Everything you need to know about changes to your prostate

Three men chatting and laughing in the sun

Men don’t like talking about their health and easily get embarrassed. But we need men to talk and be aware of their own health including issues related to their prostate and when they need to see the GP.  Prostate problems are more common than you’d think and being mindful about your prostate’s health can help you identify and seek treatment for problems before they become more serious.

In this article, we will explore the following topics:

  1. What is a prostate, and where is it located?
  2. What does the prostate do?
  3. Signs that something isn’t right
  4. Prostate problems
  5. Enlarged prostate
  6. Prostatitis
  7. Prostate cancer
  8. How to look after your prostate

What is a prostate, and where is it located?

The prostate is a small gland that sits below the bladder and surrounds the urethra and plays a very important role in the male reproductive system.

The prostate, or prostate gland, is approximately the size of a walnut. It can be found in front of the rectum, between the bladder and the penis[i]. This gland is only present in men, and the urethra (the tube that urine flows through) goes through the centre of the prostate.


What does the prostate do?

The prostate has two main functions. The main function being the production of the fluid aspect known as seminal fluid which mixes with the sperm. The seminal fluid helps the sperm to travel and survive. The semen contains an enzyme known as prostate-specific antigen (PSA). PSA is controlled by the male hormone testosterone which is produced by the testis. The second function of the prostate is to control the flow of urine. The muscle fibres of the prostate surround the urethra and are controlled by the involuntary nervous system. These fibres therefore slow or stop the flow of urine.


Signs that something isn’t right

Prostate problems are common and are likely to develop more as a man gets older particularly over the age of 50. Some of the problems may be related to an enlarged prostate, prostatitis (inflamed prostate) or prostate cancer.

Given how vital the health of the prostate gland is, you should take time to familiarise yourself with the warning signs that something may be wrong[ii].  Some of the signs may include:

  • Waking up during the night to pass urine more frequently. To pass urine once or twice during the night is quite normal but any more than this can be annoying and tiring. If this happens you should see your GP
  • Dribbling after you have finished peeing
  • Needing to pass urine more frequently or with urgency
  • Weak flow of urine or straining when your passing urine
  • Feeling like you’re not able to empty your bladder
  • Blood present in your urine or semen.
  • It is painful when you urinate, or you feel a burning sensation.
  • If you have pain when ejaculating or pain in the pelvis, genitals, lower back or buttocks

You should contact your GP if you have any symptoms or concerns.


Prostate problems

Issues with your prostate are common, particularly in older men. As with most health issues, they can be treated more easily if caught at an early stage. Now you’re aware of the general warning signs; we will discuss common prostate problems, their symptoms, causes and treatments.

 

Enlarged Prostate

Enlarged prostate, also known as Benign Prostatic Hyperplasia (BPH), is very common and associated with aging. 1 in 3 men over the age of 50 will have some degree of an enlarged prostate[iii]. The enlarged prostate may present some of the below symptoms:

  • Straining when passing urine
  • A weak flow of urine
  • Feeling like your bladder is never fully empty
  • Dribbling after you have finished peeing
  • Urge to pass urine more frequently or suddenly
  • Struggling to start or stop urinating
  • Waking more frequently to pass urine in the night

 

Causes

The cause of an enlarged prostate as a man ages is unknown, but it is assumed to be linked to hormone changes that naturally occur as part of the ageing process. However, it is not caused by cancer and having an enlarged prostate does not increase the man’s risk of developing prostate cancer.

 

Treatment

Treatment will depend on the severity of the symptoms. However, some minor lifestyle changes may help to improve your symptoms.

Changes to your lifestyle. This is always the first port of call for treating or lessening the symptoms of an enlarged prostate.

  • Reduce intake of caffeine, fizzy drinks, alcohol, and artificial sweeteners as they can irritate the bladder and make symptoms much worse
  • Limit the amount you drink in the evening before going to bed and avoid drinking anything 2 hours before going to bed. However, make sure you drink enough fluids in the daytime
  • Bladder retraining where you train the bladder to hold urine for longer. This is usually a personalised training exercise that would be provided by your GP or specialist nurse
  • Maintain a healthy weight according to your BMI
  • Regular exercise

Medicines.  If lifestyle changes don’t help alleviate symptoms, your doctor may prescribe medication. This could include muscle relaxants, diuretics to speed up urine production during the day, desmopressin to slow it down at night, and inhibitors to shrink the prostate gland[iv].

