What is the prostate?

The prostate is a gland found only in men. It is about the size of a walnut, lies just below the bladder and surrounds the tube (urethra) that drains urine from the bladder. Its job is to secrete a milky fluid, which becomes part of the semen and nourishes the sperm.

Common prostate conditions

Prostatitis is inflammation of the prostate gland, which is often caused by urinary tract infection. It usually affects younger men.

Prostatitis usually results from blockage or irritation of some of the ducts within the prostate gland, and the cause may be mechanical or infective. The infective causes may be viral or bacterial (eg, sexually transmitted infections such as Chlamydia) or secondary to a urine infection.

Symptoms of prostatitis may include:

• painful, burning or frequent urination
• weak urine flow or incomplete emptying
• fever and chills
• low back pain.

Examination and treatment

Your doctor may feel your prostate through your rectum (digital rectal examination), to check if your prostate is tender, and take blood or urine samples to test for infection. If you have prostatitis, you may need antibiotic treatment. Take the medication for as long as it is prescribed, to stop the infection recurring.

Benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is a normal, gradual enlargement of the prostate caused by hormonal effects. It usually commences in middle age. BPH does not lead to cancer.

In men with BPH, the prostate gland grows larger with ageing. BPH affects about half of men aged over 60 and 80% of men aged 80 or more. Almost every man over 45 has some prostate enlargement, but symptoms are rarely felt before the age of 60.

If the symptoms mentioned below do occur and you are under 60 then it is important to see your doctor to discuss these symptoms. Many of the symptoms are not specific to just one cause of prostate problem.

Common symptoms of BPH:

• having to wait for the urine stream to start
• poor urinary flow and a variable flow rate
• frequent urination
• difficulty postponing urination (urgency) 
• dribbling of urine at the end of urination
• having to wake at night to pass urine multiple times (nocturia).

If BPH causes no symptoms, it requires no treatment – it only leads to problems if the enlargement narrows the urethra and makes it difficult to pass urine. BPH does not lead to prostate cancer, although prostate cancer can occur in a man with BPH.

If you have burning or pain while urinating, see your doctor right away.

What can I do to relieve the symptoms?

• avoid or cut down on alcohol
• seek individual advice from your doctor.

Difficult urination is annoying but not a significant problem in itself. However, BPH can cause urine back-up in the kidneys, bleeding through the urethra, infections, bladder stones or complete inability to urinate. All of these conditions can lead to serious health problems and they must be treated.

Examination and treatment

If you have any symptoms of BPH, you should see your doctor who will carry out a digital rectal examination to check your prostate for any abnormality. A urine sample may be taken to test for blood, infection or other problems, such as diabetes.

If you have few symptoms, your doctor may decide simply to monitor your condition with regular check-ups. However, if your condition is complicated, medication or surgery may be suggested.

Medications can work by relaxing the muscles around the prostate or blocking the action of the hormone testosterone, shrinking the prostate.

Surgical treatment of BPH often involves removing excess prostate tissue (about 25% of men with BPH will require this).

Prostate cancer

Prostate cancer is a relatively common cancer, especially in older men. It occurs less commonly than BPH, and it is usually slow-growing. There are no symptoms of early prostatic cancer. In older men prostatic cancer is usually slow to develop and enclosed within the prostate gland itself, and thus seldom life-threatening.

When prostate cancer does occur in younger men, both diagnosis and treatment outcomes are improved the earlier it is brought to the doctor's attention.

Prostate cancer may be suspected if a digital rectal examination reveals an abnormal feeling prostate or if a blood test for prostate-specific antigen (PSA) is over a certain level, or both. Because of the nature and development of prostate cancer there is no test that is 100% diagnostic.

Your doctor will probably discuss with you the significance of their concerns and your examination results and arrange further examinations.

Testing

Routine screening for prostate cancer in all men without symptoms is not recommended in New Zealand at present. Experts have been unable to agree that prostate cancer screening helps patients.

The pros and cons of screening tests should be discussed with your doctor to help guide you in deciding if it is the right course of action.

There is debate about whether all men need to be screened for prostate cancer. This debate is because the treatments doctors have to offer may not improve the quality of life for the man, as the cancer is often slow growing.

However, any man over the age of 50 who wants to know should be offered a digital rectal examination and PSA test. If either is abnormal your doctor will refer you to a specialist (urologist) to be considered for a prostate biopsy, in which small samples of the prostate gland are taken for examination.

The aim of these investigations is to find out if you might have early prostate cancer and, if so, whether it needs treatment. The treatment options can then be discussed with you. If the biopsy shows no evidence of cancer you will be advised to attend future check-ups.

Any man who has a close relative with prostate cancer, especially if that relative had cancer diagnosed before the age of 60-65 years, should consider seeing his doctor for the above assessment, but starting from the age of 40 years.

Treatments

Prostate cancer can be treated by surgery, radiotherapy or hormone treatment. The choice of treatment depends on the size, type, growth and spread of the cancer, and on your age, general health, symptoms and personal choice.

Prostate cancer that has not spread can respond well to treatment. Some of the treatments can leave side effects such as incontinence and impotence (you should discuss these with your doctor).

Sometimes, particularly if you are very elderly and the cancer is at an early stage, your doctor may advise against treatment as it may not be of benefit if the cancer is not affecting your quality of life – and it may never do so. You will still need to be examined regularly to check that the cancer is not growing.

Related topics

For more information also see Diagnosing prostate cancer, Treatment of prostate cancer
What does that term mean? See Cancer glossary

Original material supplied by UBM Medica (NZ) Ltd. Reviewed by everybody, February 2005.