Sign of prostate problems

Prostate Problems

Treating Prostate Cancer

Treatment for prostate cancer depends on whether cancer is in part or all of the prostate, or if it has spread to other parts of the body. It also depends on your age and overall health. Talk with your doctor about the best treatment choice for you and the possible side effects of treatment. You may want to ask another doctor for a second opinion.

Treatment for prostate cancer may be:

  • Watchful waiting, also called active surveillance. If the cancer is not causing problems, you may decide not to get treated right away. Instead, your doctor will check regularly for changes in your condition. Treatment will start if the cancer begins to grow.
  • Surgery. The most common type of surgery removes the whole prostate and some nearby tissue.
  • Radiation therapy. This treatment uses radiation to kill cancer cells and shrink tumors. The radiation may come from an x-ray machine or from tiny radioactive pellets placed inside or near the tumor.
  • Hormone therapy. Men having other treatments, like radiation therapy, also may be treated with drugs to stop the body from making testosterone. This is done if it seems likely that the cancer will come back. Hormone therapy also can be used for prostate cancer that has spread beyond the prostate.

For more details on treatment choices for prostate cancer, call the National Cancer Institute’s Cancer Information Service at 1-800-422-6237 or visit their website.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information About Prostate Cancer and Other Prostate Problems

MedlinePlus
National Library of Medicine

This content is provided by the National Institute on Aging (NIA), part of the National Institutes of Health. NIA scientists and other experts review this content to ensure that it is accurate, authoritative, and up to date.

Content reviewed: July 01, 2016

Could Your Symptoms Be Prostate Cancer? 11 Signs You Might Have Prostate Problems

Prostate cancer often has not symptoms in the early stages, and those that do appear early — namely problems with urination — can mimic those caused by benign conditions associated with aging. What should you be on the look out for?

Problems with urination are among the common symptoms of prostate cancer. iStock

Let’s face it: Many of us put off seeing a doctor until things get worrisome. But for your own good and for the sake of the people you love, it’s important to take charge of your health. And knowing about prostate problems should be high on your priority list.

Prostate cancer is the most commonly diagnosed cancer in men (excluding skin cancer), and the second leading cause of cancer death. According to the American Cancer Society, more than 161,000 American men were diagnosed in 2017; it was the cause of nearly 27,000 deaths that year. (1)

What Are Early Signs of Prostate Cancer?

Here are the main symptoms of prostate cancer:

  • Frequent urination
  • Other urinary difficulties
  • Painful ejaculation
  • Blood in the urine or semen
  • Pain or stiffness in the hips, lower back or upper thighs

But a man may not experience any of these symptoms and still have prostate cancer.

“Prostate cancer is, like most cancers, a silent disease in its early stages,” says Gerald Chodak, MD, a urologist in Chicago and the author of Winning the Battle Against Prostate Cancer: Get the Treatment That Is Right for You.

For many men, the first sign of prostate problems involves urination changes.

“Some men may begin to notice increased frequency, slowing of their stream, and getting up at night to empty their bladder,” says Dr. Chodak.
Urinary troubles can often signal a noncancerous gland enlargement, which is called benign prostatic hyperplasia, a condition that is common in men over 40. “Virtually every guy over 70 has some prostatic enlargement,” says Edward Geehr, MD, the chief medical officer of ILinkMD Corporation.

Still, any urination changes — including pain, weak flow, difficulty starting or stopping, frequent nighttime urination or blood in the urine or semen — should be evaluated by a doctor.

In its advanced stages, prostate cancer can cause leg swelling and bone pain as the cancer spreads to other areas of the body.

People With These Characteristics Should Pay More Attention to Symptoms

Some populations should take potential symptoms more seriously, because they’re at higher risk for the disease. These include:

1. Advanced age The older a man is, the greater his chances of developing prostate cancer. In fact, if a man lives long enough, the odds are very good that he will develop the disease. Cancer can be diagnosed, however, at much younger ages — even at age 28. And men in their 20s and 30s tend to have more aggressive forms of the disease. (2)

2. African-American descent Medical experts aren’t sure why, but African-American men have the highest rate of prostate cancer incidence in the United States, according to the National Cancer Institute. What’s more, they are also more likely to be diagnosed at an advanced stage and are more than twice as likely to die of prostate cancer as white men. (3) On the other hand, according to the American Cancer Society, rates of death from prostate cancer have declined faster among black men than they have in white men. (4)

3. Family history Prostate problems tend to run in families. A man who has one first-degree relative (meaning a father or brother) with prostate cancer has more than twice the average risk of developing the disease, according to the National Cancer Institute. (5) That risk increases if more than two first-degree relatives had it. In addition, a man’s risk is increased if two first-degree relatives were diagnosed before age 55. Men in families known to carry one of the BRCA genes (BRCA1 and BRCA2) are also at higher risk for prostate cancer. (6)

4. Weight While being overweight or obese does not raise a person’s overall risk of developing prostate cancer, researchers think that it may raise the risk of being diagnosed with a more advanced and aggressive form of the disease. According to a study published in the December 2013 issue of the journal Prostate Cancer and Prostatic Diseases, obese men had more aggressive and more advanced cancer at the time of surgery than those who weren’t obese. (7)

