A Discussion with Prof Padraig Daly, Consultant Urologist at Aut Even Hospital, about the field the issue prostate health.

Is there a particular age when prostate systems are likely to occur?

Prostate systems can occur at any age.  Obviously, as we get older, men become more aware of symptoms.  Men are typically very bad for presenting to doctors at the best of times, however, the one thing men tend to complain about is urinary systems. So men will actually go to the doctor more frequently than women if they have a urinary issue. If patients feel that they are urinating too frequently or are getting up at night or if they are in any way worried then they should seek medical advice.

Many people will have heard about a PSA Blood Test. What is it and what does a high PSA mean? 

A PSA blood test is a test that is done in males as part of a screening process for prostate cancer.

PSA is a chemical that is released by the prostate gland.  The prostate gland is a part of the male fertility system. So, when you ejaculate, 80% of the fluid actually comes from your prostate gland. In the same way that your salivary glands produce fluid, your prostate glands produce fluid also. So PSA is one of the chemicals that is released.  A certain amount of that leaks into the blood, so it is normal to have PSA in your blood and certain conditions can cause it to rise, such as an underlying inflammation in your prostate gland, for example.

You might have a slightly larger prostate gland than a normal person.  People often ask what does that mean?  Well, it means that some people are 6ft 6″ and some people are 5ft 2″.  Some people have a 20g prostate gland and some people have a 60g prostate gland.  So, if you have a larger prostate gland you will also have a little bit more of the chemical.  The reason we focus on PSA is because if you do have a prostate cancer it can show up as a raise in this blood test.  However, that is only one of the reasons that could cause it [PSA] to be elevated.

Why might someone have blood appearing in their urine?

This is a very complex question, so I will try and shorten the answer. So, there are pre-renal causes (i.e. before the kidney), renal causes (kidney related) and post-renal causes.  As a Urologist, I am specifically interested in the renal and the post-renal causes.

The commonest renal cause, by far, is normally an infection in the kidney, but normally patients have pain with that.  But sometimes you don’t always have pain with an infection and that can cause blood.  The other thing that people often worry about is whether they have kidney cancer and this has to be investigated.

For post renal causes, the commonest reason is due to an infection in the bladder, so something like cystitis and then you can have the second commonest cause which would be stones, followed by be an unusual type of bladder or prostate cancer.  But they would be lower down the list.  It is normally an infection that causes blood in the urine, but obviously if you see blood in your urine, you should seek medical advice immediately.

What investigations are necessary if someone has blood appearing in their urine?

If you have blood in your urine, it is a very standard work up which is internationally recognised.

You come to see the doctor and you get a history and examination, which is very important as that can normally guide the doctor.  Most patients when they have blood in their urine will have to have upper tract imaging to make sure they do not have a lesion in their kidney.  That would either involve an ultrasound or a CT scan.

Sometimes with a CT scan, you may require to get contrast which will involve getting a needle in your arm and an injection.  That allows us to look at the tubes that drain the kidney and then also you would require a camera test which is where I come in as a Urologist.  That can either be done under local anaesthetic or a general anaesthetic.  Also, with that, the Urologist would normally send off some blood tests to make sure that there is not a pre-renal cause that I mentioned previously, such as if your clotting factors are working normally, to make sure you are not anaemic, make sure your platelets are all okay.  Urine will also be sent off to check if there is any infection and also to make sure that there is not an inter-renal cause, such as losing protein, or if there is some sort of an injury to your kidney.

What advice would you give to men when it comes to their prostate health

There are guidelines for what is “normal” but often times what is normal for one person is abnormal for another….. so if you feel [something] is abnormal or if something is beginning to bother you, then you should seek advice.