In the third part of the Your Health series, Dr Muiris Houston, Medical Correspondent, looks at the scarcity of prostate disease specialists in the Republic.
A recent European survey of men's health services found a worrying lack of awareness - among patients and doctors - of how the symptoms of benign prostate disease affect quality of life.
The study of eight European countries also noted a significant shortage of urologists or prostate disease specialists in the Republic, which suggests that men here could be denied access to the treatments they need.
Benign prostatic hyperplasia (BPH) is the commonest form of prostate disease. As a man gets older, his prostate usually becomes larger. Most of this enlargement takes places after the age of 50. The prostate lies just below the bladder. A tube called the urethra carries urine from the bladder, passing through the prostate as it does so.
It is not the growth itself in the prostate which causes problems, but rather the pressure it puts on the urethral tube. As the prostate enlarges it squeezes the urethra and narrows the opening through which urine flows. This is called urinary obstruction and causes the slowing down of the flow of urine.
Obstruction occurs gradually and so the symptoms of BPH come on slowly. Urine flows with less force, there is a wait before water begins to flow and there may be a feeling of incomplete emptying. While these symptoms may not be too much bother, the bladder has to work harder to overcome the obstruction.
After a while, the muscle of the bladder becomes irritated, leading to more troublesome symptoms: frequency in going to the toilet, the need to pass water at night, and a feeling of urgency (unable to hold on to urine) - all of which have a significant impact on a man's quality of life. Prostate enlargement affects one in three men over 50, and 80 per cent of men over 70. One in five men of working age report a worsening in their working ability due to symptoms of prostate enlargement.
The European survey found that there were only 23 urologists in the State, representing a rate of 3.2 specialists per 100,000 males aged 40 and over. Spain topped the table with a ratio of 19 to 100,000; Slovenia, formerly part of the Yugoslav Federation, has 7.2 per 100,000 males over 40 (see panel).
It is estimated that up to 100,000 men in the State may need surgical treatment for prostate enlargement should they live to the age of 80.
Without additional urologists, it may not be possible to provide this service.
Latest figures show that 1,834 trans-urethral resections of the prostate are carried out here every year, at an approximate cost of €1.6 million. The cost of providing primary care to patients in the State with BPH is estimated at €8 million.
The impact of BPH on employment was considerable, according to the European report.
In Denmark, an estimated 13,000 workdays a year were lost due to benign prostate disease, while it accounted for 0.45 per cent of all early retirements in the State.
The survey found that little international research had been done on the impact of the disease and of its treatment on patients. Only Spain had a national education programme aimed specifically at male illness.
"There is a grey area before BPH symptoms are brought to the attention of doctors, in which men are floundering due to lack of information," said Tom O'Dowd, professor of community health and general practice at Trinity College Dublin.
Here, the Construction Employees' Health Trust runs presentations on leading a healthy lifestyle for male construction workers on selected sites. But experts from Denmark, the Republic, Spain and the UK reported insufficient awareness of prostate enlargement in their countries.
Emphasising the need to raise awareness across Europe, Prof O'Dowd said he would like to see men form an alliance with the women's health movement and to learn from its success.
"We have a largely male Cabinet and a largely male medical profession, both of whom must come out more strongly and actively argue for improved health services for men," he said.