About 1 in 10 cases of these kinds of cancers are related to carrying excess body fat. Experts think that too much body fat may increase the body’s production of insulin which acts as a growth factor for cancers. (8,9)

5. High-fat diet Men who eat a large amount of red meat or high-fat dairy products appear to have a slightly higher chance of developing prostate cancer, the American Cancer Society reports. (10)
The way the meat is cooked may also increase your risk of prostate problems, according to a study published in November 2012 in Carcinogenesis by researchers at the University of Southern California Keck School of Medicine. (11)

The researchers found that men who ate more than 2.5 weekly servings of red meat cooked at high temperatures were 40 percent more likely to have advanced prostate cancer than men who ate less than that amount. (12)

RELATED: Are Big Men More Prone to Aggressive Prostate Cancer?

A Lingering Question: Do Vasectomies Increase Prostate Cancer Risk?

There’s no need to panic if you’ve heard about studies suggesting that men who have vasectomies are at a greater risk of developing prostate cancer.

Controversy has existed for several decades over the possible relationship between vasectomy and prostate cancer, says Chodak. But those studies were flawed.

A Mayo Clinic review of 53 studies published in September 2017 in JAMA Internal Medicine found no link between the procedure and high-grade, advanced, or fatal prostate cancer. Whatever negligible association they did detect between vasectomies and cancer probably had nothing to do with the disease, say the authors. (13)
“Men considering a vasectomy and those who have already had one need not become alarmed or take any special action,” adds Chodak.

Additional reporting by Carlene Bauer.

Prostate Cancer in Younger Men

Although the median age for prostate cancer diagnosis is roughly 66 years old, with the highest proportion of those diagnosed between 65 and 74 years old, it is still possible to develop prostate cancer earlier on in life.1 Information on early-onset prostate cancer as well as its causes and trends are not very common in the literature.

Despite the general lack of information, researchers and medical professionals have become increasingly more interested in this condition, as the number of cases of early-onset prostate cancer has increased by roughly six-fold over the past 30 years.2 This increase could be due to a variety of factors, including environmental factors, such as smoking or diet, as well as more thorough and earlier screening methods.
Early-onset prostate cancer is roughly defined as prostate cancer that is diagnosed before age 55, and most research points towards genetic factors being responsible for its occurrence.3-5 Roughly 2% of deaths related to prostate cancer occur in those 35-54 years old.1

How common is prostate cancer in young men?

Common estimates suggest that early-onset prostate cancer comprises roughly 10% of all prostate cancer occurrences. As mentioned previously, the number of cases of early-onset prostate cancer is increasing, and has increased roughly six-fold from 5.6 to over 30 cases per 100,000 person-years since 1986. This increase could be due to a wider range of those being screened for the condition, as well as more refined screening methods, such as tests for PSA (prostate-specific antigen) in the blood. Additionally, and the same as with all prostate cancer diagnoses, the largest proportion of those diagnosed are African American males.1,2

What does it mean to get prostate cancer as a younger man?

Early-onset prostate cancer is currently being investigated further to better define this group and their case presentations. Typically, those who are diagnosed at a younger age have been found to possess more genetic variants, or mutations that can contribute to cancer. These individuals also typically have a familial history of the condition, with the greatest risk in those who have one or more close relative with early-onset prostate cancer. Findings like these suggest that early-onset prostate cancer is tied more to genetic factors that to environmental factors, such as smoking or diet.

General findings for those with high grade or stage early-onset prostate cancer trend towards a higher cause-specific mortality than their older counterparts. This means that individuals with aggressive early-onset prostate cancer are typically more likely to die due specifically to their prostate cancer. However, this could also be due to more comorbid conditions present in older men. For example, a male at age 90 might have more age-specific life-threatening conditions in addition to his prostate cancer that may threaten his life more than a slow-spreading cancer.

Prognosis difference?

The 5-year relative survival rate for the early-onset group is still very high, and is estimated to be 98%, however, this number is still lower than the nearly 100% five-year survival rate for slightly older men. The only men who show comparable survival rates under 100% are men ages 80 and older (who may also be dying of causes other than prostate cancer).

The good news though, is that the large majority of early-onset prostate cancer cases are local or low-grade. Even those that are found when they have spread beyond the prostate are typically lower in grade overall for younger men. Despite this, because long-term effects are not as well distinguished in this group, many sources recommend initiating treatment immediately for this population instead of taking the watch and wait approach that is common in older men.

Additionally, another advantage in this group is that there are typically more treatment options than in older men, as individuals are usually treatment-naïve (meaning haven’t had any other prostate cancer treatments or hormone therapies) and have less comorbidities that could decrease treatment options. For this reason, younger individuals with a Gleason score of 5-7 have a higher survival rate than older men with this same classification. This means that although the risk of cancer-specific death is higher for younger men, when their cancer is lower in grade and more local, they have a better response to treatment than older men with the same cancer characteristics.2-6

What should I look for?

Regardless of age, prostate cancer often starts without warning signs until it has advanced further. This is why it is important to engage in appropriate screenings and talk with your provider regularly about your risk and family history of cancer.

