Preventive urology check-up after 40: what it involves and how often

After the age of forty, changes in a man’s body happen quietly: the prostate gradually grows, the blood vessels lose their elasticity, and the most serious urological diseases – cancer of the prostate, kidney and bladder – cause almost no symptoms in their early stages. That is exactly why a preventive urology check-up is most valuable when nothing hurts.

November is men’s health month (Movember) and a good reason to think about when you last saw a urologist. Below, Dr Penev sums up when to start, what the check-up involves and how often to repeat it – without unnecessary worry and without unnecessary tests.

Why screening starts around 40

Benign enlargement of the prostate affects roughly half of men over fifty, and the first changes in the urine stream and getting up at night often appear a decade earlier. The risk of prostate cancer rises with age and is higher in men whose father or brother has had the disease. Small kidney tumours and cysts, meanwhile, are usually found by chance on an ultrasound scan. A preventive check-up picks up these conditions while treatment is at its gentlest and the choice of options is at its widest.

When to start: 45, 50 or earlier

The European Association of Urology (EAU) recommends that early detection of prostate cancer is discussed with well-informed men whose life expectancy is more than ten to fifteen years. Without particular risk factors, the conversation about PSA usually starts at around the age of 50; if your father, brother or son has had prostate cancer – at around 45; with a confirmed inherited mutation (for example BRCA2) – at around 40. These are guidelines: Dr Penev decides individually based on your symptoms, family history and general health, and the first check-up after 40 is often simply the conversation that sets your personal schedule.

What the preventive check-up involves

The check-up with Dr Penev in Plovdiv or Karlovo takes about half an hour and has several steps:

• Conversation – passing urine, getting up at night, erections, past infections, medicines, family history; a short symptom questionnaire allows changes to be tracked over the years.
• Physical examination – feeling the abdomen, the kidney areas and the testicles; the rectal examination of the prostate takes seconds and gives information about its size and texture.
• Ultrasound – ultrasound of the kidneys, bladder and prostate shows stones, cysts, swelling of the kidney, the volume of the prostate and the urine left in the bladder after passing urine.
• Tests – a urine test (hidden blood, protein, infection), creatinine for kidney function, and PSA after first talking about what it can and cannot tell you.

You will find details of what happens during the prostate check on the service page.

How often to have a check-up

How often depends mainly on the results of the first check-up. With a normal ultrasound and a low PSA value, the next check-up can often wait several years; with borderline values, an enlarged prostate, residual urine or a family history, the interval is usually one to two years. After the age of 70 the benefit of prostate cancer screening decreases, and whether to continue is decided individually. A raised PSA on its own does not mean cancer: the value is affected by inflammation, an enlarged prostate, recent ejaculation or cycling, so the test is often repeated after a few weeks, and an MRI scan is usually done before a biopsy.

Lifestyle is part of prevention

Smoking is the leading preventable risk factor for bladder and kidney cancer. Being overweight, high blood pressure and diabetes damage the blood vessels and often show up first as weaker erections – a signal that deserves a check-up, not silence. At least half an hour of exercise a day, enough fluids and moderation with salt and red meat support both the heart and the kidneys. If you have heard conflicting claims about the prostate, read prostate myths and facts.

When not to wait for your check-up

If symptoms appear, do not put things off until the next planned date: blood in the urine (even once and painless), difficult or frequent urination, a lump or change in a testicle, pain in the lower back, weight loss without a reason. Painless blood in the urine is the most common early sign of a bladder tumour and needs an examination within days, not months. If you cannot pass urine, have a high temperature with shivering and pain in the lower back, or sudden severe pain in a testicle, go to an emergency department or call 112 (the European emergency number). You will find the full list in the article on ten symptoms that mean you should see a urologist.

A calm check-up every few years, and more often if needed, is a small investment in decades of health. An initial consultation with Dr Penev is €50 and a follow-up consultation €30. Book an appointment with Dr Penev in Plovdiv or Karlovo and make this Movember the start of a good habit.