100 or more treatments for BPH.

 

He is the joint chairman of the prostate cancer multidisciplinary team for private patients at the Wellington Hospital and the Princess Grace Hospital where he operates and sees patients. He also sees patients at The London Clinic.

 

Mr Laniado was appointed as a consultant in 2002 and started performing conventional robotic prostatectomies in 2008. In 2016, He switched to the Retzius-sparing approach because of the much better bladder control and recovery of erections with similar cancer outcomes. He trains surgeons learning how to perform Retzius-sparing prostatectomies at the Royal Berkshire Hospital. NHS patients consult with him at the Royal Berkshire Hospital and Wexham Park Hospital (Frimley Health), where he is the lead for urological cancer.

 

Mr Laniado graduated from Guy's Hospital Medical School in 1989, having previously gained a BSc in physiology. Following specialist urology training in London, he became a Fellow of the Royal College of Surgeons (Urology) in 2000, going on to complete his MD in prostate cancer research, Fellow of the European Board of Urology in 2002, and become an international member of the American Urological Association. Before taking up his career as a consultant, Mr Laniado extended his knowledge and skills on a Visiting Fellowship at the Cleveland Clinic Foundation in the USA, where he trained in minimally invasive surgical techniques. 

 

Mr Laniado chooses treatments wherever possible for prostate problems that maximise the benefit-to-risk ratio, which are often less readily available. However, it is not possible to completely eliminate the chance or impact of after-effects after treatment, although the risk and impact are minimalised as much as possible.

 

 

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