For young men especially, it may be beneficial to see a genetic counselor to look at your specific genetic risk. When prostate cancer manifests, early symptoms include changes in urination, such as increased urgency and frequency of urination, blood in the urine or semen, interrupted or changed flow of urine stream, painful urination, erectile dysfunction, and pain in the pelvis, hips, thighs or lower back.

Rare atypical prostate cancers in very young men

One very rare form of prostate cancer, classified as a sarcoma, is typically found in younger men between 35 and 60 years old. This type of cancer makes up less than 0.1% of all cases of primary prostate cancer (meaning cancer that originates in the prostate). Sarcomas can infiltrate the soft tissues in the body. These tissues include our muscles and nerves. Since this tissue is essentially everywhere in our body, sarcomas can develop just about anywhere.

Sarcomas can break away from their original locations and spread to the bones or lungs. Two of the more common types of prostate cancer sarcomas are leiomyosarcomas and rhabdomyosarcoma which can affect very young men, including children. The important thing to note however, is that these atypical prostate cancers are incredibly rare.7-9

Prostate cancer

Each year, more than 164,000 American men are diagnosed with prostate cancer. No one knows if or when the disease will develop, but understanding the risk factors for prostate cancer may help you take preventive measures to reduce the likelihood of getting the disease. Screenings may help detect prostate cancer early, before symptoms occur.

What causes prostate cancer?

Prostate cancer forms when the DNA in cells in the prostate develop mutations that may disable their ability to control cell growth and division. In many cases, these mutated cells die or are attacked by the immune system. But some mutated cells may escape the immune system and grow out of control, forming a prostate tumor.

While the exact cause of prostate cancer may not be known, the risk of developing the disease increases with age. Also, men with a family history of prostate cancer have an increased risk of developing the disease.

Some common risk factors for prostate cancer include:

General

Race: Studies show that African American men are approximately 70 percent more likely to develop prostate cancer in their lifetime than Caucasian or Hispanic men.

Age: The risk of developing prostate cancer increases with age. While only one in 10,000 men under age 40 will be diagnosed with prostate cancer, one in 15 men in their 60s will be diagnosed with the disease.

Genetics

Family history: Men with an immediate blood relative, such as a father or brother, who has or had prostate cancer, are twice as likely to develop the disease. For men who have another family member diagnosed with the disease, the chances of developing prostate cancer increase.

Lifestyle

Diet: A diet high in saturated fat, as well as obesity, increases the risk of prostate cancer.

High testosterone levels: Men who use testosterone therapy are more likely to develop prostate cancer, as an increase in testosterone stimulates the growth of the prostate gland.

Other conditions

Prostatic intraepithelial neoplasia (PIN): This condition may be associated with increased risk of prostate cancer. PIN is a condition in which prostate gland cells look abnormal when examined with a microscope. It is not necessarily linked with any symptoms. Nearly one half of men will be diagnosed with PIN before age 50.

Genome changes: Certain genes have been known to elevate prostate cancer risks, such as BRCA1 and BRCA2 genes.

Next topic: What are the symptoms of prostate cancer?

THE “NEW” PROSTATE CANCER INFOLINK

Dimitropoulou et al. have reported data from a case-control study in > 800 men in the United Kingdom. The study was designed to investigate whether there is a real association between the frequency of sexual activity (intercourse, masturbation, overall) and prostate cancer risk in men diagnosed at ≤ 60 years of age. The results of this study are interesting, but it should be emphasized how much the results of studies like this are biased by the honesty and accuracy of the study participants.

In total, 431 prostate cancer patients and 409 controls participated and provided information on their sexual activity. The frequencies of intercourse and masturbation during the participants’ different age decades (20s, 30s, 40s, and 50s) were collected. The “New” Prostate Cancer InfoLink would immediately point out that many boys’ are sexually active at much younger ages than their 20s, possibly beginning to masturbate at ages under 10 years and participate in intercourse by the time they are in their mid to late teens. The lack of this information may be important, and we are surprised that the study did not seek this information. It’s not exactly a secret!

With this limitation, the study showed the following:

  • Frequent overall sexual activity in younger life (20s) increased overall prostate cancer risk.
  • Frequent overall sexual activity appeared to be protective against the disease when older (50s).
  • Frequent masturbation was a marker for increased risk in the 20s and 30s.
  • Frequent masturbation appeared to be associated with a decreased risk for men in their 50s, while intercourse activity alone was not associated with disease risk for men in this age group.

The authors note that these results potentially imply more than one mechanism by which sexual activity is involved in the etiology of prostate cancer at different ages. They also observe that higher levels of sexual activity at younger ages may (at least in part) explain the protective effect seen for men in their 50s (“reverse causation”).

We can expect the results of this study to be front page news in certain types of newspaper. Unfortunately, we suspect that the study is fatally flawed by the lack of information about these men at even younger ages. Any psychologist can tell us that sexual behaviors are highly predicated on very early behavioral learning and activity. It would perhaps be critical to have more information about when each individual in this study started to become sexually active at a significant level in order to understand the significance of the data collected by this group.

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. Use the menu to see other pages.

