Understanding prostate health
Written by:
Urologist
Published: 20/12/2018
Edited by: Bronwen Griffiths
If you are suspected of having problems with your prostate, normally, the first diagnostic step would be a PSA test. Following the results of this, a biopsy may be performed as well. If you are diagnosed with an enlarged prostate, there are several treatment methods available, including HoLEP. Mr Rick Popert, a leading urologist, explains how a prostate biopsy is performed, what HoLEP is and shares advice on when men should start checking their prostate.
When should men start checking their prostate and how frequently?
Prostate cancer diagnosis really starts from the age of 40 in my view. If a man has a family history of prostate cancer, they should have their PSA levels (prostate specific antigen) checked starting at the age of 40. It should probably be repeated every two or three years until the age of 50 when it should be done annually.
The critical thing with the PSA blood test is to know what your baseline is. If one finds that the PSA is slowly increasing over time, that may simply reflect benign enlargement of the prostate, but there is also the possibility that prostate cancer may be developing silently within the prostate, which may require treatment.
Most routine medicals done as part of a health assessment will include the PSA blood test from the age of 50. Do not be afraid to ask for the PSA blood test from your GP though. If you wish to have the PSA checked, they should do it for you. They may explain that the PSA blood test is prostate-specific, not prostate cancer specific. But take it from me, it is better to know what your PSA level is at the age of 40 or 50 and follow it yourself and if it goes up, seek specialist attention.
How is a prostate biopsy carried out?
In order to biopsy the prostate, you have to visualise it with an ultrasound probe, which is about the size of the width of a thumb. It is placed into the back passage so that we can see the prostate gland in situ.
The options for doing the biopsy are either:
With a biopsy gun that is fired through the wall of the rectum directly into the prostate. This is called a trans-rectal prostate biopsy. Alternatively, and in my view, much more safely and effectively, we can actually go through the skin between the back passage and the scrotum. That area of skin is called the perineum. In this situation, we do a transperineal biopsy. This avoids going through the back passage which is dirty. It also allows us to take biopsies all the way around the outside of the prostate so it is actually a much better method. We also have a method called an MRI-ultrasound fusion targeted biopsy, which in my view is the most accurate way of diagnosing a potentially high-risk prostate cancer. We use the information that you can get from an MRI scan. If we can see an area of abnormality on the MRI scan, we can do targeted biopsies of that area. In some patients, we can take the MRI images and fuse those on a computer software program with the ultrasound images so that we can take a very accurate biopsy.What is a holmium laser prostatectomy (HoLEP)?
The prostate gland gets bigger as you get older. In some men, the prostate gland can get very big indeed. Most prostate cancers exist in the outer peripheral portion of the prostate gland. The central bit is the bit that gets bigger as you get older and it gets bigger in men (and dogs!), restricting the flow of urine. If you try to remove that central core of the prostate gland through an open operation, it can cause very significant bleeding.
The holmium laser prostate enucleation allows us to do that same operation, but through the penis without needing to make an incision. Most patients will regain their urinary control very quickly after the operation. For people with a very large prostate, it is the safest way of managing benign enlargement to the prostate. This is not prostate cancer. This is surgery for patients who just got a very big, enlarged prostate.
My experience in holmium laser prostate surgery is more than 15 years. I have done over a thousand of these operations. I have to say, it is the most effective way of improving a man’s urinary flow if they have significant prostate enlargement. However, it is critical that the surgeon that you go to understands the anatomy of the prostate and how to carry out this form of surgery safely.