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Prostate problems


Expert reviewer, Dr Adrian Raby, General Practitioner and Clinical Lecturer
Next review due June 2022

Your prostate gland is about the size of a walnut and lies underneath your bladder. It surrounds part of your urethra – the tube that you pass urine and semen through.

The risk of prostate problems increases with age. These problems are very common – around one in three men has symptoms at some time.

An image showing the position of the prostate gland and surrounding structures

What does the prostate gland do?

The way your prostate gland works and grows depends on the male sex hormone, testosterone. Your prostate gland plays an important role in reproduction. Its main job is to produce the fluid part of semen which nourishes the sperm. It also produces a protein called prostate specific antigen (PSA), which is involved in turning your semen into liquid.

As you get older, the prostate gland tends to get larger, which increases the risk of it causing problems.

Symptoms of prostate problems

Your prostate surrounds your urethra – this means that problems with your prostate are likely to affect the way you pee. You may hear doctors refer to these problems as ‘lower urinary tract symptoms (LUTS)’ or ‘bladder outflow obstruction’.

Symptoms vary, but you may:

  • find it difficult to pee, for example straining or taking a long time
  • notice a weak flow of urine
  • feel that your bladder has not emptied fully
  • keep dribbling urine after you’ve finished
  • have a sudden urge or frequent need to pee
  • keep getting up at night to pee

If you have these symptoms and you’re concerned about them, discuss them with your GP.

In men, the most common cause of these symptoms is an enlarged prostate, which can block the flow of urine. See our section: Enlarged prostate for more information. Other causes of prostate problems, which may include these symptoms in addition to other specific symptoms, include infection or inflammation of the prostate (prostatitis) and prostate cancer. See our sections below for more information about these.

Enlarged prostate

An enlarged prostate is also known as benign prostatic hyperplasia (BPH). This is caused by an increase in the number of cells in your prostate gland. ‘Benign’ means non-cancerous. So, having an enlarged prostate doesn’t mean you’ve got prostate cancer, nor does it mean you’re at greater risk of getting it.

An enlarged prostate doesn’t always cause symptoms. But see our symptoms section for more information about the kind of problems you may have.

For some men, an enlarged prostate may cause only mild symptoms that don’t trouble them too much. Your doctor may suggest not treating you straight away but keeping an eye on things. This is called watchful waiting. You can help to reduce your symptoms by:

  • drinking less fluid in the evenings
  • cutting down on caffeine

Some men need to take medicines to help control their symptoms. Taking medication can help to avoid the need for surgery. There are different medicines available and your doctor will talk you through your options. Some medicines can help to reduce symptoms within days. But if your prostate is larger, you may need a medicine that you take for several months before you see any benefit.

If your symptoms are very severe, don’t get better with medication or there are complications, your doctor may recommend an operation. The most common operation is a transurethral resection of the prostate (TURP). This removes the inner core of your prostate gland. Laser surgery is also sometimes used, particularly if you take any blood-thinning medication such as warfarin.

Prostatitis

Prostatitis means inflammation of your prostate gland. It can be acute (sudden) or chronic (long-term) and is often caused by infection. Prostatitis can cause a variety of different symptoms, including:

  • pain and discomfort in your genitals or the area between your scrotum and back passage; you may also have pain in your lower abdomen (tummy) or your back
  • an urgent or frequent need to pee
  • pain and discomfort when peeing
  • fever and chills, sometimes with aching muscles and/or joints
  • pain on ejaculation

If you have these symptoms, you need to see your GP.

Prostatitis can be treated in different ways depending on the cause. You may have a course of antibiotics to clear up any bacterial infection. This is usually a course of tablets. However, if you have a fever and chills, your doctor may suggest you have antibiotics through a tube into a vein (intravenously, IV). It’s very important that you take the whole course of antibiotics, to prevent your prostatitis coming back. Your doctor may also suggest painkillers such as ibuprofen.

If you have chronic prostatitis, you may have other medicines called alpha-blockers as well. These can help to relax the muscle fibres around your prostate gland if you’re having problems peeing.

For some men with chronic prostatitis, symptoms can come and go for months or even years. If so, your GP may refer you to a urologist, a doctor who specialises in treating conditions affecting the urinary system.

Prostate cancer

Prostate cancer is the most common type of cancer in men in the UK. It is often slow-growing so may not cause problems for many years, if ever. However, in some people the cancer grows quickly and may spread to other parts of the body.

Prostate cancer mainly affects men over 65, although one in five men who get it will be under that age. You’re more likely to get it if your father or brother has had it or if you’re black African–Caribbean. Symptoms may include difficulties with peeing – see our symptoms section. If the cancer is advanced, your symptoms may include tiredness, weight loss, pain in your bones and blood in your urine.

If you have a very slow-growing prostate cancer, your cancer specialist may keep an eye on it, but not actively treat it straight away. This is called active monitoring or watchful waiting. You’ll have treatment as and when you need it.

If you have a faster growing prostate cancer, you may have hormone therapy, surgery, chemotherapy, radiotherapy or a combination of these. Your treatment depends on whether your cancer has spread, the risk of side-effects and your personal preference.

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Diagnosing prostate problems

If you have any signs or symptoms of prostate problems, you should contact your GP – no matter how old you are. Your GP will ask about your symptoms and how they affect your day-to-day life.

