Prostate Disease
What is Prostate Disease?
It is normal for the prostate gland to increase in size and volume with age. In the majority of cases this is non-cancerous and what is known as benign prostatic hyperplasia or BPH. Symptoms can include frequency of urination, nocturia (having to get up at night to pass urine), hesitancy (difficulty getting started), dribbling and a sensation of incomplete bladder emptying.
In a smaller number of cases more serious pathology can arise in the form of prostate cancer which is now the most prevalent cancer in men.
How is Prostate Disease diagnosed?
Prostate disease is often picked up in its earliest stages by blood tests in the form of PSA (prostate specific antigen). An elevated PSA blood result may not necessarily mean cancer if it is raised in proportion to the size of an enlarged prostate but it should initiate further investigation.
Further initial investigations can include an ultrasound examination to assess the size of the prostate gland and to determine if the bladder is emptying completely. More detailed investigation is by MRI scanning and in particular Multiparametric MRI which is a dedicated and detailed MRI scanning protocol. It gives more detailed information and can estimate the likelihood or otherwise of prostate cancer. MRI is not 100% diagnostic of cancer but can indicate which patients require biopsy to confirm the diagnosis and can help plan targeted biopsy to optimise the accuracy of the procedure and help plan further management.
Dr. Crowe is a member of the Birmingham Prostate Clinic which offers the full range of prostate investigations and treatments. He participates in regular multidisciplinary treatment meetings (MDTs). These are meetings attended by expert urologists. oncologists and specialist radiologists and pathologists to discuss each individual case including imaging and biopsy results to agree an consensus on best management and plan treatment or follow up.
What treatments are available?
Age related enlargement of the prostate due to benign prostatic hyperplasia (BPH) does not necessarily require treatment unless it is causing troublesome symptoms. Symptoms can include frequency of urination, nocturia (having to get up at night to pass urine), hesitancy (difficulty getting started), dribbling and a sensation of incomplete bladder emptying.
Initial assessment is usually by a urolgist and Dr. Crowe works closely with colleagues in the Birmingham Prostate Clinic. There is a wide variety of availble treatment options for BPH ranging from medications to Prostatectomy surgery or trans-urethreal resection (TURP) surgery, laser TURP as well as less invasive options such as Urolift and aquablation (Rezum).
The interventional radiology option of prostate artery embolisation (PAE) is at the lower end of the scale in terms of invasiveness but all treatments have their merits and disadvantages.
Prostate Artery Embolisation for Benign Prostatic Hyperplasia (BPH)
Prostate artery embolisation (PAE) is a minimally invasive interventional radiology procedure to treat benign prostatic hyperplasia (BPH). It aims to shrink the prostate gland and improve urinary symptoms by blocking the blood supply. It is done under x-ray screening guidance and is usually a day-case local anaesthetic procedure.
Multparametric MRI (mpMRI) for Prostate Disease
This is a special MRI technique to image the prostate and uses anatomical (identifying a focal abnormality) and functional (identify likelihood of cancer) sequences. The advantages of this technique are that it is non-invasive, can accurately record the size of the prostate gland and identify significant prostate cancer, if the volume is above 0.5cm3 (7mm lesion). It also can clearly identify the front of the gland and the apex (lowest point) and identify the likelihood of any spread of tumour outside the gland.
A completely normal mpMRI can therefore be very reassuring that there is no significant prostate cancer and can help you make the decision if you need a TRUS biopsy or could be followed up with PSA measurements and interval mpMRI scans.
