Healthy Conversation with urologist Paul Verhagen
It is slightly larger than a walnut, lies around the man’s urethra and normally you don’t feel or notice it at all: the prostate. Until you get a bit older, the prostate starts to play up in many men. Urologist Paul Verhagen takes the time to explain how these complaints arise and what can be done about it.
The prostate is a gland that surrounds the urethra in men. This gland produces fluid that mixes with sperm cells during ejaculation to form sperm. In boys, the prostate grows as soon as they reach puberty, under the influence of the male hormone testosterone. But actually, the prostate continues to grow throughout life, and that can cause problems in the long run. This phenomenon is known as benign prostatic hypertrophy (BPH = benign prostatic hypertrophy).
enlarged prostate
As the prostate grows, the urethra gets less and less space. In response, the bladder must contract more and more in order to empty the pee. It is a kind of strength training for the bladder, but it can become overstimulated as a result. The urine stream becomes less strong, you have to go to the toilet more often, you suffer from dripping, or you are less able to hold your urine when urged. It is also possible that the bladder can no longer empty itself properly. For one man, those complaints are something that doesn’t bother him that much. For the other it can lead to problems, for example because you often have to get up at night to urinate and then don’t go back to sleep immediately. Urologist Paul Verhagen: “We can map the complaints with a simple examination. This is first of all a urination test, in which you urinate in a special toilet to measure the strength of the jet and the volume. We also make an ultrasound of the bladder. , to check whether it is emptied properly by urinating. Sometimes men are reassured by the examination, and they decide not to do anything about their complaints. Sometimes the prostate enlargement is treated, for example with medication and sometimes with surgery.”
No indication for prostate cancer
Men are often afraid that their prostate symptoms indicate prostate cancer, but there is no relationship between these complaints and the presence of prostate cancer. “In fact”, Verhagen says: “Usually prostate cancer does not give any complaints and is discovered by chance”. An indicator of prostate cancer is the PSA level in the blood. PSA is Prostate Specific Antigen, a protein that the prostate makes. That protein is only present in the prostate. It ‘leaks’ a little into the bloodstream, but normally the levels in the blood are very low. If the PSA level is elevated, this may be an indication of prostate cancer. Verhagen: “You can therefore detect prostate cancer with the PSA value. There is a lot of discussion about whether or not this should be a standard screening for men. Until now, this has not been the case. On the website prostaatwijzer.nl a doctor can enter data and thus estimate the risk of prostate cancer in a patient.’ You can also take a test on this website to estimate your risk of prostate cancer. Factors include age, ethnicity and family history of prostate cancer. If a father or brother has prostate cancer, the risk of prostate cancer is up to twice as high. The risk of prostate cancer also increases with age. Prostate cancer is more common in men of African ethnicity and dark skin.
watchful waiting
In the case of an elevated PSA value and an increased risk of prostate cancer, additional research is performed to diagnose prostate cancer. Tissue is taken from the prostate with a needle under local anaesthetic to be examined in the laboratory. An MRI scan is also done. If the diagnosis is complete, this does not always mean that the prostate cancer is also treated, says Verhagen: “In the beginning it is often enough to ‘wait and see’: someone remains under intensive monitoring without the need for treatment. The PSA -value is then regularly tested, and doctor and patient keep a record of any complaints.Most forms of prostate cancer grow so slowly that sometimes it is not necessary to treat it for years.In fact, most men die with prostate cancer, but not from prostate cancer: at an advanced age 80 to 90 percent of men have prostate cancer, without causing immediate problems. This is the main reason that screening for prostate cancer is not standard.”
Treatment of prostate cancer
If the tumor grows quickly, or if it causes many complaints, treatment is necessary. “There are now many forms of treatment for prostate cancer,” says Verhagen. “Irradiation is possible, or an operation in which the prostate and seminal vesicles are removed. Every treatment has drawbacks and possible long-term effects, such as incontinence, infertility or impotence. The treatment is therefore always tailor-made.” Prostate cancer can also metastasize, for example to the lymph nodes or the bones. Once the prostate cancer has spread, it is no longer possible to cure. However, it is still possible to treat, for example with hormone therapy. Verhagen: “This inhibits the production of testosterone in the body. The cancer cells depend on testosterone for their growth and will therefore grow less rapidly or even decrease. Unfortunately, we see that effect decreases again after 1 to 3 years. Then – in consultation – other treatments are needed, such as medication or chemotherapy. Each treatment has consequences and side effects. For example, hormone therapy can lead to fatigue, hot flashes, gloomy or emotional moods and loss of libido.”
You can listen to the podcast with Paul Verhagen below.