The symptoms and signs of prostate cancer may include:

  • Frequent urination

  • Weak or interrupted urine flow or the need to strain to empty the bladder

  • The urge to urinate frequently at night

  • Blood in the urine

  • Blood in the seminal fluid

  • New onset of erectile dysfunction

  • Pain or burning during urination, which is much less common

  • Discomfort or pain when sitting, caused by an enlarged prostate

Other noncancerous conditions of the prostate, such as BPH or an enlarged prostate, can cause similar symptoms. Or, the cause of a symptom may be a different medical condition that is also not related to cancer. Urinary symptoms also can be caused by an infection of the bladder or other conditions.

If cancer has spread outside of the prostate gland, a man may experience:

  • Pain in the back, hips, thighs, shoulders, or other bones

  • Swelling or fluid buildup in the legs or feet

  • Unexplained weight loss

  • Fatigue

  • Change in bowel habits

If you are concerned about any changes you experience, please talk with your doctor. Your doctor will ask how long and how often you have been experiencing the symptom(s), in addition to other questions. This is to help figure out the cause of the problem, called a diagnosis.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may be called palliative care or supportive care. It is often started soon after diagnosis and continued throughout treatment. Be sure to talk with your health care team about the symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Use the menu to choose a different section to read in this guide.

Prostate Cancer Symptoms

Most men are diagnosed before showing symptoms

About 85 percent of prostate cancers are detected during early screening tests, before the patient develops any symptoms. A blood test may show abnormally high or rising prostate-specific antigen (PSA) levels. Or, a physician may detect abnormalities during a routine rectal exam.

Symptoms of Prostate Cancer

Though early warning signs of prostate cancer are rare, sometimes men experience symptoms before they are diagnosed. The severity of symptoms may depend on where the cancer is located in the prostate and how advanced it has become. However, having any of these symptoms does not necessarily mean that you have prostate cancer or that the disease has progressed beyond its early stages.

Urinary Symptoms

  • A need to urinate frequently, especially at night
  • Difficulty starting urination or holding back urine
  • A weak or interrupted flow of urine
  • Painful or burning urination
  • Hematuria (blood in the urine)

Erectile and Ejaculatory Symptoms

  • Difficulty achieving or maintaining an erection
  • Painful ejaculation
  • Blood in the semen
  • Decreased volume of ejaculation (though hydration, diet and frequency of ejaculation are more likely than prostate cancer to impact the volume of fluid)

Lower Extremity Symptoms

  • Frequent pain or stiffness in the lower back, hips or upper thighs
  • Swelling in the lower extremities

If a patient experiences bone pain and swelling in the lower extremities—especially when accompanied by urinary, erectile or ejaculation dysfunction—these could be symptoms of advanced prostate cancer.

When to See a Doctor

Consult with your doctor if you experience any of the symptoms discussed on this page particularly if they have been going on for a while. You will need a thorough work-up to determine the underlying cause, which may or may not be prostate cancer.

It’s important to understand that other diseases or disorders can share these same symptoms. Benign prostatic hyperplasia (BPH), also called enlargement of the prostate, and are quite common. Men with these benign conditions can experience symptoms more often and more severely than men with prostate cancer.

Erectile dysfunction is relatively common, especially as one ages, and can also have causes unrelated to prostate cancer, such as smoking or cardiovascular disease. Experiencing a lower amount of fluid during ejaculation can be related to something as simple as diet or dehydration.

It’s important to keep track of your symptoms, determining what’s normal or abnormal for your own body. If you are worried about a particular symptom, or if it’s interfering with a relationship, you should discuss your concerns with your primary care physician.


Based on content from the NIH/National Institute on Aging AgePage “Prostate Problems.”

It’s true that prostate problems are common after age 50. The good news is there are many things you can do.

The prostate

The prostate is a gland about the size of a walnut. It is part of the male reproductive system and wraps around the tube that carries urine out of the bladder. It grows larger as you get older. If your prostate gets too large, it can cause health issues. Having prostate problems does not always mean you have cancer.
Sometimes a doctor may find a problem during a routine checkup or by doing a rectal exam. If you think there is something wrong with your prostate, see your doctor right away.

Common Problems

Here are some examples of non-cancer prostate problems:

Benign prostatic hyperplasia, or BPH, means your prostate is enlarged, but is not cancerous. It is very common in older men. An enlarged prostate may make it very difficult to urinate or cause dribbling after you urinate. You may feel the need to urinate a lot, often at night. See your family doctor for an exam. Treatments for BPH include:

  • Watchful waiting, also called active surveillance. If your symptoms are not too bad, your doctor may tell you to wait before starting any treatment to see if the problem gets worse. Your doctor will tell you how often you need to return for checkups. You can start treatment later if your symptoms worsen.
  • Medications. There are medicines that can help shrink the prostate or help relax muscles near your prostate to ease your symptoms. Talk with your doctor about possible side effects.
  • Surgery. If nothing else has worked, your doctor may suggest surgery to help urine flow. There are many types of BPH surgery. Talk with your doctor about the risks. Regular checkups are important after surgery.
  • Other treatments. Sometimes radio waves, microwaves, or lasers are used to treat urinary problems caused by BPH. These methods use different kinds of heat to reduce extra prostate tissue.