Your GP will examine you. This usually includes a rectal examination to check the size and feel of your prostate. See our FAQ: What happens during a rectal examination? for more information about this test.

Your GP may also ask you for a urine sample. They may do some tests on your urine in the surgery to see if you have an infection. They may also send a sample to the laboratory for further testing.

You may be asked to take away a chart to fill in at home. Over at least three days, you record how much you drink and how often you pee. You measure and record the amount you pee each time and whether you have leaking after peeing. This information helps your GP understand the problems you’re having.

Your GP may suggest that you have a PSA (prostate specific antigen) test. This blood test is often used in men who have problems passing urine. It’s normal to have a small amount of PSA in your blood, but you may have a prostate problem if your PSA level is raised. Having a raised PSA might be a sign of prostate cancer, but this is not always the case. PSA level increases naturally with age and may be raised for other reasons such as infection or an enlarged prostate that is not cancerous. You can also have prostate cancer without a raised PSA, so a PSA test can’t definitely diagnose prostate cancer. If you’ve been offered a PSA test, talk to your doctor about the pros and cons. They’ll be able to help you make a decision that’s right for you.

How to keep your prostate healthy

There is always research looking into how to prevent prostate problems. Most of the factors that increase your risk of getting prostate cancer are things you can’t change. These include your age, family history and ethnicity.

You can make changes to your lifestyle that may make a difference to your prostate cancer risk. Men who are overweight or obese have a greater chance of developing a faster growing prostate cancer. Exercising regularly may help to reduce your risk by helping you to keep to a healthy weight.

It used to be thought that eating some specific foods reduced prostate cancer risk. Experts now think this is less likely, but there is some limited evidence that eating a lot of dairy foods may increase risk.

So, think about losing any excess weight, eating a healthy diet and taking regular exercise. Don’t put off seeing your GP if you’re worried about possible problems with your prostate. Getting it checked out can give you peace of mind. If any treatments are recommended, your GP will be able to help you make a decision that’s right for you.

Frequently asked questions

  • If you have symptoms of prostate problems, your GP will probably recommend that you have a rectal examination. They will feel your prostate through the wall of your rectum (back passage) with their finger.

    The test is called a digital rectal examination or sometimes a ‘prostate exam’. Although it may feel a little strange and uncomfortable, it doesn’t usually hurt and only takes a minute or two.

    Your doctor will make sure that the examination is done privately. You may be behind a curtain or they may lock the door so that no one comes in unexpectedly. You can ask to have someone with you during the examination if you wish.

    You remove your lower clothing and lie on your left side on the couch, with your knees drawn up. Your GP will put on a glove and lubricate their fingers with gel. They will gently and slowly slide one finger into your back passage until they can feel your prostate gland. You may feel their finger moving around. They will check whether or not the prostate is enlarged, and if it has any hard or lumpy areas. Normally, the prostate feels smooth.

    Your GP will then remove their finger and tell you they’ve finished. If you need some tissue to wipe away any excess gel, your GP will give you some. You can then get dressed again and your GP will discuss what they found.

    It’s important not to put off seeing your GP about your prostate symptoms because you’re worried about having a rectal examination. There’s no need to feel embarrassed – it’s an important medical test that your GP has done many times before. And it’s a quick and easy way to help your GP diagnose problems with your prostate.


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Related information

    • Prostate symptoms: bladder outlet obstruction. British Association Urological Surgeons. baus.org.uk, accessed April 2019
    • Benign prostatic hyperplasia. Medscape. emedicine.medscape.com, updated January 2019
    • Raised PSA. British Association Urological Surgeons. baus.org.uk, accessed April 2019
    • Prostate specific antigen. PatientPlus. patient.info/patientplus, last edited March 2019
    • Benign prostatic hyperplasia. BMJ Best Practice. bestpractice.bmj.com, last reviewed March 2019
    • LUTS in men. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised November 2018
    • Acute prostatitis. BMJ Best practice. bestpractice.bmj.com, last reviewed March 2019
    • NIH chronic prostatitis symptom index. British Association Urological Surgeons. baus.org.uk, accessed April 2019
    • Prostatitis treatment and management. Medscape. emedicine.medscape.com, updated December 2018
    • Prostate cancer statistics. Cancer Research UK. cancerresearchuk.org, accessed May 2019
    • Prostate cancer. PatientPlus. patient.info/patientplus, last edited March 2019
    • Prostate cancer incidence. Cancer Research UK. cancerresearchuk.org, accessed May 2019
    • Prostate cancer risk. Cancer Research UK. cancerresearchuk.org, accessed May 2019
    • Prostate cancer. BMJ Best Practice. bestpractice.bmj.com, last reviewed April 2019
    • Prostate cancer. World Cancer Research Fund. wcrf-uk.org, accessed May 2019
    • Prostate cancer EAU guidelines (presented at the EAU Annual Congress Barcelona 2019) European Association of Urology. ISBN 978-94-92671-04-2
    • Rectal examination. PatientPlus. patient.info/patientplus, last edited November 2014

  • Reviewed by Natalie Heaton, Specialist Health Editor, Bupa Health Content Team, June 2019
    Expert reviewer, Dr Adrian Raby, General Practitioner and Clinical Lecturer
    Next review due June 2022



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