10-minute consultation: Prostatic symptoms.

x Discuss the cause of his symptoms. Show him a picture of where the prostate is and how it causes problems. He may be worried about cancer, so explain that usually the prostate simply enlarges but that in a small minority the symptoms are due to cancer. About 1 in 14 men will develop prostate cancer at some point in their life. x Discuss plans for initial investigation, including the prostate specific antigen test. Tell him that if the test result is high then further tests will be needed, although cancer is not the only reason for an abnormal result. x Explain the three main options if the test results are normal: (a) try to reduce symptoms by managing fluid intake and avoiding caffeine; (b) use medication, which often helps but sometimes has side effects (most people start by using an á blocker, which is likely to improve symptoms such as frequency, urgency, and poor stream—it works quickly, but there is no evidence that it reduces long term complications—but finasteride is an alternative drug that takes up to six months to work); (c) consider surgery, which is usually very effective but occasionally leads to complications (surgery is usually reserved for those with severe symptoms and for those in whom medication has not worked).