Acute bacterial prostatitis usually starts suddenly from a bacterial infection. It can cause fever, chills, or pain. It might hurt when you urinate, or you may see blood in your urine. See your doctor right away. He or she can prescribe medicine to make you feel better.

Chronic bacterial prostatitis is an infection that comes back again and again. This is a rare problem that can be hard to treat. Sometimes taking antibiotics for a long time may work. Talk with your doctor about other things you can do to help you feel better.

Chronic prostatitis, also called Chronic Pelvic Pain Syndrome, is a common prostate problem. It can cause pain in the lower back, in the groin area, or at the tip of the penis. Men with this problem often have painful ejaculation. They may feel the need to urinate frequently, but pass only a small amount of urine. Treating this condition may require a combination of medicines, surgery and lifestyle changes.

Prostate Cancer

Prostate cancer is common among American men. Your chance of getting prostate cancer may be affected by your:

  • Age. Men age 50 and older run a greater risk.
  • Race. Prostate cancer is most common among African-American men.
  • Family history. If your father or brother has had prostate cancer, you are more likely to have it too.
  • Diet. Eating high-fat food with few fruits and vegetables may raise your risk.

Diagnosing Prostate Cancer

At the start, prostate cancer does not cause symptoms. As the cancer grows, you may have trouble urinating. Some men need to urinate often, especially at night. Others have pain or burning during urination, blood in the urine or semen, pain in the back, hips or pelvis, and painful ejaculation.

To find out if these symptoms are caused by prostate cancer, your doctor will ask about your past medical problems and your family’s medical history. He or she will perform a physical exam. During the exam, your doctor will put a gloved finger into your rectum to feel your prostate for hard or lumpy areas.

Your doctor may also do a blood test to check the prostate-specific antigen, or PSA, level. PSA levels can be high in men with an enlarged prostate gland or with prostate cancer. You may also need an ultrasound exam that takes computer pictures of the prostate.

If tests show that you might have cancer, your doctor will want to confirm this with a biopsy. He or she will take out tiny pieces of the prostate to look for cancer cells. Your doctor may want to do a biopsy again to re-check the results.

Treating Prostate Cancer

Treatment for prostate cancer depends on whether cancer is in part or all of the prostate or if it has spread to other parts of the body. It also depends on your age and overall health. Talk with your doctor about the best treatment choice for you. You may want to ask another doctor for a second opinion.

For cancer that has not spread from the prostate to other parts of the body, your doctor may suggest:

  • Watchful waiting or active surveillance. If the cancer is growing slowly and not causing problems, you may decide not to treat it right away. Instead, your doctor will check regularly for changes in your condition.
  • Surgery. The most common type of surgery removes the whole prostate and some nearby tissue. As with any surgery, there are risks. Talk to your doctor about problems that may result from surgery.
  • Radiation therapy. This treatment uses radiation to kill cancer cells and shrink tumors. The radiation may come from an x-ray machine or from tiny radioactive seeds placed inside or near the tumor. Talk with your doctor about possible side effects.
  • Hormone therapy. Men having other treatments like radiation therapy may also be treated with drugs to stop the body from making testosterone. This is done if it seems likely that the cancer will come back. Hormone therapy can also be used for prostate cancer that has spread beyond the prostate.

PSA Testing

Some doctors think that men younger than 75 should have yearly PSA tests: others do not. Not all prostate cancers are life-threatening, and treatments can cause side effects. Sometimes high PSA levels can be caused by infections, BPH or small cancers that may not grow or spread. Your doctor may prefer “watchful waiting” until there are signs that treatment is needed. Researchers are studying ways to improve the PSA test so that it detects only cancers that need treatment.

Protecting Yourself

Remember that the following can be signs of a prostate problem:

  • Frequent urge to urinate.
  • Need to get up many times during the night to urinate.
  • Blood in urine or semen.
  • Painful or burning urination.
  • Not being able to urinate.
  • Painful ejaculation.
  • Frequent pain or stiffness in lower back, hips, pelvic or rectal area, or upper thighs.
  • Dribbling of urine.

If you have any of these symptoms, see your doctor right away.

For More Information

American Cancer Society

(800) 227-2345 (toll-free)

(866) 228-4327 (TTY/toll-free)

American Urological Association Foundation

1000 Corporate Boulevard

Linthicum, MD 21090

(800) 828-7866 (toll-free)


National Cancer Institute

Cancer Information Service 

(800) 422-6237 (toll-free)

(800) 332-8615 (TTY/toll-free) 


For more information on health and aging, contact:

Next Avenue Editors Also Recommend:

  • How to Recognize Prostate Problems
  • Pain, Size of Prostate Could Indicate Problems
  • Enlarged Prostate: A Common Condition as a Man Ages
  • Prostate Problems Not Always Linked to Cancer

Next Avenue brings you stories that are inspiring and change lives. We know that because we hear it from our readers every single day. One reader says,

“Every time I read a post, I feel like I’m able to take a single, clear lesson away from it, which is why I think it’s so great.”

Your generous donation will help us continue to bring you the information you care about. What story will you help make possible?

