The prostate is a small gland, about the size of a walnut and shaped like a doughnut. It is located in the abdomen, surrounding the urethra at the base of the bladder. One of its roles is to make and store a fluid that makes up semen.
This gland undergoes many changes during a man's life. At birth, it is about the size of a pea. It grows only slightly until puberty, when it begins to enlarge rapidly, attaining adult size and shape when a man reaches his early 20s. It generally remains stable until about the mid-40s when, in most men, it begins to enlarge again.
Conditions of the prostate
There are three main conditions that can affect this gland:
Benign Prostatic Hyperplasia: This is the medical term for a prostate gland that becomes abnormally enlarged. Benign Prostatic Hyperplasia shares many of the same symptoms of prostate cancer where urinary symptoms can be particularly troubling. It can usually be managed with daily medication.
Prostatitis or inflammation of the prostate: This usually occurs as a result of urinary tract infection and can subside when the infection is treated quickly.
Prostate cancer: This is when prostate cells start to grow uncontrollably. If it is not treated, the cancer may spread to other parts of the body. Prostate cancers are not all the same; some are fast growing and others spread very slowly.
Who is at risk?
Age is the most significant risk factor of all for prostate cancer. It is quite rare in men under 50. Nearly two out of three cases occur in men aged 70 and over.
Tiny areas of slow-growing prostate cancer are extremely common among elderly men and many are unaffected by them during their natural lifetime. It is thought that all men would show some signs of prostate cancer if they lived to over 100 years of age (see also Prostate Cancer Facts and Figures).
It is important to note that most men with urinary difficulties or symptoms of Benign Prostatic Hyperplasia are no more at risk of prostate cancer than those without.
Often prostate cancer is ‘silent’, but when symptoms do occur they may include:
The need to pass water more frequently;
Disturbed sleep because of this;
Difficulty or pain when passing water;
Delay or hesitancy before urinating;
A feeling that the bladder has not completely emptied;
Pain or stiffness in the lower back, pelvis and hips.
However, there are a number of other, non-cancerous medical conditions that may also cause these symptoms.
In advanced prostate cancer, the following may also occur:
Pain in the loins, pelvis or lower back;
Blood in the urine or semen.
The main diagnostic screening test for prostate cancer is a Prostate Specific Antigen blood test. There are arguments for and against having the test, as results may be misleading, but your doctor will be able to discuss these with you in detail.
You are also likely to have a digital rectal examination, which can reveal unusual lumps in the prostate gland (see Prostate Cancer Diagnosis).
If either or both of these tests suggest that you might have prostate cancer, your doctor will refer you for a prostate biopsy to find out if the disease is present.
The results of these tests will also indicate whether or not the cancer is aggressive; and will influence the types of treatment available to you.
Prostate cancer, detected early, can be straightforward to treat and there is a good chance that it can be dealt with once and for all. So you should see your GP as early as possible if you have any concerns.
In many men a policy of ‘active surviellance’ is carried out, with regular visits to the doctor for digital rectal examination, blood tests and general check ups before any treatment is started. If symptoms change or become more aggressive, your doctor will then be able to discuss other options with you. These include surgery, radiotherapy or hormone therapy. (See also Prostate Cancer Treatment).
Regular exercise is vital for your general wellbeing
Living with prostate cancer
The extent of your symptoms will vary greatly depending on the type of cancer and the treatment. Difficulties with passing water are very likely and, after either surgery or radiotherapy, many men find they do not have complete control over their bladder.
Sexual problems, such as loss of sex drive, or difficulty getting and maintaining an erection, are also very common. These can be caused by the physical symptoms of prostate cancer, the treatment, or worrying about it. It’s very important to talk openly with your partner about these issues in order to maintain a supportive and loving relationship.
Don’t assume that nothing can be done about such symptoms. There are many ways of managing the problems, so do discuss any worries with your doctor or nurse.
A balanced and healthy diet, low in animal fat and high in fruits and vegetables, is particularly important if you have prostate cancer as there is some evidence to show that it can slow down the illness (see also Diet and Prostate Cancer).
Regular exercise is vital for general wellbeing and specific pelvic floor exercises can help many men regain control of their bladders. Your doctor or nurse will be able to provide advice on improving your diet and to suggest the level of exercise suitable for you.
Where to turn to for information and advice?
Remember - your doctor is likely to have treated many other men with the same problem, so ask their advice and try not to feel embarrassed about discussing your symptoms and feelings.
Most hospital departments will have a specialist nurse to answer questions and relieve anxieties. There are also a number of very active prostate cancer support charities, which can give you advice and information and even put you in touch with other patients who have been through the same experiences. Some of these are listed below.