Prostate health
The prostate gland
Only males have a prostate gland as part of their reproductive system. The prostate is a small, round gland approximately the size of a walnut in young adult men. It weighs between 15-20 grams (approximately the same weight as a 20 cent coin).
It is located directly below the bladder and completely wraps around the urethra. The urethra is the tube through which urine and semen flow to the opening at the end of the penis.
If the prostate gland becomes enlarged it can squeeze the urethra and place pressure on the bladder – making urination difficult.
Function of the prostate gland
The main function of the prostate gland is to produce a milky, alkaline fluid, which forms part of the semen.
Benign prostatic enlargement (BPE) is a non-cancerous enlargement of the prostate gland.
A benign prostatic enlargement usually occurs on the inner part of the prostate gland where it is most likely to squeeze the urethra and cause obstruction. The obstruction to the normal flow of urine and the pressure built up in the bladder by a partially blocked urethra may give rise to lower urinary tract symptoms (LUTS).
BPE does not ‘turn into’ prostate cancer. Not all men will develop symptoms of prostate disease, even though enlargement of the prostate occurs naturally with the ageing process, from 40-45 years onwards.
LUTS occurs in both men and women and can have a range of causes. These include infection, medications and other illnesses. In men over the age of 50 the most common cause of LUTS is BPE.
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Table 1 – Lower Urinary Tract Symptoms (LUTS) |
- Difficulty in starting – when the flow of urine is delayed and you have to wait for your urine flow to begin.
- Urgency – when you suddenly need to go to the toilet without warning. You may even wet your pants while on your way to the toilet. This is called urge incontinence.
- Frequency – when you need to go to the toilet more frequently than every two hours.
- Weaker urine stream – when the strength of your urine stream is noticeably reduced.
- Dribbling of urine – dribbling or a wet spot in your underpants and/or down your trouser leg after you’ve finished urinating. This is common in men over 70 years of age.
- Incomplete emptying – a feeling after urination that you have not emptied your bladder completely and you need to urinate again.
- Disrupted sleep – due to waking with the urge to urinate two or more times during the night.
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Prostate cancer
Prostate cancer does not show symptoms in the early stages as it grows in the outer section of the gland where it is less likely to put pressure on the urethra and obstruct urine flow.
At later stages, prostate cancer can cause symptoms similar to those in Table 2 below. However, it is important to note that these symptoms are not always indicative of cancer.
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Table 2 – Urinary symptoms that require medical assessment without delay |
- Painful or burning sensation when passing urine.
- Painful ejaculation.
- Blood in urine or semen.
- Discomfort or pain in the lower back, upper thighs, buttocks area or along one side of the penis.
- Involuntary loss of large amounts of urine (severe incontinence).
- Discharge from the urethra.
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Talking with your doctor
Illnesses involving the prostate can cause anxiety for you and your family. Many men naturally worry that urinary symptoms or the notion that anything is wrong ‘down there’ may change the sense of who they are as a man and mean the end of their sex life. For the vast majority of men, this does not happen.
It is important to consult your doctor for any symptoms that are concerning you. If you are over the age of 50 your should discuss issues of prostate disease with your doctor. Being aware of the associated risks and symptoms can help with early detection.
Family history
A family history of prostate cancer, particularly a father or brother, increases your risk of developing cancer of the prostate gland. The risk is higher if your father or brother were diagnosed at an early age (less than 50 years old).
If more than one relative has been diagnosed with prostate cancer, then your risk is higher again.
Examination by a doctor
If you report urinary symptoms similar to those in Table 1 to your doctor, he or she may conduct some tests, including examining your prostate, penis, testes and abdomen and test your urine for infection.
Digital rectal examination
Examination of the prostate gland is a simple procedure where the doctor feels your prostate gland by inserting a lubricated, gloved finger in your back passage (rectum). The size, shape and texture of the prostate gland are assessed.
A digital rectal examination (DRE) may be a slightly uncomfortable procedure, but it helps if you relax your body, particularly by not tightening your buttocks, as this may cause you more discomfort.
Prostate specific antigen
The prostate specific antigen (PSA) is a protein found in the blood that is made mainly by the prostate gland and therefore specific to the prostate.
The PSA test is a simple blood test to measure your levels of PSA. A raised PSA level may suggest benign (non-cancerous) enlargement, inflammation or cancer of the prostate gland. A raised PSA level does not necessarily mean prostate cancer.
Referral to a urologist
If your urinary symptoms are causing you a lot of bother, or if any medical tests are abnormal, your doctor may refer you to a specialist doctor called a urologist.
If you have abnormal results from your rectal examination or PSA blood test, your urologist may assess your prostate for cancer by performing a biopsy. A biopsy is the removal of some of your prostate tissue and currently is the only definite way to diagnose prostate cancer.
Further Information
The DVA publication You and Your Prostate is available from the Department of Veterans’ Affairs.