Prostate cancer usually develops slowly and is often asymptomatic until it reaches an advanced stage when it presents with:1
Blood in the urine
Pain in the hips, back, or chest
Prostate cancer is the second most common cancer in men worldwide. It typically affects men over the age of 50 and is more common in men of African descent.2 Prostate cancer can be detected early before symptoms present by screening for elevated levels of prostate specific antigen (PSA) in the blood, or by a digital rectal examination. However, these tests are non-specific and a formal diagnosis needs to be confirmed by a transrectal ultrasound or prostate biopsy.2
The decision to treat prostate cancer can be complex. Some men choose not to receive treatment but to wait and see if it progresses, rather than undergo surgery or tolerate potential side-effects from treatments. Hormone therapy is typically used to treat prostate cancer. This reduces testosterone levels which prevents the cancer from progressing.2 Other treatment options for prostate cancer include surgery, radiotherapy, and chemotherapy.2
Benign prostatic hyperplasia (BPH) is a common condition where the prostate becomes enlarged. This can lead to urinary symptoms such as a frequent or urgent need to urinate and difficulty starting or completing urination. Urologic Disease in America reports approximately 200,000 Emergency Room admissions per year with BPH as a primary diagnosis between 2002-2007.3
The prevalence of BPH increases with age, affecting an estimated 50% of men over the age of 604 and BPH is associated with reduced quality of life.5 However, patients often consider current treatments to be unsatisfactory because of side-effects, including sexual dysfunction.5 These may also reduce quality of life5 despite an improvement in urinary symptoms. For this reason, adherence to treatments remains low.6
Benign prostatic hyperplasia is usually diagnosed by measuring the level of prostate specific antigen (PSA) in the blood, and by feeling for abnormalities in the prostate during a digital rectal examination.7 Additional tests, for example a urine test, may also be used to confirm a BPH diagnosis and rule out other, more severe conditions.
Lifestyle modifications such as drinking fewer liquids may be attempted to manage BPH symptoms; however, BPH treatment usually requires pharmaceutical intervention. Three different classes of pharmaceutical agents can be used to treat BPH, and they are often prescribed concurrently. These are:7 Alpha-receptor blockers to relax the muscles in the prostate and bladder, which may alleviate symptoms;7 5-alpha reductase inhibitors (5-ARIs) to shrink the prostate;7 and phosphodiesterase 5 inhibitors (PDE5 inhibitors) which help to increase urinary flow.7 In severe cases, surgery may be required.
Acute urinary retention (AUR) is the sudden inability to pass urine and can be associated with benign prostatic hyperplasia (BPH).8 It is classified as a medical emergency and requires immediate catheterization.8 Further management may include initiation of alpha-receptor blockers, which relax the muscles of the prostate and bladder to increase urinary flow.9 However, since this does not address the underlying cause of BPH, the problem is likely to recur and may require re-catheterization.9 In severe cases, a prostatectomy may be performed.
American Cancer Society prostate cancer https://www.cancer.org/cancer/prostate-cancer.html (accessed July 2019).
World Cancer Research Fund prostate cancer https://www.wcrf.org/dietandcancer/prostate-cancer (accessed July 2019).
Litwin MS, Saigal CS. Urologic Diseases in America; US Government Printing Office: 2012
Berry S, et al. J Urol 1984; 132: 474–9.
Alcaraz A, et al. Int Urol Nephrol 2016; 48: 645–56.
Cindolo L, et al. BMC Urol 2015; 15: 96.
WebMD prostate enlargement/BPH health centre https://www.webmd.com/men/prostate-enlargement-bph/default.htm (accessed July 2019).
National Institute of Diabetes and Digestive and Kidney Diseases urinary retention https://www.niddk.nih.gov/health-information/urologic-diseases/urinary-retention (accessed July 2019).
Serlin DC, et al. Am Fam Physician. 2018; 98 :496–503.