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The prostate is one of the male sex glands. The other major sex glands are the testicles and seminal vesicles. Together these glands secrete the fluids that make up semen.
The normal prostate is about the size of a walnut. It lies just below the bladder and surrounds the beginning of the urethra. The urethra is the tube that runs through the penis. It carries urine from the bladder and semen from the sex glands.
As the prostate is a sex gland, its growth is influenced by male sex hormones. The chief male hormone is testosterone, which is produced mostly by the testicles.
Many men begin to have problems with their prostate as they get older. Most problems are caused by simple enlargement of the prostate, but a few are caused by cancer.
Usually the first sign of trouble is with passing urine. A man may notice one or more of the following symptoms:
• trouble getting the flow of urine started, especially if in a hurry
• trouble stopping the flow of urine (“dribbling”)
• the stream of urine is weak, or it stops and starts
• needing urgently to pass urine at any time
• feeling a need to pass urine more often during the day, even though not much comes out
• getting up at night to pass urine more than once
• feeling a need to pass more urine, even though none comes out
• pain and/or burning when passing urine; this may be a sign of infection.
In men with prostate problems, nine out of ten will have a prostate which has grown too big. This puts pressure on the urethra and may squeeze it enough to block outflow of urine.
This condition of enlarged prostate is called “benign prostatic hyperplasia” or BPH. Benign means it is not cancer, and hyperplasia means “too much tissue”.
BPH occurs with ageing. It affects more than half of all men older than 50.
Medicines or surgery are used to treat it but only when symptoms become troublesome. Remember, BPH is not prostate cancer even though most of the symptoms are the same when passing urine.
Infection of the prostate is called prostatitis. It can cause pain, fever, swelling of the prostate, and blood and pus in the urine.
It may have symptoms similar to BPH. Prostatitis is usually treated with antibiotics. Infection of the bladder usually occurs at the same time as infection of the prostate. If blood appears in the urine (haematuria), contact your doctor for an appointment.
The doctor will need to determine whether the patient’s problems are due to BPH, prostatitis, prostate cancer, or some other cause.
The doctor may do the following tests:
The doctor wears a rubber glove and inserts a finger into the anus to feel the prostate through the wall of the rectum. This is called a digital rectal examination or DRE. The doctor checks the size, shape and hardness of the prostate.
PSA is a small protein released into the blood by the prostate. If the amount of PSA in the blood is above the normal levels, it may be due to an enlarged prostate or prostatitis. If the PSA level is high, it is more likely to be due to prostate cancer. However, results from a PSA test alone cannot confirm whether prostate cancer is present. Other tests need to be done.
Different laboratories use different tests to measure PSA levels in the blood. This can result in different values of PSA levels for the same man. The doctor will take this into consideration when keeping track of a patient’s PSA levels.
A biopsy is the removal of very small pieces of prostate tissue using a fine needle. A local anaesthetic may be given first. Several samples may be taken. Men say the discomfort is mild.
The tissue is then looked at under a microscope to see if cancer cells are present. A biopsy is the only way to show for certain whether or not the man has prostate cancer.
Some doctors like to take a picture of the prostate and nearby organs before they do a biopsy. This is done with an ultrasound probe. By producing a picture of the prostate and nearby organs, ultrasound guides biopsy.
Regular tests are important for men who:
• have a family history of prostate cancer
• are older than 50, but younger than 70
• have any problems with passing urine
As early prostate cancer may not cause symptoms in some men, regular tests may detect cancers that should be treated. If you have any concerns you may want to talk to your doctor about the need for screening and regular tests, and their importance for you.
Your doctor will be able to advise you, based on your medical history, age, personal situation, family history and other factors.
There is debate among cancer experts about the value of mass screening for all men who do not have symptoms. Some doctors and anticancer organisations do not recommend screening tests for prostate cancer in men over 70 because other illnesses are more likely to decrease the quality and length of life.
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