  • Make a Donation

Sponsored

Topics

  • Health
  • Health Care
  • Alcaraz A, Hammerer P, Tubaro A, Schröder FH, Castro R. Is There Evidence of a Relationship between Benign Prostatic Hyperplasia and Prostate Cancer? Findings of a Literature Review. Eur Urol. 2009;55(4):864–75.
  • Egan KB. The Epidemiology of Benign Prostatic Hyperplasia Associated with Lower Urinary Tract Symptoms. Urol Clin North Am. 2016 Aug;43(3):289–97.
  • Emberton M, Fitzpatrick JM, Garcia-Losa M, Qizilbash N, Djavan B. Progression of benign prostatic hyperplasia: systematic review of the placebo arms of clinical trials. BJU Int. 2008;102(8):981–6.
  • Emberton M, Fitzpatrick JM, Rees J. Risk stratification for benign prostatic hyperplasia (BPH) treatment. BJU Int. 2011 Mar;107(6):876–80.
  • Fisher E, Subramonian K, Omar MI. The role of alpha blockers prior to removal of urethral catheter for acute urinary retention in men. Cochrane Database Syst Rev. 2014;(6).
  • Fitzpatrick JM, Desgrandchamps F, Adjali K, Guerra LG, Hong SJ, Khalid SE, et al. Management of acute urinary retention: a worldwide survey of 6074 men with benign prostatic hyperplasia. BJU Int. 2012 Jan;109(1):88–95.
  • Gacci M, Corona G, Vignozzi L, Salvi M, Serni S, De Nunzio C, et al. Metabolic syndrome and benign prostatic enlargement: a systematic review and meta-analysis: Metabolic syndrome and BPE. BJU Int. 2015 Jan;115(1):24–31.
  • Jarvis TR, Chughtai B, Kaplan SA. Bladder Outlet Obstruction and BPH. Curr Bladder Dysfunct Rep. 2014 Dec;9(4):372–8.
  • Konwar R, Chattopadhyay N, Bid HK. Genetic polymorphism and pathogenesis of benign prostatic hyperplasia. BJU Int. 2008;102(5):536–44.
  • Lee CH, Akin-Olugbade O, Kirschenbaum A. Overview of Prostate Anatomy, Histology, and Pathology. Endocrinol Metab Clin North Am. 2011 Sep;40(3):565–75.
  • Ørsted DD, Nordestgaard BG, Jensen GB, Schnohr P, Bojesen SE. Prostate-Specific Antigen and Long-Term Prediction of Prostate Cancer Incidence and Mortality in the General Population. Eur Urol. 2012 May;61(5):865–74.
  • Parsons JK, Kashefi C. Physical Activity, Benign Prostatic Hyperplasia, and Lower Urinary Tract Symptoms. Eur Urol. 2008;53(6):1228–35.
  • Parsons JK. Benign Prostatic Hyperplasia and Male Lower Urinary Tract Symptoms: Epidemiology and Risk Factors. Curr Bladder Dysfunct Rep. 2010 Dec;5(4):212–8.
  • Public Health England. Prostate cancer risk management programme (PCRMP): benefits and risks of PSA testing . GOV.UK; 2016. Available from: https://www.gov.uk/government/publications/prostate-cancer-risk-management-programme-psa-test-benefits-and-risks/prostate-cancer-risk-management-programme-pcrmp-benefits-and-risks-of-psa-testing
  • Raheem OA, Parsons JK. Associations of obesity, physical activity and diet with benign prostatic hyperplasia and lower urinary tract symptoms: Curr Opin Urol. 2014;24(1):10–4.
  • Rees J, Bultitude M, Challacombe B. The management of lower urinary tract symptoms in men. BMJ. 2014 Jun 24;348(1):g3861–g3861.
  • Roehrborn CG. BPH progression: concept and key learning from MTOPS, ALTESS, COMBAT, and ALF-ONE. BJU Int. 2008;101 Suppl 3:17–21.
  • Russo GI, Castelli T, Urzì D, Privitera S, La Vignera S, Condorelli RA, et al. Emerging links between non-neurogenic lower urinary tract symptoms secondary to benign prostatic obstruction, metabolic syndrome and its components: A systematic review. Int J Urol. 2015 Nov;22(11):982–90.
  • Sanda MG, Beaty TH, Stutzman RE, Childs B, Walsh PC. Genetic susceptibility of benign prostatic hyperplasia. J Urol. 1994;152(1):115–9.
  • Schenk JM, Kristal AR, Arnold KB, Tangen CM, Neuhouser ML, Lin DW, et al. Association of Symptomatic Benign Prostatic Hyperplasia and Prostate Cancer: Results from the Prostate Cancer Prevention Trial. Am J Epidemiol. 2011;173(12):1419–28.
  • Speakman M, Kirby R, Doyle S, Ioannou C. Burden of male lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) – focus on the UK: Burden of male LUTS suggestive of BPH. BJU Int. 2015 Apr;115(4):508–19.
  • Vignozzi L, Gacci M, Maggi M. Lower urinary tract symptoms, benign prostatic hyperplasia and metabolic syndrome. Nat Rev Urol. 2016 Jan 12;13(2):108–19.
  • Vignozzi L, Rastrelli G, Corona G, Gacci M, Forti G, Maggi M. Benign prostatic hyperplasia: a new metabolic disease? J Endocrinol Invest. 2014 Apr;37(4):313–22.
  • Vuichoud C, Loughlin KR. Lower urinary tract symptoms, benign prostatic hyperplasia and metabolic syndrome. Can J Urol. 2015;
  • Wynder JL, Nicholson TM, DeFranco DB, Ricke WA. Estrogens and Male Lower Urinary Tract Dysfunction. Curr Urol Rep . 2015 Sep ;16(9). Available from: http://link.springer.com/10.1007/s11934-015-0534-6
  • Young JM, Muscatello DJ, Ward JE. Are men with lower urinary tract symptoms at increased risk of prostate cancer? A systematic review and critique of the available evidence. BJU Int. 2000;85:1037–48.

