Men are famously bad at going to the doctor, and there is one area they avoid more than any other. Urinary and prostate symptoms get quietly tolerated for years, blamed on getting older, and mentioned to nobody.
The difficulty is that the early warning signs of a serious prostate problem and the signs of a completely harmless one are almost identical. You cannot tell them apart by how you feel. Only a test can.
What the prostate does, and why it causes trouble
The prostate is a small gland that sits below the bladder and wraps around the urethra, the tube that carries urine out of the body. Its job is to produce part of the fluid in semen.
The problem is purely one of position. Because the urethra runs straight through the middle of it, anything that makes the prostate bigger squeezes that tube. This is why prostate problems announce themselves through your urine stream rather than through any pain in the gland itself.
From about the age of forty the prostate naturally starts to enlarge. This very common, non cancerous enlargement is called benign prostatic hyperplasia, or BPH. It is not cancer, it does not turn into cancer, and it is treatable.
The symptoms to take seriously
See a doctor if you notice any of the following, whether or not they bother you day to day.
A weak or slow stream. It takes longer than it used to, or the flow starts and stops.
Difficulty starting. You stand and wait for the stream to begin.
Getting up at night to pass urine. Once may be normal. Two, three or more times is not.
Sudden urgency. You need to go immediately and struggle to hold it.
Not feeling empty. You finish and still feel you need to go, or you dribble afterwards.
The symptoms that need checking sooner rather than later
Some signs point beyond simple enlargement and should be assessed promptly: blood in the urine or semen, bone pain particularly in the back, hips or pelvis, unexplained weight loss, or new difficulty with erections alongside urinary symptoms.
None of these automatically mean cancer. They do all mean the same thing: stop waiting and get examined.
Who should get checked, and when
This matters more in the Caribbean than most men realise. Prostate cancer is the most commonly diagnosed cancer among men in Trinidad and Tobago, and men of African and Afro Caribbean descent face both a higher risk of developing it and a higher risk of it being aggressive.
Early prostate cancer produces no symptoms whatsoever. By the time it is causing pain it has usually spread. That is precisely why screening exists: it is designed to find the disease during the years when it is silent and curable.
What the assessment involves
It is far less of an ordeal than men imagine, and it is usually finished in one visit.
A conversation. The doctor asks about your stream, your nights, your general health and your family history.
A PSA blood test. PSA is a protein made by the prostate. A raised level can indicate enlargement, infection, recent vigorous activity or cancer, so it is a signpost rather than a verdict. Our laboratory is on site.
A physical examination. A brief digital rectal examination lets the doctor feel the size, shape and texture of the gland. It takes seconds and it detects problems that a blood test alone can miss.
A urine test, and imaging if needed. Urine is checked for infection or blood. An ultrasound can measure the prostate and show how much urine is left in the bladder after you go. If more detail is required, CT scanning is available here as well.
If those results raise a concern, the next step is a referral for a prostate biopsy, where small samples are taken and examined under the microscope. Only a biopsy can confirm or rule out cancer.
Treatment, if you need it
For benign enlargement, many men do well on medication that either relaxes the muscle at the bladder outlet or gradually shrinks the gland. Simple changes help too, such as cutting back on fluids in the evening and reducing alcohol and caffeine. When medication is not enough, surgical treatment to relieve the obstruction is very effective.
For prostate cancer, treatment depends entirely on how early it is caught, which is the whole argument for testing before symptoms appear. Some slow growing cancers in older men are safely monitored rather than treated. Others are treated with surgery, radiotherapy or hormone therapy, often with excellent outcomes when found early. Our role is to assess you, arrange the tests and refer you to the right specialist care, since treatments such as radiotherapy are given at specialist centres.
The honest bottom line
Most men who come to us with these symptoms do not have cancer. They have a gland that has enlarged with age, and they leave with treatment that gives them their nights back.
But the men who do have something serious feel exactly the same as the men who do not. That is the entire problem, and it is the reason a check is worth an hour of your time. Waiting does not keep you healthy. It only removes your options.
Get your prostate and urinary health checked at Newtown.
Consultation, PSA blood testing, urine testing, ultrasound and CT scanning are all available under one roof at 55 Woodford Street, Port of Spain, so your assessment can usually be completed in a single visit. Book a consultation and our doctors will examine you and arrange any tests you need. Our Accident and Emergency department is open 24 hours if you cannot pass urine at all.
This article is for general education only and is not a substitute for personal medical advice, diagnosis or treatment. Always consult a qualified healthcare provider about your own health. If you believe you have a medical emergency, call or visit our 24-hour Accident and Emergency department immediately.