Men's Health

What are the signs of prostate issues?

About 1 in 8 men will be diagnosed with prostate cancer during their lifetime, so chances are that you know someone who has been affected. And many men can be affected by other prostate problems too. So how do you know if there is an issue with your prostate?

Firstly, what is the prostate?
The prostate is a small gland that helps make semen. It is located just below the bladder and is wrapped around the tube that transports urine and semen out of the body (1). In young men, the prostate is about the size of a walnut, and as men get older, their prostate tends to get larger (2). If it gets too large, it can cause problems. The enlargement of the prostate may be due to cancerous growths or other non-cancer problems (1).

What are the typical symptoms of an enlarged prostate?

  • Frequent need to urinate
  • Blood in urine or semen
  • Painful urination
  • Painful ejaculation
  • Pain or stiffness in lower back, hips, pelvic or rectal area, or upper thighs
  • Dribbling of urine

What are the possible causes of an enlarged prostate?
An enlarged prostate can be caused by prostate cancer or other common non-cancer problems. First, we will discuss the less serious, non-cancer-related issues.

Benign prostatic hyperplasia (BPH) refers to an enlarged prostate, but it is not due to cancerous growths. Medications, surgery, or laser treatment may be required to help treat urinary problems associated with BPH (1).

Acute bacterial prostatitis occurs due to a bacterial infection, with symptoms appearing suddenly and often accompanied by fever or chills. Antibiotics are generally an effective treatment and other medications may also be required to help with pain (1).

Chronic bacterial prostatitis is also caused by a bacterial infection, but in this case, the infection comes back again and again. Sometimes long-term antibiotics are an effective treatment option (1).

Chronic prostatitis is also known as chronic pelvic pain syndrome and is a common prostate issue. Treatment options may include medication, surgery, and lifestyle changes (1).

Each of these issues can cause a lot of pain and discomfort, but the most serious prostate problem is of course prostate cancer. It is common in American men, with higher rates in African Americans, followed by Hispanic and Native Americans. Other risk factors for prostate cancer include being over 50 years, having a family history of prostate cancer, and following a high-fat diet (1).

How is prostate cancer diagnosed?
Routine screening is the best way to detect prostate cancer, as often early prostate cancer (when it is easier to treat) doesn’t cause any symptoms (2).

Screening for prostate cancer may include a prostate specific antigen (PSA) test, such as the one offered here. Elevated PSA can be indicative of prostate cancer, but may also occur due to benign (non-cancerous) conditions. More info about PSA is available here.

Another screening option is a digital rectal examination (DRE) when a health care provider inserts a gloved, lubricated finger into the rectum to feel the prostate. However, this is not recommended as an initial screening method by the US Preventive Services Task Force (3).

If the PSA test and/or DRE are indicating prostate abnormalities, additional diagnostic tests can be conducted, including an ultrasound and a prostate biopsy. The biopsy involves the removal of prostate tissue for examination under a microscope to detect cancer cells (4).

How is prostate cancer treated?
Treatment options for prostate cancer vary depending on the cancer stage and if it has spread elsewhere in the body. If it is determined that the cancer is unlikely to grow quickly and there are no symptoms, no treatment may occur. Instead, the affected person is closely monitored with more frequent PSA tests and prostate biopsies (5).

Other treatment options include surgery to remove the prostate (as well as surrounding tissues if necessary) and radiation therapy to kill the cancer cells. There are also several treatment options currently undergoing investigation, including cryotherapy, chemotherapy, high-intensity focused ultrasound, and hormone therapy (5).

References:
1. Prostate Problems, National Institute on Aging, NIH. Reviewed July 2020.
2. What is Prostate Cancer? American Cancer Society. Revised August 2019.
3. What is screening for prostate cancer? CDC. Reviewed August 2021.
4. How is prostate cancer diagnosed? CDC. Reviewed August 2021.
5. How is prostate cancer treated? CDC. Reviewed August 2021.