What is the prostate?
The prostate is a gland. It is usually the size and shape of a walnut and grows bigger as you get older. It sits underneath the bladder and surrounds the urethra, which is the tube that carries urine out of the body. The prostate’s main job is to help make semen – the fluid that carries sperm. †
What makes prostate problems more likely?
There are a number of factors that may make prostate problems more likely. These include:
Strong risk factors
- A family history of prostate problems. Figures show that you are two and a half times more likely to get prostate cancer if your father or brother has had it, compared to a man who has no relatives with prostate cancer. Your risk of getting prostate cancer may also be higher if your mother or sister has had breast cancer.
- Ethnicity. While more research is needed to explain why, figures show that African Caribbean men are 2-3 times more likely to develop prostate cancer than their white counterparts and black men are also more likely to develop prostate cancer at a younger age.
Other risk factors
- High calcium intake. A high calcium intake is linked with a higher risk of prostate cancer in many studies.
- Smoking. Smoking appears to result in worse disease. Stopping smoking is always a good idea.
- High cholesterol. There is ongoing debate around a possible link between cholesterol and prostate cancer. This started when a number of observational studies found that high cholesterol levels were associated with an increased risk of total or advanced prostate cancer. Some studies went on to report that those people taking statins, a drug that lowers your cholesterol, appeared to have a lower risk of having advanced prostate cancer. However, the link is far from proven and will need further research before we know if statins could actually protect against prostate cancer.
What you can do to try to keep your prostate healthy
There are a number of lifestyle changes or habits you can adopt to try to look after your prostate. These include:
- Eat tomatoes as part of a Mediterranean diet. Studies suggestthat eating a lot of tomatoes is associated with a reduction in risk of prostate cancer. Tomatoes cooked in oil seem to have a more protective effect, so the Mediterranean diet seems to be most suitable.
- Eat fish. Studies show a 63% reduction in prostate cancer–specific mortality associated with higher total fish intake.
- Do exercise. Among men over 65 years of age, those who did vigorous activity had a 77% lower risk of advanced prostate cancer. Among men diagnosed with prostate cancer, physical activity has been linked to improved survival and decreased prostate cancer progression. Both vigorous and milder exercise appears to be protective and improves quality of life.
- Lose weight if you are obese. Being very overweight appears to make prostate problems more likely and to result in worse outcomes.
- Drink Coffee. Some studies suggest that men who drink many cups of coffee a day are less likely to develop prostate cancer regardless of whether it contains caffeine or not. It’s thought this may be down to the chemicals found in coffee: cafestol and kahweol. However, more research is needed.
- Vitamin D. There is early evidence that Vit D may be protective against prostate cancer. More research is needed but getting the right amount of vitamin D to support your overall health is important regardless.
Prostate related problems
There are a number of problems and diseases that might affect your prostate. These include:
Benign prostate enlargement: Prostate enlargement is a very common condition associated with ageing. More than 1 in 3 of all men over 50 will have some symptoms of prostate enlargement. It’s not known why the prostate gets bigger as you get older, but it is not caused by cancer and does not increase your risk of developing prostate cancer. An enlarged prostate can put pressure on the urethra, which can affect how you urinate.
Prostate cancer: In the UK, prostate cancer is the most common type of cancer in men, with more than 40,000 new cases diagnosed every year. It’s not clear why it occurs, but your chances of developing prostate cancer increase as you get older. The condition mainly affects men over 65, although men over 50 are also at risk.
Prostatitis: Prostatitis is inflammation (swelling) of the prostate gland. It can be very painful and distressing, but will often get better eventually. Prostatitis can come on at any age, but usually between 30 and 50.
Signs and symptoms of prostate problems
There are a range of symptoms that may indicate prostate problems. These can include:
- Difficulty starting or stopping urinating
- A weak flow of urine
- Straining when peeing
- Feeling like you’re not able to fully empty your bladder
- Prolonged dribbling after you’ve finished peeing
- Needing to pee more frequently or more suddenly
- Waking up frequently during the night to pee
- Blood in semen
- Blood in urine
What do my symptoms mean?
If you do experience any of the symptoms listed above, you must talk to your GP. It may be a minor issue, but it is not possible to distinguish between cancerous and non-cancerous (benign) enlargement of the prostate by symptoms alone. So, you need to see your GP if you notice any problems with, or changes to, your usual pattern of weeing. It’s also very important to talk to your doctor if you see any blood in your urine or semen.
Going to the GP for prostate problems
If you do go to the GP for any of the symptoms mentioned above, here’s what you may experience:
- Your GP may ask you about your medical history, including emotional, physical, psychological, sexual, social issues.
- Your GP may ask you a series of questions about any symptoms to better understand your International prostate symptom score (IPSS). This questionnaire can help your GP in determining which treatment option is best for you and then monitoring any improvement.
- You may be asked to fill in a urine frequency volume chart over a number of days.
- Your GP may also review all current medication, including herbal or medicine you can buy at the chemist.
- Your GP may carry out an examination of your tummy, external genitals and examination of your rectum with a finger in order to feel the size and denseness of the prostate.
- You may be offered a urine test for possible infection.
- You may also be offered blood tests to check your kidneys are working properly.
- You may be offered a prostate Specific Antigen Test (PSA test), a test to check for cancer of the prostate (read more about this below in the next section).
- You can expect to be referred to a team specialising in the management of urological cancer within 2 weeks if the GP finds:
– A hard, irregular prostate on rectal examination
– A high (or rising) PSA after blood tests
– Significant blood in the urine
You may be offered an MRI scan of the prostate to help doctors decide if you need further tests and treatment. You may need other tests, such as a biopsy. This involves taking small samples of your prostate and checking them for cancer.
- Your GP should offer you reassurance and lifestyle advice and provide access to support for relevant physical, emotional, psychological, sexual and social issues.
The PSA Test
The PSA test is a blood test to help detect prostate cancer. It’s not perfect and will miss about 15% of cancers. About 3 in 4 men with a raised PSA level will not have cancer.
Before deciding to have the PSA test, you may want to talk to a GP and practice nurse, as well as your partner or a friend or family member.
A raised PSA level in your blood may be a sign of prostate cancer, but it can also be a sign of other conditions that are not cancer, such as:
PSA screening. The debate.
There’s currently no screening programme for prostate cancer in the UK although men over 50 can ask for a PSA test from their GP. That’s because the NHS says results can be unreliable as outlined earlier. If you are offered PSA test it’s worth talking to your GP and weighing up your options as it can potentially lead to unnecessary investigations and even treatment.
There is an argument for African-Caribbean men with a family history of prostate cancer to get screened, as they have a particularly high risks and, in their case, the benefits of screening may outweigh the risks.
†The following people have a prostate:
- Trans women*
- Non-binary people who were assigned male at birth**
- Some intersex people.***
*A trans woman is someone who was assigned male at birth but identifies as a woman. Trans women can develop prostate problems, even if they have taken hormones. The prostate is not removed during genital reconstructive surgery.
** A non-binary person may not identify as a man or a woman.
*** An intersex person may have both male and female sexual characteristics and so might have a prostate.