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03 December 2016Last updated
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Features | Health

Throwing light on prostate issues

As Movember puts the spotlight on men’s health, Colin Drury finds out that prostate-related conditions are not only extremely common, they are also one of the most neglected. So if you are over 45, now is a good time to book a check-up

Colin Drury
18 Nov 2016 | 12:00 am
  • Source:Shutterstock Image 1 of 2
  • Dr Herwig says that all men, without exception, if they live long enough, will develop prostate cancer at some point.

    Source:Supplied Image 2 of 2

It is a little-known health fact that is both shocking and somewhat scary: every man, if he lives long enough, will get prostate cancer.

‘There are no exceptions,’ says Dr Ralf Herwig, head of the prostate unit at the German Medical Center in Dubai Healthcare City.

‘As a male, it is not a case of if you develop this; it is a case of when.’

Every year, this disease kills more than 30,000 people across the world – a figure which, itself, is just a tiny fraction of the numbers actually diagnosed. Virulent forms can spread so fast and with such lack of mercy, they leave strong men dead within the year. And the risk to each of us rises with each passing decade. A man of 30 has a 30 per cent chance 
of carrying a trace of the cancer, according to research by Wayne State University in Michigan.

For those in their 60s, that increases to 60 per cent. By the time you’re 90, it’s almost certain you’ll carry some form.

And yet, despite these horrifying statistics, it seems the prostate remains one of those areas of male health that men here in the UAE, as elsewhere, continue to neglect.

‘I just always assumed it was an old man’s illness,’ says David Tanner*, a 48-year-old who was diagnosed in 2014. ‘I never thought I had to worry about it at my age.’ It is an attitude that is distressingly common, health experts here say.

In 2013, just under two men a month were being diagnosed in Dubai hospitals, and while regular campaigns by the Dubai Health Authority have undoubtedly helped increase awareness, the feeling remains that, across the Middle East as a whole, this is something men do not concern themselves enough with.

Perhaps Ashraf Abusamra, the well respected consultant in urology at the King Abdulaziz Medical City in Jeddah, Saudi Arabia, put it best during a conference on the subject in Dubai just last year: ‘There is simply a lack of awareness about prostate cancer and other prostate diseases in the region,’ he noted.

And so, with this in mind, Friday is today seeking to answer three key questions. What exactly are the risks? Can problems be prevented? And, if they arise, how should you deal with them?

The prostate is a surprisingly small, unspectacular-looking gland for something that can be at the centre of such misery – and also such joy.

It is about the size of a walnut and a deep red colour. In the body, it sits between the bladder and the urethra, and produces the seminal fluid that transports a man’s sperm during procreation. It’s an important little thing, in other words.

Developing cancer, however, is not the only problem that can arise with it.

More common, in fact, is an enlarged prostate – something that will affect 40 per cent of all men over 50 (and 75 per cent of those in their 70s) but that can exist in younger chaps, too.

‘All men’s prostates grow over time,’ says Dr Herwig, who is also associate professor of urology at the University of Vienna, Austria. ‘But issues arise when it gets too enlarged, because then it can place pressure on the bladder and the urethra.’

This in itself can cause minor difficulties. Passing urine becomes harder. The frequency of toilet visits increases. And incontinence becomes quite a common problem.

But if treated at this stage, an enlarged prostate shouldn’t cause too many major issues. Lifestyle changes, such as reducing caffeine consumption and a little bladder training, could solve the issue alone; or a course of prescribed medicine can be taken for more severe cases.

But left undiagnosed, an enlarged prostate can lead to urinary tract infections – caused because the bladder is never emptied properly and, therefore, doesn’t rid the body of harmful bacteria – which can irreversibly damage the kidney. Worse still, acute urinary retention, known as AUR, is a second possible consequence. In these medical emergencies, the prostate has enlarged so much that it becomes impossible to pass urine, meaning the body’s waste substances are passed back into the kidney, essentially poisoning them.

‘This is why it is important to understand prostate issues,’ says Dr Herwig. ‘Because at this stage, what was a relatively simple issue if it had been treated earlier, has now become a medical emergency. At this stage you call an ambulance because a tube needs to be inserted to get rid of the urine. Surgery is now a possibility.’

Another issue that can arise in the prostate is prostatitis – an inflaming and swelling of the gland.

Unlike enlargement, this is more common in younger men, and symptoms can be more distressing: it’s painful to both pass water and to ejaculate, urination becomes stop-start and is required more frequently, and there can be pain in the pelvis, lower back and buttocks. Fever and aching joints might develop later. So too might temporary impotence.

The cause of prostatitis remains something of a mystery even today. Occasionally, it can be put down to bacteria but this is not always true.

This unknown means it can be difficult to treat. In many cases, painkillers and antibiotics or a course of prescribed medicine will do the trick. But about one in 10 men go on to develop something called chronic prostatitis, where the symptoms come and go over several months, and then return again in the future. In this case, medication and painkillers will reduce the symptoms but may not cure the problem for good.

‘Research continues to be done into this,’ notes Dr Herwig.

While both enlargement and prostatitis are serious issues, it is reasonable to say it is prostate cancer that exercises most concern.