Understanding Prostate Changes: A Health Guide for Men

Prostate Changes That Are Not Cancer

Prostatitis

Prostatitis is an inflammation of the prostate gland that may result from a bacterial infection. It affects at least half of all men at some time during their lives. Having this condition does not increase your risk of any other prostate disease.

Symptoms of prostatitis

  • Trouble passing urine
  • A burning or stinging feeling or pain when passing urine
  • Strong, frequent urge to pass urine, even when there is only a small amount of urine
  • Chills and high fever
  • Low back pain or body aches
  • Pain low in the belly, groin, or behind the scrotum
  • Rectal pressure or pain
  • Urethral discharge with bowel movements
  • Genital and rectal throbbing
  • Sexual problems and loss of sex drive
  • Painful ejaculation (sexual climax)

Several tests, such as DRE and a urine test, can be done to see if you have prostatitis. Correct diagnosis of your exact type of prostatitis is key to getting the best treatment. Even if you have no symptoms you should follow your doctor’s advice to complete treatment.

Types of Prostatitis and Treatments

  • Acute bacterial prostatitis: This type is caused by a bacterial infection and comes on suddenly (acute). Symptoms include severe chills and fever. There is often blood in the urine. Your PSA level (see PSA test) may be higher than normal. You must go to the doctor’s office or emergency room for treatment. It’s the least common of the four types, yet it’s the easiest to diagnose and treat.

    Most cases can be cured with a high dose of antibiotics, taken for 7 to 14 days, and then lower doses for several weeks. You may also need drugs to help with pain or discomfort. If your PSA level was high, it will likely return to normal once the infection is cleared up.

  • Chronic bacterial prostatitis: Also caused by bacteria, this type of prostatitis doesn’t come on suddenly, but it can be bothersome. The only symptom you may have is bladder infections that keep coming back. The cause may be a defect in the prostate that lets bacteria collect in the urinary tract.

    Antibiotic treatment over a longer period of time is best for this type. Treatment lasts from 4 to 12 weeks. This type of treatment clears up about 60 percent of cases. Long-term, low-dose antibiotics may help relieve symptoms in cases that won’t clear up.

  • Chronic prostatitis or chronic pelvic pain syndrome: This disorder is the most common but least understood type of prostatitis. Found in men of any age from late teens to the elderly, its symptoms can come and go without warning. There can be pain or discomfort in the groin or bladder area. Infection-fighting cells are often present, even though no bacteria can be found.

    There are several different treatments for this problem, based on your symptoms. These include anti-inflammatory medications and other pain control treatments, such as warm baths. Other medicines, such as alpha-blockers, may also be given. Alpha-blockers relax muscle tissue in the prostate to make passing urine easier. Some men are treated with antibiotics in case the symptoms are caused by an undetected infection.

  • Asymptomatic inflammatory prostatitis: You don’t have symptoms with this condition. It is often found when you are undergoing tests for other conditions, such as to determine the cause of infertility or to look for prostate cancer. If you have this form of prostatitis, your PSA test may show a higher number than normal.

    Men with this condition are usually not treated, but a repeat PSA test will usually be done if the PSA number is high.

Enlarged Prostate (BPH)

BPH stands for benign prostatic hyperplasia. Benign means “not cancer,” and hyperplasia means abnormal cell growth. The result is that the prostate becomes enlarged. BPH is not linked to cancer and does not increase your risk of getting prostate cancer—yet the symptoms for BPH and prostate cancer can be similar.

Urine flow in a normal (left) and enlarged (right) prostate. In diagram on the left, urine flows freely. On the right, urine flow is affected because the enlarged prostate is pressing on the bladder and urethra.

Symptoms of BPH

  • Trouble starting a urine stream or making more than a dribble
  • Passing urine often, especially at night
  • Feeling that the bladder has not fully emptied
  • A strong or sudden urge to pass urine
  • Weak or slow urine stream
  • Stopping and starting again several times while passing urine
  • Pushing or straining to begin passing urine

At its worst, BPH can lead to: a weak bladder, backflow of urine causing bladder or kidney infections, complete block in the flow of urine and kidney failure.

The prostate gland is about the size of a walnut when a man is in his 20s. By the time he is 40, it may have grown slightly larger, to the size of an apricot. By age 60, it may be the size of a lemon. The enlarged prostate can press against the bladder and the urethra. This can slow down or block urine flow. Some men might find it hard to start a urine stream, even though they feel the need to go. Once the urine stream has started, it may be hard to stop. Other men may feel like they need to pass urine all the time, or they are awakened during sleep with the sudden need to pass urine. Early BPH symptoms take many years to turn into bothersome problems. These early symptoms are a cue to see your doctor.