Incontinence supplies. If your prostate enlargement has triggered urinary incontinence and you

have found yourself leaking urine involuntarily, you should speak to your GP or local bladder and bowel service. Male incontinence products such as absorbent pads and pouches may help to manage your symptoms and offer security and protection to help you go about your day.

Surgery. This option will be explored if none of the above treatments have helped to improve your symptoms. There are several types of surgery, and your doctor will decide which is best for you.


Prostatitis

Prostatitis is where the prostate gland becomes inflamed and is usually very painful and worrying but treatable. Symptoms of prostatitis can affect any age, but the most common age is between 30 and 50 years old.

There are two forms of prostatitis:

  • Chronic prostatitis – symptoms come and go. This is the most common type of prostatitis
  • Acute prostatitis – sudden onset of severe symptoms. This can be life threatening and requires immediate treatment

Symptoms

Contact your GP if you are worried or concerned you have prostatitis.

 

Chronic Prostatitis

Chronic symptoms are on and off for several months.

  • Pain whilst passing urine or needing to pass urine more frequently, especially at night time, and the inability to maintain a constant ‘flow’ of urine
  • Pain in/around the testicles, anus, penis, lower back and abdomen
  • Erectile dysfunction, pelvic pain after sex
  • A swollen, tender prostate on rectal examination

 

Acute Prostatitis

Acute symptoms are sudden and severe but will improve with the right treatment.

  • Pain whilst passing urine or needing to pass urine more frequently, especially at night time, and the inability to maintain a constant ‘flow’ of urine
  • Blood in your urine
  • Pain which may be severe in/around the testicles, anus, penis, lower back and lower abdomen. It may also be painful when opening bowels
  • Inability to pass urine (retention of urine)
  • Feeling generally unwell which may include a high temperature and aches and pains
  • Pain when ejaculating and lower back pain

 

Causes

Similarly to prostate enlargement, the exact cause of prostatitis is unknown. However, certain factors can increase your risk of developing chronic or acute prostatitis such as[v]: –

  • Nerve damage in the pelvic area
  • Recent UTI (Urinary Tract Infection)
  • Urinary catheter
  • Sexually transmitted infection
  • HIV & AIDS

 

Treatment

Acute prostatitis can usually be treated with a 2-4 week course of antibiotics and painkillers, but if the pain is more severe and you are unable to pass urine, you may need hospital treatment.

Chronic prostatitis can last for months, so treatment is focused on controlling symptoms. Treatment involves painkillers, antibiotics, alpha-blockers if you are having trouble passing urine or laxatives if it is painful when having your bowels open.

 


Prostate Cancer

Prostate cancer is the most common cancer amongst men in the UK, with 48,487 new prostate cancer cases reported from 2015-2017[vi].

 

Symptoms

The tricky part about identifying prostate cancer in its early stages it that symptoms generally don’t present until the prostate is enlarged enough to affect the urethra’s functionality. At this stage, affected men may notice: –

  • Straining whilst passing urine
  • Feeling that the bladder is never fully emptied
  • The need to pass urine more frequently
  • Blood in urine or semen
  • Sudden erectile dysfunction

These symptoms of prostate cancer can be difficult to distinguish to those symptoms similar to  prostatitis and prostate enlargement so it is always important to see your GP if you develop any symptoms.

 

Who is at risk?

Every man is at risk of prostate cancer, but some groups are at a higher risk of developing prostate cancer.

  1. There is an increased risk of developing prostate cancer if there is a family history of prostate cancer. Having a close relative such as father or brother who developed prostate cancer under the age of 60 increases the risk significantly. There is also an associated risk if a close female relative has a history of breast cancer
  2. Men of African-Caribbean and African ethnicity are at high risk of prostate cancer. Reasons for this are unknown, but it’s likely to be genetics
  3. The risk of developing prostate cancer increases with age especially men over the age of 50 although the most common age for diagnosis is between the ages of 65 – 69 years

 

How do they test for prostate cancer?

