Talking to Your Doctor

Working with your doctor

BPH is very common and one in four men over the age of 40 will suffer from it as they get older.¹ If you‘re experiencing urinary symptoms, your doctor will be happy to offer advice and a range of options.

Treatment might simply involve “watchful waiting”, where you have regular check-ups to make sure the problem isn't getting any worse. There are also medicines and procedures available both over the counter and on prescription to relieve symptoms and help you regain control of your life.

Alpha–blocker drugs are one of the drugs of first choice to treat BPH ²¹ because they work for 60–90% of men and help improve urine flow quickly. ¹⁰. They can provide effective symptomatic relief from within one week of treatment ¹¹ and are available with and without a prescription. Alternatively, 5–alpha reductase inhibitors can reduce prostate growth, but improvement takes three to six months. ⁹

The most common surgical operation for BPH is transurethral resection of the prostate (TURP), where the excess prostate tissue is removed from the urethra. This is usually very successful at improving urine flow but requires general anaesthetic.¹³

If left untreated BPH symptoms often deteriorate and increasingly impact quality of life. Worse still, BPH can lead to urinary tract infections; chronic urinary retention leading to kidney damage, and there is even the possibility of acute urinary retention where a catheter is required to empty the bladder. ^10,15

Tips for talking to your doctor

There is no single test to diagnose BPH so you should discuss your symptoms in detail with your doctor and you may also need a physical examination.

Symptoms of common lower urinary tract symptoms (LUTS) include: ⁴

• Poor stream - The flow of urine is weaker, and it takes longer to empty your bladder
• Hesitancy - You may have to wait at the toilet for a while before urine starts to flow
• Dribbling - Towards the end of passing urine, the flow becomes a slow dribble
• Poor emptying - You may have a feeling of not quite emptying your bladder
• Frequency (passing urine more often than normal). This can be most irritating if it happens at night. Getting up several times a night is a common symptom and is called ‘nocturia’.
• Urgency. This means you have to get to the toilet quickly when you ‘need to go’.

While BPH is the most common cause of these symptoms in men over the age of 40, other conditions can also cause them. The more information you can provide to your doctor, the easier it will be to make a correct diagnosis and offer the best treatment for your particular needs. As an aide memoir, try to remember MAPS:

• Medications: have a complete list of all medications that you take. That should include prescription items, over-the-counter products, alternative therapies and herbal remedies.
• Allergies: provide a full list of everything that you're allergic to.
• Personal: don't be embarrassed to disclose personal information. BPH is very common and its symptoms will come as no surprise to your doctor.
• Share: be prepared to discuss your family medical history.

What will happen if I tell my doctor I think I have BPH?

There is no single test to diagnose BPH. Your doctor will want to rule out other conditions that can cause similar symptoms, by listening to you talk about your symptoms and doing a physical examination.

He or she might go through the International Prostate Symptom Score (IPSS) with you to find out how severe your symptoms are. LUTS can be graded as mild, moderate, or severe. The IPSS also indicates how much your life is being disrupted by the symptoms and may help you decide on treatment. You can find out how effective a treatment has been by comparing your IPSS scores before and after treatment has begun.

Your doctor will probably want to do some tests to exclude other conditions. These may include:

Urinalysis - i.e. analysis of your urine. The doctor will look for blood, which can be a sign of bladder cancer or an infection, and glucose, which might mean you have diabetes. If an infection is causing your symptoms, there may be white blood cells (leucocytes) and nitrites in your urine.⁹

Blood test - You may also have a blood test to check your kidneys are working properly. This test measures the level of a substance called creatinine. Well-functioning kidneys keep the levels of creatinine below a certain point; raised creatinine in the blood can be a sign of kidney problems, which can cause urine retention (an enlarged, full bladder).⁹

Digital Rectal Examination (DRE) - Your doctor may check the size, shape and consistency of the prostate by doing a DRE. This involves inserting a gloved finger into your rectum (back passage). Whilst this might be uncomfortable, and you might feel a bit embarrassed, it won't hurt. Try to relax, and remember your doctor has probably done this many times before. ⁹

PSA testing - Your doctor might want to measure the level of a hormone called PSA to check for prostate cancer. PSA stands for prostate specific antigen'. It's a type of protein produced by the prostate, and is found in the cells of the prostate. If the prostate is damaged, more PSA leaks into the blood. So raised levels of PSA in the blood could mean prostate cancer. But PSA also increases with age and other prostate conditions, including BPH, prostatitis and even after a fall or vigorous exercise. So it is not possible to diagnose prostate cancer or BPH just by testing PSA. It is possible to have a normal PSA level and still have prostate cancer; it's also possible that you don't have cancer if your PSA is raised.⁹ The only way to find out is to have a biopsy. However, a PSA test can provide useful information, particularly if you have regular tests so your doctor can see if the PSA level is rising.¹⁰

Other tests

If you have raised PSA and your doctor can feel a lump in your prostate, or if you're thinking about having prostate surgery, he or she might refer you to a specialist for further tests. These can include:

• Prostate biopsy - where a few samples (usually 6-12) of prostate tissue are taken for analysis in a laboratory. The biopsy is done via your back passage (rectum). There is some risk of bleeding or infection afterwards.⁴¹
  • Cystoscopy - where the doctor uses a small camera on the end of a flexible or rigid tube to see the inside of your urethra and bladder. The tube is passed up through the urethra (the tube that carries urine out through the penis).
  • Ultrasound scan - where a probe is inserted into your rectum to allow the doctor to see images of your prostate on a screen.
  • Urine flow testing - where the speed of the urine flow, the amount of urine left in your bladder after you pee and other detailed measurements are taken.