For something roughly the size of a walnut, the prostate can cause an astonishing amount of trouble.
Most men spend the first several decades of their lives barely knowing it’s there. Then comes middle age, and suddenly trips to the bathroom become more frequent, the urinary stream isn’t quite what it used to be, or the doctor starts talking about something called a PSA test.
The prostate isn’t something men necessarily enjoy discussing. But understanding it—and knowing when something needs medical attention—becomes increasingly important as we get older.
What Exactly Is the Prostate?
The prostate is a small gland in the male reproductive system located below the bladder and in front of the rectum. The urethra—the tube carrying urine out of the body—passes through it.
Its primary job is reproductive. The prostate produces some of the fluid that becomes part of semen and helps support and transport sperm.
In younger men, it’s normally about the size of a walnut.
The problem is that it usually doesn’t stay that size.
The Prostate Changes as We Age
For many men, the prostate gradually enlarges with age.
This extremely common condition is called benign prostatic hyperplasia, or BPH.
“Benign” is important: BPH is not prostate cancer.
However, because the prostate surrounds part of the urethra, an enlarging prostate can begin squeezing it and interfering with the flow of urine.
That can produce symptoms such as:
- Needing to urinate more frequently
- Getting up repeatedly during the night to urinate
- Difficulty starting urination
- A weak or interrupted urine stream
- Dribbling after urination
- Feeling as though the bladder hasn’t completely emptied
- A sudden or urgent need to urinate
These symptoms become increasingly common as men get older.
But don’t automatically diagnose yourself with an enlarged prostate.
Similar symptoms can sometimes result from urinary tract infections, bladder problems, prostatitis and other medical conditions. They can also occur with prostate cancer.
That’s why persistent changes deserve a conversation with a healthcare professional.
Then There’s Prostate Cancer
Prostate cancer is among the most commonly diagnosed cancers in American men.
The encouraging news is that many prostate cancers grow slowly, and some may never cause serious problems during a man’s lifetime.
Others can be aggressive.
One difficulty is that early prostate cancer often causes no symptoms at all.
When symptoms do occur, they can include urinary problems, blood in the urine or semen, erectile difficulties, or persistent pain in the back, hips or pelvis. Those symptoms can also have causes other than cancer, so their presence does not mean someone has prostate cancer.
They do mean it’s worth getting checked.
What About the PSA Test?
PSA stands for prostate-specific antigen, a protein produced by prostate cells. A PSA test measures its level in the blood.
An elevated PSA can be associated with prostate cancer—but this isn’t a simple cancer/no-cancer test.
PSA can also rise because of an enlarged prostate, inflammation, infection and other factors. Some men with prostate cancer don’t have dramatically elevated PSA levels.
That’s one reason prostate-cancer screening isn’t simply a matter of telling every man to get the same test at the same age.
For many men, the decision should be made after discussing the potential benefits and drawbacks of screening with a healthcare professional.
Age matters. So does family history.
Men with a father or brother who developed prostate cancer—particularly at a younger age—can face greater risk. Black men also have higher rates of prostate cancer and prostate-cancer mortality in the United States.
Your personal risk should help determine when the screening conversation begins.
Yes, We Have to Talk About That Exam
It’s probably one of the most joked-about examinations in men’s healthcare: the digital rectal examination, or DRE.
During a DRE, a healthcare professional inserts a lubricated, gloved finger into the rectum to feel part of the prostate and check for abnormalities.
Is it anyone’s favorite way to spend an afternoon?
Probably not.
But embarrassment isn’t a particularly good medical strategy.
The examination is generally brief, and whether a doctor recommends one depends on the patient’s symptoms and circumstances. It also isn’t a replacement for other methods of evaluating prostate problems.
If your doctor thinks it’s necessary, a few uncomfortable moments are a pretty reasonable trade for useful medical information.
Don’t Ignore an Inability to Urinate
There is one prostate-related symptom that shouldn’t wait for a routine appointment.
If you suddenly cannot urinate at all, particularly if your bladder feels painfully full, seek medical care promptly.
Severe obstruction can cause acute urinary retention and may require immediate treatment.
Blood in the urine, significant pain, fever accompanying urinary symptoms, or rapidly worsening symptoms also deserve medical attention.
What Can Men Do?
There isn’t a magic food, vitamin or supplement guaranteed to prevent prostate enlargement or prostate cancer.
That hasn’t stopped an enormous industry from selling men products suggesting otherwise.
Be skeptical of supplements promising to “shrink your prostate,” “prevent prostate cancer,” or replace medical evaluation. “Natural” does not automatically mean effective—or harmless—and supplements can interact with medications.
The less exciting advice remains the useful advice: maintain a healthy weight, stay physically active, don’t smoke, eat a balanced diet, manage chronic health conditions and keep up with routine medical care.
Most importantly, notice when something changes.
Men Are Not Always Great at Going to the Doctor
We’ll drive a car for three weeks while it’s making a horrible noise and convince ourselves it’s probably fine.
Unfortunately, some of us treat our bodies the same way.
Urinary changes can be embarrassing. Sexual problems can be even harder to discuss. And fear of hearing bad news sometimes convinces people that avoiding the doctor somehow prevents the problem.
It doesn’t.
Most urinary symptoms aren’t proof of prostate cancer. Many prostate problems are treatable, and even when cancer is discovered, finding it at an appropriate stage can make an enormous difference in the options available.
Growing older comes with enough surprises.
Your prostate doesn’t need to be one of them.
If you’ve noticed changes—or you’re simply reaching an age when prostate health and cancer screening deserve a conversation—talk with your healthcare professional.
A walnut-sized gland isn’t particularly intimidating.
Ignoring one can be.
This article provides general health information and is not a substitute for medical advice, diagnosis or treatment. Talk with a qualified healthcare professional about your individual symptoms, risk factors and screening decisions.
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