A lot of us men don’t know everything there is to know about our bodies. This is especially true when it comes to the prostate. Most of us don’t know what the prostate does and about half of us don’t know where it is. It’s also been shown that 1 in 5 men don’t know they even have a prostate1!
The prostate is an organ in the body that sits at the base of the bladder and surrounds the urethra (the tube that takes urine from the bladder through the penis). The purpose of the prostate is to produce fluid that protects and supports sperm.
Diseases of the prostate include prostate enlargement (often referred to as benign prostatic hyperplasia or BPH), prostatitis (inflammation, a response to infection or damage, of the prostate) and prostate cancer, which is the second-most common cancer-related cause of death in Australian men (second only to lung cancer).
In childhood, the prostate is small. As boys enter puberty and their testosterone levels increase, the prostate begins to increase in size. By the end of puberty, it weighs about 20 grams. The prostate doubles in size between 20 and 50 years of age, and doubles in size again by age 80.
In some men, the prostate seems to grow more quickly than in others, resulting in enlargement.
Prostate enlargement, or BPH, is a normal part of aging for some men. It affects about 8% of men in their 30s, 25% of men in their 50s, 33% in their 60s, and about 50% of men over 802. Because prostate enlargement places pressure on the urethra, it usually causes trouble with urination. Men with BPH can feel the need to urinate more often or with more urgency than usual, and more frequently — this is especially noticeable during the night. BPH can also cause a weak urine stream and the inability to completely empty the bladder.
The urinary symptoms of prostate enlargement can also include pain caused by buildup of urine in the bladder because of problems with emptying the bladder, urinary tract infection and bladder stones. Each of these causes requires its own diagnosis. Kidney function can also decline to the point of failure, as a result of the buildup of urine. These serious symptoms of prostate enlargement mean that men should seek medical advice if they have problems urinating.
BPH is not life-threatening. Treatment options vary for BPH depending on severity and how much it affects daily life. Men with mild symptoms may opt for no treatment, to avoid possible side effects that might have a greater impact than the condition itself.
Medications can reduce the size of the prostate in men with mild or moderate BPH but these may not relieve all symptoms. A variety of surgical options are available for moderate or severe prostate enlargement, each with its own benefits and side effects.
Discomfort or pain in and around the prostate may be caused by inflammation of the prostate (prostatitis).
Usually, prostatitis is cause by a bacterial infection that is easy to diagnose and treat but if it’s not dealt with quickly, bacterial prostatitis can be life-threatening. Recurring bacterial prostatitis can be caused by some underlying prostate problem, such as BPH or repeated urinary tract infections.
In some cases, the prostate can be inflamed without bacterial infection. The cause of this type of prostatitis is unknown. It may come and go, and worsen with stress.
Bacterial prostatitis can be treated with antibiotics. Medicine to relax the muscle in the upper part of the urethra (where the prostate surrounds it) can be effective for relieving the pain of prostatitis. Prostate massage and pelvic floor exercises may also help relieve the pain of prostatitis. Surgery is an option for removing sources of infection that contribute to prostatitis.
The pain of prostatitis, and uncertainty about whether it will go away, can lead to a sense of hopelessness and depression. Prostatitis can reduce libido (sex drive) and fertility can decrease because production of prostate fluid, which protects and supports sperm, can be reduced and/or sperm may be damaged by bacteria. Experts are undecided about whether prostatitis leads to prostate cancer.
Prostate enlargement and prostatitis are not signs of prostate cancer, which is the growth of abnormal prostate cells. The exact causes of prostate cancer are unknown but the main contributing factors are age and genetics.
Prostate cancer is most commonly diagnosed in men aged over 50 years. About two thirds of cases in Australia are diagnosed in men over 65, and one in five Australian men aged 85 or over has prostate cancer.
Prostate cancer may be localised (no abnormal cells outside the prostate) or advanced. The stage of prostate cancer depends on if abnormal cells have moved into the tissues and organs around the prostate, or further into the body (e.g. in the lymph nodes or bones).
Some prostate cancers detected in the early stage grow slowly, so may never pose a risk to the health or lifespan of many men. Ninety-five percent of men who are diagnosed with prostate cancer are still alive 5 years later3. The eventual cause of death for most men with prostate cancer is something completely unrelated, like cardiovascular disease or accidents.
Localised prostate cancer can have no symptoms in some men. Others may have urinary problems like men with BPH. Men with advanced prostate cancer may have blood in their urine, and can have pain in their lower back, pelvis and thighs.
There is no simple test for prostate cancer. A blood test for prostate specific antigen (PSA) (a substance made by normal and abnormal prostate cells) can be used and a digital rectal examination (DRE) can be performed to identify abnormal prostate size, shape or texture. Results of these tests help indicate the risk of prostate cancer but these tests alone are not enough for diagnosis.
A prostate biopsy (collection of samples of prostate tissue) is required for cancer diagnosis but this procedure is not perfect at detecting cancer and has its own risks. Prostate biopsy can result in bleeding (resulting in blood in urine and/or semen), infections, and temporary (lasting up to 6 months) problems with urination or erections.
Based on the biopsy examination, prostate cancers are classified in terms of their grade (an indication of how quickly the cancer may grow). Medical imaging (like an MRI, x-ray or ultrasound) is also required to assess cancer stage (i.e. localised or advanced).
In some cases, biopsy can detect prostate cancers that would never actually cause harm. The detection of low grade, low stage prostate cancers presents a challenge as prostate cancer treatments (surgery, radiation therapy, chemotherapy or hormone reduction) have side effects and risks that may be worse than the consequences of the cancer itself. Surgery and radiotherapy can result in erectile dysfunction and urinary incontinence; radiotherapy can result in bowel problems as well, and (at least temporary) infertility. This means that the effects of treatment of prostate cancer could be worse for some men than the cancer itself. Men, in consultation with their healthcare providers, need to decide on a course of management that suits them.
‘Active surveillance’ of prostate cancer may be preferable to treatment for men with low grade cancers, for whom prostate cancer may never have a physical impact on their lives. ‘Active surveillance’ involves regular PSA blood tests, examinations, scans and repeated biopsy procedures. ‘Watchful waiting’ might be suggested to some men, which involves fewer tests than active surveillance. These approaches to managing prostate cancer can avoid the complications of treatment but may have a psychological impact for those men, who live knowing they have the disease.
Although your genetics play a large part in the development of prostate disease, keeping on top of your health, and seeing your doctor when something doesn’t seem right, is the most important thing you can do for your health.
1 The development of human benign prostatic hyperplasia with age. Journal of Urology 1984
2 Benign prostatic hyperplasia: review of modern minimally invasive surgical treatments. Seminars in interventional radiology 2016
3 Prostate Cancer. Cancer Council Australia 18 May 2020 (retrieved from cancer.org.au)
Read more about prostate health in the July 2020 issue of The Male.