The prostate is a walnut-sized gland located below the bladder and in front of the rectum in men. It produces fluid that makes up part of semen. Prostate problems become increasingly common with age, and understanding them helps with early detection and effective management.
Common Prostate Conditions
Benign Prostatic Hyperplasia (BPH)
An enlargement of the prostate gland that is not cancer. It is extremely common:
- Affects about 50% of men in their 50s and up to 90% of men over 80
- The enlarged prostate presses on the urethra, causing urinary symptoms
Symptoms (Lower Urinary Tract Symptoms - LUTS):
- Difficulty starting urination (hesitancy)
- Weak or intermittent urine stream
- Needing to urinate frequently, especially at night (nocturia)
- Urgency (sudden strong urge to urinate)
- Feeling that the bladder is not fully empty
- Dribbling after urination
Prostatitis
Inflammation of the prostate, which can be acute (sudden, bacterial) or chronic:
- Pain in the pelvis, groin, or lower back
- Pain during urination or ejaculation
- Urinary frequency and urgency
- Fever and feeling unwell (acute bacterial prostatitis - a medical emergency)
Prostate Cancer
The most common cancer in men in many countries:
- Often grows slowly and may not cause symptoms for years
- When symptoms do occur, they may resemble BPH symptoms
- Risk increases with age (most commonly diagnosed after 50)
- Family history significantly increases risk (father or brother with prostate cancer)
- More common and often more aggressive in men of African descent
Prostate Cancer Screening: The PSA Test
PSA (Prostate-Specific Antigen) is a protein produced by the prostate. A blood test can measure PSA levels, but it is not a definitive test for cancer:
What PSA tells us:
- Elevated PSA can indicate prostate cancer
- But PSA is also raised by BPH, prostatitis, urinary infections, and vigorous exercise
According to NICE guideline NG131 (Prostate cancer), men should be informed that:
- PSA testing is not a perfect screening tool
- A raised PSA does not necessarily mean cancer (many men with elevated PSA do not have cancer)
- A normal PSA does not guarantee the absence of cancer
- If PSA is raised, further investigation (MRI, biopsy) may be needed
The decision to have a PSA test should be an informed choice made after discussion with your doctor.
Diagnosis
For BPH
- Symptom assessment using the International Prostate Symptom Score (IPSS)
- Digital rectal examination (DRE)
- Urine flow test
- PSA blood test (to help rule out cancer)
- Ultrasound if needed
For Prostate Cancer
- PSA blood test
- MRI scan of the prostate
- Prostate biopsy (if MRI is suspicious)
- Gleason score: grades the aggressiveness of the cancer
Treatment
BPH Treatment (NICE CG97)
Mild symptoms:
- Lifestyle changes: reduce caffeine and alcohol (especially in the evening), avoid large amounts of fluid before bed, double voiding (urinate, wait, and try again)
- Watchful waiting with annual review
Moderate to severe symptoms:
- Alpha-blockers (tamsulosin, alfuzosin): Relax the prostate muscles to improve urine flow
- 5-alpha reductase inhibitors (finasteride, dutasteride): Shrink the prostate over several months
- Combination therapy for larger prostates
Surgery: When medication is insufficient:
- TURP (transurethral resection of the prostate): The standard surgical option
- Laser procedures: Newer alternatives with fewer side effects
- Other minimally invasive options
Prostate Cancer Treatment
Depends on the stage, grade, overall health, and patient preference:
- Active surveillance: For low-risk, slow-growing cancers - regular monitoring with PSA tests, MRI, and biopsies
- Surgery (radical prostatectomy): Removal of the prostate
- Radiotherapy: External beam or brachytherapy
- Hormone therapy: Reduces testosterone to slow cancer growth
- Chemotherapy: For advanced disease
When to See a Doctor
See your doctor if you experience:
- Any urinary symptoms that concern you or affect your daily life
- Blood in the urine or semen
- Difficulty urinating or complete inability to urinate (urinary retention - seek urgent care)
- Persistent pain in the pelvis, back, or hips
- If you are over 50 (or over 45 with a family history) and want to discuss prostate cancer screening
This article is for informational purposes only and does not replace professional medical advice. Always consult your doctor for personalised guidance.