Mr Christian Brown, Consultant Urologist at The Prostate Centre and at The Princess Grace Hospital, takes us through his interest in urology and tells us all about benign prostate enlargement, from symptoms to treatment.

What made you interested in medicine and urology?

I was attracted by the science in medicine, by the patient interaction and putting it all together. And then I found my way into urology because of great opportunities with mentorships when I was a junior surgeon. I found the job quite stimulating, the work with our patients and the types of surgeries I did.  
I joined HCA UK as an independent urologist in 2011. When I was first appointed as a consultant, I was working at London Bridge Hospital before HCA UK at The Shard was built, so that was quite a while ago.  

What are the most common conditions that patients generally come to you for?

I specialise in prostate conditions, so many patients come to me because they have symptoms of an enlarged prostate.  
I also see men who may not have any symptoms but have a raised PSA, which is a blood test done by GPs to screen for prostate cancer. A raised PSA can be an early warning sign of prostate cancer, so we can do more tests to investigate this and diagnose the cause. It’s not always cancer, but it’s important to rule it out. 
I spend a lot of my time talking to men about their risks of prostate cancer - this is really important even if a patient isn’t currently experiencing any symptoms, because catching prostate cancer early makes it very treatable and, in most cases, curable. Prostate cancer can run in families due to this genetic link, so I always discuss family history with patients. If they have a very strong family history, I will discuss this risk with them and how they should be monitored. 

What are the symptoms of prostate enlargement?

Some common symptoms of an enlarged prostate include: 

  • Getting up at night to pass urine 
  • Passing urine more frequently during the day 
  • Passing urine with a weak stream or dribbly flow 
  • Infections
  • Blood in the urine
  • Pain passing urine 
  • Sexual dysfunction

All of the above can be symptoms of an enlarged prostate and some men may get it as early as 50.

While many prostate symptoms lead to a diagnosis of a benign (non-cancerous) condition, these symptoms can also be a sign of prostate cancer, so it’s important to have them investigated. Most prostate cancers that are caught early are curable, so it’s important not to ignore any symptoms.

How common is benign prostate enlargement?

It's very common, so when I see men with urinary symptoms, typically that's from benign enlargement of the prostate. And sometimes that can cause really extreme problems, like not being able to pass urine at all. These men are managed with operations in order to widen the prostate channel so they can pass urine again. 

Does having benign prostate enlargement increase the risk of cancer?

Not at all. It's a common myth that if you have an enlarged prostate, you're at an increased risk of having prostate cancer, but that's not true.  
Most men will get a benign enlargement of their prostate at some point in their life, and it may or may not cause symptoms, but only about one in eight men will get prostate cancer at some point in their life. The two can coexist, but one doesn't lead on to the other.  

What is the treatment for an enlarged prostate?

The treatment of a benign enlarged prostate really depends on the level of symptoms.  
Sometimes we don't need to treat it at all, we can just monitor them and change the patient's lifestyle choices. For example, having a lot of tea and coffee can sometimes make bladder and prostate symptoms worse, as can certain medications. I also recommend my patients reduce their intake of caffeine and alcohol as that can reduce the symptoms. 
Apart from lifestyle choices, we would also prescribe medication specifically designed to combat this issue. There are several medications on the market now which can really be beneficial to men with the symptoms of a benign, enlarged prostate, and quite often, these medications help us prevent surgery. 
However, if the medication doesn’t help the issue, or if they can't pass urine at all without a tube or catheter, then we would offer them surgery. Surgery is very effective for benign enlargement of the prostate and the purpose of it is to increase the size of the prostatic urethra or tube that runs through the middle of the prostate. If you widen the channel, then men can then pass urine easily and feel much better afterwards.  

What happens during surgery?

For benign prostate enlargement we do something called trans-urethra surgeries, which basically mean keyhole surgery, but through the male penis. We would insert cameras with telescopes through the natural hole of the penis and then use lasers to widen the channel through the enlarged prostate. For this condition, we only remove the inner part of the prostate. If a patient had prostate cancer, then we would recommend a complete removal of the prostate, which is called a prostatectomy. 
So far, in total, I've done over 1,000 surgeries, so I do anywhere from 2-5 prostatectomies a week across my NHS and private practice.  

Is blood in the urine always something to worry about?

Blood in the urine is a red flag symptom and all red flag symptoms need to be investigated. Not all red flag symptoms end up with a diagnosis of cancer, but some will, so it's very important that blood in the urine is not ignored. It might be something different, like a urinary tract infection or a kidney stone, but there's also a chance it could be bladder cancer, kidney cancer, or prostate cancer. And for those reasons, we would encourage any man or woman that saw blood in their urine to seek a referral.  

Has the way you've been doing consultations changed since COVID-19?

I've been doing a mixture of online and in-person consultations. 
I think for some patients, online consultations work really well and it allows us to continue to see international patients. Some of our patients were unable to come to London for an assessment so we've been reviewing them with video conferencing, which works well. It's also very handy for initial consultations. 
However, I also feel it is important to give people the option of coming to see me in person. Sometimes having a face-to-face consultation can feel more personal. 

What is special about The Prostate Centre?

The Prostate Centre really is one of a kind. It's a group of urologists and uro-oncologists and we work together as a team in a multidisciplinary way. What makes this really special is the expert team we have built around each patient and our sole focus on prostate health.  
At our weekly MDT meetings, we are able to discuss individual patients, their diagnosis, and a proposed treatment plan. This means each patient has the expertise of a whole team behind them. We have nurse specialists, psychosexual therapists, in-house radiologists and pathologists who report our diagnostics, as well as the group of specialists delivering the treatments. We take a holistic view, considering both the medical needs and the long-term wellbeing of our patients. We work very closely together as a team and I think that's what makes us so special.  
Through HCA Healthcare UK we’re able to see patients at a number of locations across London, including 18 Devonshire Street, at the diagnostic centre, HCA UK at The Shard, as well as through virtual consultations. This makes it quick and convenient for patients to be seen by a specialist. 
Lastly, I would say, if anyone is worried about prostate symptoms, don’t delay in seeking medical advice. If you’re feeling embarrassed, please remember that we see these symptoms all the time and prostate enlargement is very common. Come and see us at The Prostate Centre and we can help you with your prostate health.   
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