A five-minute guide to Prostate Health
19 December 2022
From the age of 50, going to the loo can become a difficult or even painful experience for many men and trans women, usually because their prostates have increased in size.
Having an enlarged prostate doesn't mean you will develop prostate cancer, though. In fact, prostate enlargement is extremely common, with one in three older men experiencing a reduced urine flow, difficulty finishing peeing, or a feeling of not being able to empty the bladder.
That said, it's important for anyone with these symptoms to rule out prostate cancer, prostatitis (an infection) and UTIs (urinary tract infection).
So, if urinating becomes problematic for any reason, it's time to make an appointment with your GP.
Know your numbers
A third of men aged 50+ experience symptoms of prostate enlargement.1
What is the prostate?
The prostate is a small gland located deep inside the groin below the bladder. It surrounds the urethra, which is the tube that empties urine from the bladder, and its main function is producing a white liquid that combines with sperm to make semen.
Roughly walnut sized in a young adult male, the prostate tends to get larger as you get older.
What is benign prostate enlargement?
Benign prostate enlargement affects millions of men over the age of 50 and - although annoying to live with - is not a serious threat to your health.
Common symptoms include:
- Needing to pee more frequently
- Feeling as though you can't pee without straining
- Difficulty in 'finishing', and sometimes dribbling
- Waking up in the night to pee.
The symptoms of difficulty urinating, needing to pee more frequently, and feeling like you can't empty your bladder can often be relieved by reducing your intake of drinks such as coffee, black tea, and alcohol.
What if my symptoms get worse?
Your GP can prescribe various medications if the symptoms of an enlarged prostate become difficult to live with, for example because you have pain or bleeding when urinating or ejaculating.
Commonly prescribed medications include Finasteride or Dutasteride to reduce prostate size, and Tamsulosin or Alfuzosin to relax the bladder muscles. And in severe cases, surgery is also an option.
However, if you have prostatitis, or inflammation of the prostate, it will be treated with painkillers, an "alpha blocker" or antibiotics instead.
Your GP will also want to check whether you could have prostate cancer.
Fact or fiction?
You should check your testicles for prostate cancer. Fiction: when you check your testicles (which you should do regularly throughout adulthood) you are checking for testicular cancer, not prostate cancer.
Prostate cancer: am I at risk?
You may have a higher risk of developing prostate cancer if:
- You are aged 50 or over
- Someone in your family (brother/father) has had prostate cancer
- You are of black ethnic origin
- You are overweight
It is unusual for people under 45 to get prostate cancer, but the risk increases as you get older. Whatever your age, however, it's always worth seeing your GP if you notice symptoms.
How is prostate cancer diagnosed?
One way to check if you have prostate cancer is to do the PSA test, a blood test that measures the PSA (prostate-specific antigen) in nanograms per millilitre of blood.
However, a raised level of PSA is only linked to cancer in 25% of cases. And some people get a normal PSA test result despite having prostate cancer at the time2. These inaccuracies are one reason why there is currently no NHS prostate cancer screening programme in place.
A digital-rectal examination is another way of testing for suspected prostate cancer.
Did you know?
About 50,000 men are diagnosed with prostate cancer each year in the UK3.
What's the prognosis for prostate cancer?
The positive news is that prostate cancer tends to grow slowly compared to other cancers; as a result, less than a quarter of those with a diagnosis go on to die from it.
If you are diagnosed with prostate cancer, you will get a "Gleason Score" which tells you how aggressive the cancer is and how likely it is to spread, either quickly or slowly.
There are three types of prostate cancer:
- Localised prostate cancer is slow-growing, and many people never need treatment, simply monitoring. If you do require treatment, it could get rid of the cancer either permanently or temporarily.
- Localised advanced prostate cancer does require treatment, often in the form of hormone therapy. As with most cancer treatments, this could remove the cancer forever, but you may require further treatment after a while.
- Advanced prostate cancer is not curable, although there are various treatments to control it and help you to live with the symptoms.
Did you know?
Cancer Research UK reports that treatment at stages 1 and 2 results in a near 100% five-year survival rate, falling to around 50% at stage 44.
What are the treatments for prostate cancer?
There are various ways that specialists can treat prostate cancer, depending on which type you have and whether it has spread. Options include:
- External beam radiotherapy - for localised cancers, this treatment aims to control the cancer to slow its growth or relieve symptoms
- Permanent seed brachytherapy - involves tiny radioactive 'seeds' being placed in the prostate to stop the cancerous cells dividing and growing
- Surgery - a prostatectomy to remove the prostate and the cancerous cells could be a possibility if your cancer hasn't spread outside the prostate
- HIFU (High Intensity Focused Ultrasound) - this treatment is also suitable for localised cancers
- Hormone Therapy - prostate cancer cells usually need testosterone to grow, so the aim is to stop this happening by taking medication or using an implant or injection. In severe cases, the testicles - or part of them - may also have to be removed
- Chemotherapy - may be offered if the cancer is more advanced; it helps to control growth and manage your symptoms
- Radium-223 - can be helpful if the cancer has spread to your bones and your body has stopped responding to hormone therapy
- Clinical trials - you may be offered the opportunity to help trial newer treatments such as focal cryotherapy which uses extreme cold to destroy cancer cells.