Q&A: How serious is an enlarged prostate? As King Charles will be hospitalized for treatment of his condition

WHAT IS AN ENLARGED PROSTATE?

‘Essentially, this is where the prostate gland begins to grow with age. This gland, which is initially about the size of a walnut and located beneath the bladder, wraps around the urethra, the tube that carries urine from the bladder out of the body. ‘ explains Robert Calvert, a consultant urological surgeon at Liverpool University Hospitals NHS Trust.

The main function of the prostate is to produce a fluid that, together with sperm cells, forms semen. About half of men aged 50 and 90 percent of men over 80 have an enlarged prostate, also called benign prostatic hyperplasia (BPH).

WHAT ARE THE SYMPTOMS?

‘As the prostate enlarges, the prostate can squeeze the bladder and narrow the urethra, resulting in symptoms such as difficulty initiating urination, slower urine flow, a frequent need to void – often at night – and difficulty emptying completely of the bladder. ”, explains Mr Calvert.

Up to three million men in Britain have urinary symptoms linked to the condition: these can affect the quality of life not only for men but also for their partners.

WHAT CAUSES AN ENLARGED PROSTATE AND CAN YOU PREVENT IT?

Although the exact cause is not known, the two main risk factors are age and hormone levels – particularly the balance of estrogen and testosterone in the body, which changes as men age, according to the charity Prostate Cancer UK. (Men also produce ‘female’ sex hormone estrogen, albeit in much smaller amounts than women.)

Some research suggests that obese men and men with diabetes are more likely to develop an enlarged prostate. ‘Excess body fat further increases testosterone levels, stimulating the growth of prostate cells,’ explains Professor Christoper Eden, a consultant urological surgeon at London Bridge. Hopital.

The risk is also higher if your father or brother has BPH, although further research is needed to confirm this.

‘Although there is no guaranteed way to prevent the condition, a healthy diet and weight can help, says Mr Calvert. ‘Although sometimes it’s just one of those things.’

HOW IS IT DIAGNOSED?

Various tests have been used to diagnose the condition – and also to rule out other problems such as urinary tract infection, prostatitis – inflammation caused by infection – or prostate cancer, says Professor Eden.

‘Your GP may give you a urine test as well as carry out a physical examination, which may include feeling your prostate gland via a rectal examination,’ adds Nicholas Faure Walker, a consultant urologist at King’s College Hospital and the Prostate Center in London.

You may be offered a blood test to check your levels of prostate specific antigen (PSA). PSA is a protein produced by the prostate and levels can be elevated due to prostate cancer, as well as infection and benign enlargement.

Professor Eden says: ‘If you are aged 50 or over, and especially if you are black or have a family history of prostate cancer, you should be offered a PSA test (to rule out prostate cancer).

‘Although BPH can be diagnosed and initially treated by a GP, says Professor Eden, in some circumstances you may be referred to a urologist, for example if your PSA is elevated, if you have a urinary tract infection or suspected prostatitis.

‘If you are seen by a urologist you may need to have a flow rate test (where you pee into a funnel which measures how fast your urine flows) to assess how well you are voiding,’ says Mr Faure Walker.

HOW IS IT TREATED?

‘Treatments for BPH start with lifestyle changes such as cutting back on fluids, caffeine (found in tea, coffee and soft drinks) and alcohol, which can irritate the bladder and worsen urinary symptoms,’ says Mr Calvert.

If such changes do not help, medication may be offered. ‘First-line drugs are the alpha-1 adrenergic antagonists (including tamsulosin, doxazosin and alfuzosin), which improve blood flow and symptoms such as urgency by relaxing the smooth muscle in the prostate,’ explains Professor Eden.

‘If this is not sufficient and if the prostate is larger than 40ml, medications called 5-alpha reductase inhibitors (including finasteride and dutasteride) can be used to reduce the size of the prostate.

‘Other drug treatments include desmopressin, which works by reducing urine output so that less urine is produced at night,’ he adds.

But 30 percent of men with BPH require some form of surgery. The gold standard is transurethral resection of the prostate (TURP). Here a telescope containing a light, a camera and a wire loop (which can be heated) is passed through the urethra into the prostate and used to cut away the excess tissue causing the symptoms.

Although effective, TURP can have side effects immediately afterwards, including bleeding and infections. In the short term, the flow can be quite urgent, leading to incontinence, but this usually resolves itself, says Mr Faure Walker.

‘Long-term incontinence is quite rare. Another common risk is retrograde ejaculation, where semen is sent backward into the bladder. Nighttime urination can also be the result of hormonal changes with aging and sometimes does not improve after TURP surgery.’

A newer option is the UroLift system, which uses two to four pairs of so-called treasury tags to pull open the enlarged tissue, improving flow. The procedure is just as effective as TURP, but it is not clear how long the effects can last.

Last November, waterjet ablation, which uses high-pressure water to precisely destroy excess prostate tissue, was approved as a first-line treatment by the National Institute for Health and Care Excellent (NICE).

Another technology, known as Rezum, uses steam to remove the enlarged prostate tissue. For men with a particularly large prostate (over 80ml), most urologists would now recommend holmium laser enucleation surgery (HoLEP), says Mr Faure Walker. This is a laser treatment that removes more of the obstructing tissue than a traditional TURP, he adds.

Professor Eden says the advantage of these newer treatments is that they are less invasive compared to TURP, so have fewer side effects, but may not provide as long-lasting benefit. For more information about surgical options and treatments, see the British Association of Urological Surgeons website, baus.org.uk.

CAN HERBAL REMEDIES HELP?

King Charles has previously spoken out in support of alternative remedies, although it is not known whether he has tried them for his BPH. According to the Mail’s GP columnist Dr Martin Scurr, ‘there is little evidence’ to support the use of Saw Palmetto (an extract from the fruit of a palm tree), a popular herbal remedy for an enlarged prostate.

Another herbal preparation is cernilton, derived from a type of grass pollen – while studies have shown an improvement in symptoms, such as the need to urinate more at night (nocturia), the flow rate measured when emptying the bladder remains unchanged, says Dr .Scurr, warning that herbal remedies can interfere with standard drug treatments.

HOW LONG DOES IT TAKE TO RECOVER FROM SURGERY?

Recovery depends on the type of surgery or procedure you choose. With many minimally invasive procedures, men can go home the same day, and may need painkillers for a week or so.

For TURP – the most common surgical treatment – ​​you will usually need to stay in hospital for one to two days after your operation, although some hospitals will allow you to go home the same day. A catheter (thin tube) used during surgery is usually removed before the patient is discharged home.

With TURP, most men return to normal activity within two to three weeks.

CAN THE PROSTATE ‘GROW BACK’ AFTER TREATMENT?

Yes, that is possible, says Professor Eden.

The risk of this is 1-2% per year after treatment.

WHY SHOULD I NOT HAVE THE ENTIRE PROSTATE REMOVED?

This is a much larger operation and is only done for prostate cancer as there is a greater risk of disrupting bladder and sexual function, explains Professor Eden.

IS AN ENLARGED PROSTATE LINKED TO PROSTATE CANCER?

No, having an enlarged prostate does not increase the risk of developing prostate cancer, says Professor Eden. The two problems usually start in different parts of the prostate.

However, as both conditions affect men as they age, they often co-exist, but tests such as PSA, digital rectal examination and sometimes an MRI scan will usually be carried out before surgery is considered, to reveal this .