The prostate gland is a small gland located beneath your bladder, which is responsible for producing the semen which nourishes and transports sperm.
The tube which transports urine from the bladder to the penis (the urethra) passes straight through the centre of the prostate. When the prostate becomes enlarged due to various conditions, it can restrict the urethra and cause difficulty in urination.
There are three main conditions which affect the prostate: prostatitis, benign prostatic hyperplasia, and prostate cancer.
What is Benign Prostatic Hyperplasia?
Benign Prostatic Hyperplasia (BPH) is an enlargement of the prostate gland which is not related to cancer. It is a common condition in older men, affecting around 1/3 of men over 50 and 60% of men over 60.
What is Prostatitis?
Prostatitis is an inflammation of the prostate gland, generally caused by infection. It most commonly results from bacteria leaking into the prostate from a urinary tract infection (UTI). Prostatitis usually calms down on its own, but antibiotics and medical intervention may be prescribed if the condition doesn’t clear up or if it comes and goes over a period of months.
What is Prostate Cancer?
Around 16,000 Australians are diagnosed with prostate cancer every year, making it the second most diagnosed cancer in men. When detected early, the five-year survival rate for men with prostate cancer is 95%.
Is BPH connected to Prostate Cancer?
BPH is not linked to prostate cancer, and suffering from it does not increase your risk of developing prostate cancer. However, symptoms for BPH and prostate cancer can be very similar. As a result, you will need to be thoroughly screened for signs of prostate cancer before undergoing treatment for BPH.
What makes you more at risk for prostate conditions?
- Age – prostate conditions become more common with age as the prostate continues to grow throughout most of your life. In some men, this causes it to compress the urethra and cause lower urinary tract symptoms (LUTS).
- Family history – if men in your family have been diagnosed with a prostate condition (especially prostate cancer), you are more likely to eventually suffer from the condition yourself. Having a father or brother who has prostate cancer more than doubles your risk of developing it yourself.
- Diet – no study has been able to conclusively prove that nutrition can cause or prevent prostate conditions, but many studies have shown that there may be a connection between diet and certain conditions, particularly cancers. No specific vitamins, minerals, or other supplements have been conclusively proven to help prevent prostate cancer.
- Ethnicity – although the reason as to this is unclear, prostate conditions (particularly cancer) tend to develop more often in men of African descent and less often in men of Asian and Hispanic descent.
- Obesity – obesity has been shown to be a risk factor for a wide variety of health conditions, including many types of cancer. Losing excess weight could potentially reduce your chances of contracting a prostate condition (particularly prostate cancer).
What are the warning signs for prostate conditions?
Warning signs for prostate conditions generally come in the form of lower urinary tract symptoms (LUTS). These include:
- Urinary frequency– needing to pass urine more than usual
- Poor flow– your urine stream may be weak or interrupted
- Poor emptying– having a dribbling and/or feeling of fullness after emptying, and feeling that you need to go again straight away
- Nocturia– needing to get up in the night to urinate
- Urge– the need to rush to the bathroom to avoid leaking
- Burning or pain during urination – this can also be due to bladder or urinary tract infections
- Inability to urinate – this is a serious symptom which can lead to infection and further complications. See your doctor immediately if you are unable to urinate.
Other warning signs may relate to sexual function. These include:
- Blood in urine or semen
- Difficulty getting an erection (erectile dysfunction)
- Painful ejaculation
- Failing to ejaculate on orgasm (retrograde ejaculation)
How are prostate conditions treated?
The first line treatment option is management through medication. This can be effective but unfortunately is limited in most men by either cardiovascular side effects (dizziness, fainting) or sexual dysfunction (impotence, reduced libido).
The current gold-standard next line treatment is currently TURP – where a large tube inserted via the penis is used to core away the inside of the prostate. Whilst this does improve symptoms, it comes with surgical risk and is strongly associated with incontinence and retrograde ejaculation (failure to ejaculate on orgasm).
Other urological treatment options come with similar invasive nature and risks (Laser/greenlight) or are less well established and still require entry via the penis (eg. urolift).
Undoubtedly, symptoms are best managed by an individual patient-centred approach and some men would be best served by surgery and others by PAE or other options. When you are seen in rooms by the IR specialist you can trust that you will be only offered treatment if it is thought to be your best option.
What is PAE?
PAE stands for prostate artery embolisation. This is a newer procedure used to treat benign prostate hyperplasia (BPH) – a condition resulting in the enlargement of a prostate, a common cause for lower urinary tract symptoms (LUTS). Having been used for over 10 years now, it has been established as an effective treatment: over 90% of men gain symptomatic improvement (decreases in prostate volume and increases in urinary flow rates) following the procedure.
For more information on PAE, click here.
How do I find out if I have a prostate condition?
A variety of scans can be used to determine whether or not you have a prostate condition and its severity. These include:
Digital Rectal Examination (DRE) – your healthcare professional inserts a gloved and lubricated finger into the rectum and feels the prostate for any hard, lumpy, or otherwise abnormal areas. This process only takes a few minutes and does not cause significant pain.
Prostate-Specific Antigen (PSA) blood test – this is used to help detect prostate cancer, but can also detect non-cancerous causes for prostate issues. The PSA blood test assesses the levels of PSA (a hormone produced by the prostate) in the bloodstream and uses the level to assess whether or not you may have a prostate condition.
Urine Flow Study – this test involves urinating into a device which can measure the flow rate and quantity of urine produced.
Ultrasounds – transrectal and transabdominal ultrasounds can be used to assess the size of the prostate and the amount of urine left in the bladder after urination.
Prostate Biopsy – in this test, the physician removes small slivers of the prostate tissue with a tiny needle, which can then be examined under a microscope for signs of a condition.
Prostate MRI – this provides a view of the entire prostate and can be used to assess its size. It is also increasingly used to detect prostate cancer.