Prostate Health: Enlargement, Infection, PSA Testing and Cancer
The prostate is a walnut-sized gland below the bladder in men. It surrounds the urethra, the tube through which urine passes, and produces fluid that nourishes sperm. Because of its position, changes in the prostate often show up as urinary symptoms. Three conditions account for most problems: benign prostatic hyperplasia, prostatitis and prostate cancer.
Benign prostatic hyperplasia (BPH)
BPH is non-cancerous enlargement of the gland, extremely common with age: about half of men in their fifties and most men over 80 have some degree of it. As it grows, it squeezes the urethra and irritates the bladder.
Symptoms
- Weak or slow urine stream
- Hesitancy and straining to start
- Stopping and starting
- Frequent urination, particularly at night
- Urgency and a sense of incomplete emptying
- Dribbling after finishing
Treatment
- Lifestyle: limit fluids and caffeine before bed, avoid alcohol in the evening, double-void and treat constipation
- Alpha-blockers (tamsulosin, alfuzosin) relax muscle at the bladder neck and improve flow within days
- 5-alpha-reductase inhibitors (finasteride, dutasteride) shrink the gland over months
- Combination therapy, and tadalafil, which also helps erectile function
- Procedures when medicines fail: transurethral resection, laser enucleation, steam therapy, or prostatic artery embolisation
Untreated BPH can lead to urinary retention, infections, bladder stones and kidney damage, so persistent symptoms deserve assessment.
Prostatitis
Prostatitis is inflammation of the prostate and can occur at any age.
- Acute bacterial prostatitis causes sudden fever, chills, pelvic or perineal pain and painful, frequent urination. It is urgent and treated with antibiotics.
- Chronic prostatitis or chronic pelvic pain syndrome causes persistent pelvic pain, urinary symptoms and sexual discomfort over months, often without infection. Management combines alpha-blockers, pain relief, pelvic floor physiotherapy and stress management.
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Prostate cancer
Prostate cancer is the most common cancer in men in many countries. Most cases grow slowly and may never cause harm, but some are aggressive. Early cancer typically has no symptoms; later signs may include urinary problems, blood in urine or semen, bone pain, and unexplained weight loss.
Risk factors: age (mostly over 50), family history of prostate or breast cancer (including BRCA2 mutations), and Black ethnicity, which carries a higher risk.
The PSA test
Prostate-specific antigen (PSA) is a protein made by the prostate. A blood test can detect raised levels, which may signal cancer but also BPH, infection or recent ejaculation, cycling or catheterisation. This is why PSA is imperfect: it can miss some cancers and flag many harmless conditions.
Many guidelines recommend an informed discussion about PSA testing from around age 50, or from 45 for those at higher risk, and screening decisions are individual. Modern pathways use an MRI scan of the prostate before biopsy, which reduces unnecessary biopsies and finds significant cancers more accurately. Digital rectal examination may be part of assessment.
Diagnosis and treatment of cancer
If tests suggest cancer, a targeted biopsy establishes the grade (Gleason or Grade Group). Options depend on stage, grade, age and health:
- Active surveillance for low-risk disease, with regular PSA, MRI and biopsies, avoiding treatment unless the cancer progresses
- Surgery (radical prostatectomy)
- Radiotherapy, external beam or brachytherapy
- Hormone therapy and newer agents for advanced disease
- Chemotherapy and targeted treatments in advanced cases
Treatment can affect urinary control and erections, so a frank discussion about side effects is important.
Keeping the prostate healthy
- Maintain a healthy weight and stay active
- Eat plenty of vegetables, including cooked tomatoes, and limit processed and red meat
- Avoid smoking
- Do pelvic floor exercises
- Do not delay reporting urinary symptoms or blood in the urine
When to see a doctor
See a doctor if you notice changes in your urination, blood in the urine or semen, pain in the pelvis, back or hips, or you have a family history and want to discuss testing. Most prostate problems are treatable, and cancer found early has an excellent outlook.
This article is for general information and is not a substitute for professional medical advice. If you are worried about your health or have symptoms, speak to a doctor or other qualified health professional.