Treatments for BPH

Some men with BPH eventually find their symptoms to be bothersome enough to need treatment. BPH cannot be cured, but drugs or surgery can often relieve its symptoms. Talk with your doctor about the best choice for you. Your symptoms may change over time, so be sure to tell your doctor about any new changes.

Watchful waiting

Men with mild symptoms of BPH who do not find them bothersome often choose this approach. Watchful waiting means getting annual checkups. Treatment is started only if symptoms become too much of a problem.

If you choose watchful waiting, these simple steps may help lessen your symptoms:

  • Limit drinking in the evening, especially drinks with alcohol or caffeine.
  • Empty your bladder all the way when you pass urine.
  • Use the restroom often. Don’t wait for long periods without passing urine.

Some medications can make BPH symptoms worse, so talk with your doctor or pharmacist about any medicines you are taking such as:

  • Over-the-counter cold and cough medicines (especially antihistamines)
  • Tranquilizers
  • Antidepressants
  • Blood pressure medicine.
Drug Therapy

Many American men with mild to moderate BPH symptoms have chosen prescription drugs over surgery since the early 1990s. Two main types of drugs are used. One type relaxes muscles near the prostate, and the other type shrinks the prostate gland. Some evidence shows that taking both drugs together may work best to keep BPH symptoms from getting worse.

  • Alpha-blockers are drugs that help relax muscles near the prostate to relieve pressure and let urine flow more freely, but they don’t shrink the size of the prostate. For many men, these drugs can improve urine flow and reduce the symptoms of BPH within days. Possible side effects include dizziness, headache, and fatigue.
  • 5 alpha-reductase inhibitors are drugs that help shrink the prostate. They relieve symptoms by blocking the activity of an enzyme known as 5-alpha reductase. This enzyme changes the male hormone testosterone into dihydrotestosterone (DHT), which stimulates prostate growth. When the action of 5-alpha reductase is blocked, DHT production is lowered and prostate growth slows. This helps shrink the prostate, reduce blockage, and limit the need for surgery.

Taking these drugs can help increase urine flow and reduce your symptoms. You must continue to take these drugs to prevent symptoms from coming back. 5-alpha reductase inhibitors can cause the following side effects in a small percentage of men including: decreased interest in sex, trouble getting or keeping an erection, and smaller amount of semen with ejaculation.

It’s important to note that taking these drugs may lower your PSA test number. There is also evidence that these drugs lower the risk of getting prostate cancer, but whether they can help lower the risk of dying from prostate cancer is still unclear.

Surgery

The number of prostate surgeries has gone down over the years. But operations for BPH are still among the most common surgeries for American men. Surgery is used when symptoms are severe or drug therapy has not worked well. Be sure to discuss options with your doctor and ask about the potential short- and long-term benefits and risks with each procedure.

Types of surgery for BPH include:

  • TURP (transurethral resection of the prostate). The most common surgery for BPH, TURP accounts for 90 percent of all BPH surgeries. The doctor passes an instrument through the urethra and trims away extra prostate tissue. A spinal block (anesthesia) is used to numb the area. Tissue is sent to the laboratory to check for prostate cancer. TURP generally avoids the two main dangers linked to another type of surgery called open prostatectomy (complete removal of the prostate gland through a cut in the lower abdomen): including incontinence and/or impotence. However, TURP can have serious side effects, such as bleeding. In addition, men may have to stay in the hospital and need a catheter for a few days after surgery.
  • TUIP (transurethral incision of the prostate). This surgery, which is similar to TURP, is used on slightly enlarged prostate glands. The surgeon places one or two small cuts in the prostate. This relieves pressure without trimming away tissue. It has a low risk of side effects. Like TURP, this treatment helps with urine flow by widening the urethra.
  • TUNA (transurethral needle ablation). Radio waves are used to burn away excess prostate tissue. TUNA helps with urine flow, relieves symptoms, and may have fewer side effects than TURP. Most men need a catheter to drain urine for a period of time after the procedure.
  • TUMT (transurethral microwave thermotherapy). Microwaves sent through a catheter are used to destroy excess prostate tissue. This can be an option for men who should not have major surgery because they have other medical problems.
  • TUVP (transurethral electroevaporation of the prostate). An electrical current is used to vaporize prostate tissue.
  • Laser surgery. The doctor passes a laser fiber through the urethra into the prostate, using a cystoscope, and then delivers several bursts of laser energy. The laser energy destroys prostate tissue and helps improve urine flow. Like TURP, laser surgery requires anesthesia. One advantage of laser surgery over TURP is that laser surgery causes little blood loss. The recovery period for laser surgery may be shorter too. However, laser surgery may not be effective on larger prostates.
  • Open prostatectomy. This may be the only option in rare cases, such as when the obstruction is severe, the prostate is very large, or other procedures can’t be done. General anesthesia or a spinal block is used, and a catheter remains for 3 to 7 days after the surgery. This surgery carries the highest risk of complications. Tissue is sent to the laboratory to check for prostate cancer.

About the author

Leave a Reply

Your email address will not be published. Required fields are marked *