The method of testing for prostate cancer is called ‘screening’. During a screening, a GP or other health professional will complete a series of necessary tests and checks, including taking a urine sample, a blood sample to check levels of prostate-specific antigens (PSA test), and a digital rectal examination to examine your prostate .[vii]

 

Treatment

Cancer survival rates have tripled in the last 40 years in the UK because of PSA testing and being able to catch prostate cancer early enough for effective treatment.

Cancer treatment options vary dependant on the stage of the cancer, the size of the cancer, any other underlying health problems you may have and whether the cancer has spread to other parts of the body. The aim is to cure or control the disease.

Upon diagnosis, you will be assigned a cancer care team who will help to decide the best treatment options for you. Some of the options are listed below but if you would like more information on treatments available for prostate cancer please follow the link to [viii]Treatments | Prostate Cancer UK.

  • Watchful waiting and active surveillance
  • Surgical removal (radical prostatectomy)
  • Radiotherapy
  • Hormone therapy
  • Chemotherapy
  • Steroids

 


How to look after your prostate

Although there are no real preventative measures for issues and changes to your prostate, there are lifestyle changes you can make to help keep your body as healthy as possible.

 

Diet

Your diet has a huge impact on how your body functions. To keep your body and prostate in good health, you should:

  • Eat 5 portions of fruit and vegetables a day
  • Limit your intake of red meat and dairy
  • Have a good fluid intake
  • Avoid fluids that irritate the bladder
  • Cut down your sodium intake. See NHS advice for a lower salt diet here
  • Eat foods with healthy oils and fats like nuts, avocados and fatty fish
  • Drink green tea

Exercise

Exercising and staying active reduces your risk of developing health problems. Taking at least half an hour of exercise each day will get your blood pumping and help to try and maintain a healthy weight.

 


References

Cancer Research UK, 2021. Prostate cancer statistics. [Online] Available at: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/prostate-cancer
[Accessed February 2021].

Diagnosis, 2021. https://www.nhs.uk/conditions/prostate-cancer/diagnosis/. [Online] Available at: 2021
[Accessed February 2021].

Harvard Health Publishing, n.d. An enlarged prostate gland and incontinence. [Online] Available at: https://www.health.harvard.edu/mens-health/an-enlarged-prostate-gland-and-incontinence
[Accessed February 2021].

Hoffman, M., 2014. Picture of the Prostate. [Online] Available at: https://www.webmd.com/men/picture-of-the-prostate
[Accessed February 2021].

Knott, L. & Huins, H., 2015. Prostatitis. [Online] Available at: https://patient.info/doctor/prostatitis
[Accessed February 2021].

NHS, 2021. Treatment. [Online] Available at: https://www.nhs.uk/conditions/prostate-enlargement/treatment/
[Accessed February 2021].

NHS, 2021. Treatment. [Online] Available at: https://www.nhs.uk/conditions/prostate-cancer/treatment/
[Accessed 2021].

NHS, n.d. Prostate problems. [Online] Available at: https://www.nhs.uk/conditions/prostate-problems/
[Accessed February 2021].

NIH NIDDK, 2014. Prostatitis: Inflammation of the Prostate. [Online] Available at: https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostatitis-inflammation-prostate
[Accessed February 2021].

NIH/National Institute on Aging , 2011. Watch for Warning Signs of Prostate Problems. [Online] Available at: https://www.nextavenue.org/watch-warning-signs-prostate-problems/
[Accessed February 2021].

Prostate Cancer UK, n.d. How is an enlarged prostate treated?. [Online] Available at: https://prostatecanceruk.org/prostate-information/further-help/enlarged-prostate/enlarged-prostate-treatment
[Accessed February 2021].

 

Sources

[i] https://www.webmd.com/men/picture-of-the-prostate

[ii] https://www.nextavenue.org/watch-warning-signs-prostate-problems/

[iii] https://www.nhs.uk/conditions/prostate-problems/

[iv] https://www.nhs.uk/conditions/prostate-enlargement/treatment/

[v] https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostatitis-inflammation-prostate

[vi] https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/prostate-cancer

[vii] https://www.nhs.uk/conditions/prostate-cancer/diagnosis/

[viii] https://www.nhs.uk/conditions/prostate-cancer/treatment/

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