What Is the Prostate? What's Normal?

Many men aren't sure what their prostate is, what it does, or when to call a doctor if they think they might have a problem. So, information is the best tool you have in dealing with this aspect of men’s health.

What Does My Prostate Do?

It is a small gland that is part of the male reproductive system. It's supposed to be about the shape and size of a walnut.

It rests below your bladder and in front of your rectum. It surrounds part of the urethra, the tube in your penis that carries pee from your bladder.

The prostate helps make some of the fluid in semen, which carries sperm from your testicles when you ejaculate.

This Gland Can Grow

As you age, your prostate can become larger. It’s a normal part of aging for most men.

By the time you reach age 40, your prostate might have gone from the size of a walnut to the size of an apricot. By the time you reach 60, it might be the size of a lemon.

Because it surrounds part of the urethra, the enlarged prostate can squeeze that tube. This causes problems when you try to pee. Typically, you won’t see these problems until you’re 50 or older, but they can start earlier.

You might hear a doctor or nurse call this condition benign prostatic hyperplasia, or BPH for short. It is not cancerous.

Who Might Get an Enlarged Prostate?

BPH is common and cannot be prevented. Age and a family history of BPH are two things that increase the chances you might get it. A few stats on that:

  • Some 8 out of every 10 men eventually develop an enlarged prostate.
  • About 90% of men over the age of 85 will have BPH.
  • About 30% of men will find their symptoms bothersome.

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Symptoms

If you have trouble starting to urinate or have to go a lot, especially at night, these could be signals that you have an enlarged prostate. Other signs and symptoms include:

  • Your bladder doesn’t empty completely after you pee
  • You feel the need to go out of the blue with no sensation of build-up
  • You may stop and start several times
  • You have to strain to get any flow going

It’s important that you see your doctor if you have early symptoms of BPH. Although rare, it can lead to serious problems such as kidney or bladder damage.

A larger prostate doesn’t mean you’ll have more or worse symptoms. It’s different for each person. In fact, some men with very large prostates have few, if any, issues. But your doctor should be aware either way.

Treatments

How your doctor handles your condition depends on the details of your case -- your age, how much trouble it’s causing, and more. Treatments may include:

Watchful waiting. If you have an enlarged prostate but are not bothered by symptoms, you may be advised merely to get an annual checkup, which might include a variety of tests.

Lifestyle changes. This includes cutting back on how much you drink at night and before bedtime, especially drinks with alcohol or caffeine.

Medicine. Common treatments for BPH are alpha-blockers, which ease BPH symptoms, and what’s called 5-alpha reductase inhibitors, or 5-ARIs, which help shrink the prostate. Many men may take them together.

The FDA now requires labels on the 5-ARIs to include a warning that they may be linked to an increased chance of a serious form of prostate cancer. These medications are dutasteride (Avodart) and finasteride (Propecia and Proscar). The combination pill Jalyn also contains dutasteride as one of its ingredients.

Surgery. Men with severe symptoms who haven't been helped by other treatments might have to turn to surgery. Talk to your doctor about possible risks and outcomes.

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Prostatitis

This is an infection or inflammation of the prostate; it’s not the same thing as BPH, though some of the symptoms are similar.

It can affect men from their late teens well into old age. Symptoms include:

  • Trouble passing urine
  • Chills and fever
  • Sexual problems

Treatment usually includes antibiotics.

If you have recently had a catheter or other medical instrument put into your urethra, you have a higher chance of getting bacterial prostatitis. Some sexually transmitted diseases, such as chlamydia, may also cause ongoing infection and inflammation.

Prostate Tests

Your doctor can use a variety of tests to check on the condition of your prostate. A few of them include:

Digital rectal exam: Your doctor puts on a glove and gently inserts one finger into your rectum to check the size and shape of your prostate. He checks for things such as size, firmness, and any lumps.

Prostate-specific antigen test: This blood test checks the amount of a protein called PSA that is produced by prostate cells. Higher levels may be a sign of cancer. By themselves, they are not proof you have prostate cancer.

Higher levels could also point to an enlarged prostate or prostatitis. But, levels may be low even with men who have prostate cancer, so discuss the results with your doctor.

Prostate biopsy: Men with high PSA results or other symptoms of cancer may have a tissue sample taken of their prostate to determine whether cancer is present.

Screening for Cancer

Screening for prostate cancer is controversial. You may read different kinds of advice and guidance from various sources. Talk to your doctor about what is best for you.

The American Cancer Society: It says men should talk to their doctors about the benefits, risks, and limits of prostate cancer screening before deciding whether to be tested. This discussion should take place:

  • At age 50 for men with an average chance for prostate cancer
  • At 45 for men with a higher chance for the condition: this includes African-Americans and men who have a father, brother, or son who has been diagnosed with prostate cancer at 65 or younger
  • At age 40 for men who have more than 1 first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age

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The American Urological Association: It recommends that men age 55 to 69 who are considering screening should talk with their doctor about the risks and benefits of testing and make the decision based on their personal situation and needs.

The group does not suggest screening for:

  • Men 39 and younger
  • Men who are 40 to 54 and have only an average chance of getting cancer

A routine interval of 2 years or more may be preferred over yearly tests in those men who have decided on screening after talking with their doctor.

Compared with annual screening, it is expected that 2-year intervals give you most of the benefits and reduce false positive results.

Routine PSA screening is not recommended for men older than 70 or for any man who is expected to live only 10 to 15 more years.

The U.S. Preventive Services Task Force: It doesn't recommend routine PSA screening for men in the general population, regardless of age.

They say the tests often may find cancers that are so slow-growing that medical treatments, which can have serious side effects, may offer no benefit.

WebMD Medical Reference Reviewed by Laura J. Martin, MD on October 06, 2016

Sources

SOURCES:

U.S. Food & Drug Administration website.

National Cancer Institute: "Prostate Cancer."

UrologyHealth.org: "Adult Conditions: Prostate," "BPH Treatment."

Urological Science Research Foundation.

American Cancer Society: "Detailed Guide: Prostate Cancer."

U.S. Preventive Services Task Force.

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