As with both other prostate issues, it is not known what causes the cancer and similar too are the symptoms: needing to pass urine more suddenly and more frequently (and especially during the night), having a weak, stop-start flow, and experiencing a sensation that you’ve never quite emptied your bladder.

‘These symptoms are comparable, in many ways, to both prostatitis and enlargement,’ says Dr Herwig. ‘Which is why, when they occur, you must go to the doctors immediately. Because there is the possibility it is cancer.’

If left undiagnosed, the risk is that it will spread. Once that happens, typically into the bones, it becomes untreatable. All doctors can do then is prolong life and relieve pain.

The aforementioned David Tanner knows all this. The insurance consultant based in Dubai Motor City had found himself needing to visit the lavatory a couple of times a night, and grew concerned.

‘I’ve never had a particularly strong bladder,’ he says. ‘But when I started having to get out of bed twice a night – and even then I would feel like I’d not quite got rid of it all – I started to worry. I put it down to stress, and I stopped drinking anything for a couple of hours before bedtime. But it didn’t change anything. My wife said I might have an issue with my prostate but I just couldn’t really see it. It seemed like a granddad’s illness.’

Nevertheless, he went to a doctor.

There, he was given a prostate-specific antigen (PSA) test, a kind of blood sample that measures the level of PSA in the body.

Dr Herwig says, ‘If this is particularly elevated, we know there is an issue. That doesn’t necessarily mean it’s cancer – it could just signal an infection or enlargement – but it does mean we know something is happening with the prostate, and must investigate further.’

More tests will be carried out to identify the specific problem. Cancer is the worst news, of course, but, even then, if it’s caught early, it’s one of the most treatable forms of the illness.

Indeed, for those diagnosed who have not started to show symptoms – and do remember that Wayne State University research suggests more than half of all men over 50 will have at least minor traces – doctors actually use a policy of simply watching and waiting.

‘Do not be mistaken, prostate cancer is a killer,’ says Dr Herwig. ‘It can shorten life dramatically. But while it remains at very low levels in the prostate, it is not necessarily an issue that needs immediately dealing with. In these cases, we monitor.’

That’s because the cancer, in itself, does no real damage. As long as there are none of the above side effects and symptoms, doctors tend to consider treatment more harmful than allowing the cancer to exist.

‘But the important thing is to know it’s there,’ says Dr Herwig. ‘Because then we can monitor it and act at the appropriate time.’

For some men, of course – roughly one in every 10,000 under 40 but one in every 38 for men aged 40–59 according to the Prostate Cancer Foundation – the cancer will be more advanced.

Nonetheless, if it remains only in the prostate, it is still treatable. Methods include removing the gland and radiotherapy. Both have side effects – including possible impotence and incontinence – however, these can be dealt with and improved once the cancer is taken out. Neither method is as destructive as chemotherapy.

For David, removal was the chosen option.

‘When they say that word, “cancer”, it takes your legs from under you,’ he says. ‘I have two teenage daughters and my immediate reaction was, “Who’s going to look after them? How is it possible that I’ll never get to see my girls grow into young women?”

‘But because they caught it early, I’m so lucky that these were questions I ended up not needing to consider.’

He had the prostate removed after a period of monitoring and has recently been given the all-clear. Today, he is a picture of health.

‘I can’t tell you how lucky I am that my wife encouraged me to go to the doctor,’ he says.

‘I’m pretty sure that left to my own devices, I would have been too embarrassed and would’ve put up with the symptoms.’ Which is why, today, he is so keen to raise awareness.

The message from both him and Dr Herwig – and, indeed, the Dubai Health Authority – is the same. Men over 45 should go for a prostate check-up every few years whether they are suffering the symptoms or not.

Those under that age don’t need such regular appointments; however, they absolutely should not put off going to a doctor if they detect any of said symptoms.

‘It’s a very simple equation,’ says Dr Herwig. ‘Catching this early can stop more serious problems. It can save your life.’

Ben Stiller’s fight with cancer

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Ben Stiller is one of Hollywood’s best-loved actors, comedians and film-makers. He is also a very good example of why prostate check-ups are so important for men aged 45 or above.

He credits such a test with saving his life.

Ben was diagnosed with prostate cancer at 48. He had suffered not a single symptom and had no family history of the disease. There was no reason in the world to think he might have it. He agreed to a prostate-specific antigen (PSA) test simply because his doctor suggested he was getting to an age where it was worthwhile.

‘Taking the test saved my life,’ he later wrote in an open letter to men around the world. ‘Literally. That’s why I am writing this now.’

The results showed he had unusually high PSA in his blood, and so his doctor sent him to a urologist. After running more exams, the urologist diagnosed mid-range aggressive cancer. Within a few weeks, Stiller was undergoing surgery to have the tumour removed – an operation that was successful because it had been caught early.

‘I count my blessings that I had a doctor who presented me with the option [of a PSA test,]’ Stiller, now 50, continued in his letter. ‘I believe the best way to determine a course of action for the most treatable yet deadly cancer is to detect it early.’

Colin Drury

Colin Drury