A working GP has highlighted the ‘red flags’ for prostate cancer and urged anyone experiencing these symptoms to consult their GP immediately. This includes a lesser-known sensation in the legs.
Dr Mark Porter spoke out in his Times column after the Medicines and Healthcare Regulatory Agency sent an alert to doctors reminding them to warn men taking finasteride, a widely used drug for bladder and prostate problems, that it may have worrying psychiatric and sexual side-effects.
Dr Porter emphasised the key signs of this potentially fatal disease: “Some red flags to be aware of: blood in your urine, which is never normal and should always be reported, a burning sensation (suggestive of infection) and any change in bladder function accompanied by back pain, or weakness and/or altered sensation in the legs or pelvic area (suggestive of nerve compression).”
Dr Porter said tha non-cancerous enlargement of the prostate was very common – and explained in benign prostatic hyperplasia (BPH) the gland increases in size from about the age of 40, and by 60 at least half of men will have BPH, increasing to 90 per cent or more by 85.
And in many, but not all, it will have a noticeable impact on bladder function. He added that non-cancerous enlargement of the prostate, known as benign prostatic hyperplasia (BPH), is very common.
From the age of 40, the gland begins to increase in size, affecting at least half of men by 60, and 90 per cent or more by 85. In many cases, but not all, it will noticeably impact bladder function.
He further explained: “Not every man with BPH will have symptoms, and not everyone with symptoms will have BPH, but telltale signs include needing to get up in the night for a pee (once is normal), a weakened stream, peeing more often during the day, and having trouble getting started when you do, or stopping when you have finished.”
He also pointed out that men often exacerbate their symptoms by going to the toilet ‘just in case’ before leaving the house – a habit shared by many women with continence issues – which can speed up any decrease in bladder capacity, leading to a downward spiral. The doctor warned that caffeine can worsen symptoms, as can oral decongestants like pseudoephedrine, antihistamines found in cold and flu remedies, and some types of over-the-counter sleeping pills.
Diagnostic tests can include urine testing, a PSA blood test – levels can be elevated in both BPH and cancer – and sometimes kidney function too. Dr Porter recommended measuring urine output and taking the results to your GP.
He noted that an adult bladder typically sends the first gentle signals that it needs emptying at 150-250ml, with more urgent signals above 400ml. “Even those with good capacities are normally getting desperate by 600ml. However, if your chart shows that you are bursting to go but only passing 100-200ml at a time, then you have a problem. Not all such cases will be due to BPH, but if examination reveals your gland feels significantly enlarged then it’s likely to be a factor.”
Treatment options can encompass medication to relax the bladder outlet, such as tamsulosin, or hormone blockers like finasteride to reduce the size of the gland. Bladder training, which involves increasing bladder capacity by delaying trips to the toilet and avoiding “just in case” visits, can also be beneficial for some.
Additionally, bladder pills can be used to relax the muscular wall. In more severe cases, surgery may be employed to widen the constricted urethra.