Prostate disease

Prostate disease is a general term used to describe a number of medical conditions that can affect the prostate gland.

The prostate gland

The prostate gland is a small gland only found in men. It opens into the urethra (the tube that carries urine from the bladder to the penis), and sits just below the bladder and vas deferens (a pair of ducts through which sperm passes before ejaculation).

The prostate gland helps with the production of semen (the fluid that transports sperm). It produces a thick, white fluid that's liquefied by a special protein called prostate-specific antigen (PSA). The fluid is mixed with sperm, produced by the testicles, to create semen.

There are a number of conditions that can affect the prostate gland including:

prostate enlargement
inflammation of the prostate gland (prostatitis)
prostate cancer

Below is a summary of these conditions, plus links to more detailed information about each of them.

Prostate enlargement

Prostate enlargement is a common condition associated with ageing. About a third of all men over 50 years of age will have symptoms of prostate enlargement (see below).

The urethra is a tube that runs from the bladder through the prostate to the end of the penis. Urine flows through the urethra and out of the body when a man urinates. If the prostate becomes enlarged it can place pressure on the urethra, making it more difficult for the bladder to empty.

An enlarged prostate can cause symptoms that can affect the normal pattern of urination. For example, it can:

make it difficult for you to start urinating
weaken the flow of urine or cause 'stopping and starting'
cause you to strain to pass urine
cause you to pee more frequently
wake you up frequently during the night to pee

A simple treatment for prostate enlargement is to reduce the amount you drink before you go to bed.

Medications, such as alpha blockers, are also available to help relax the prostate gland muscles, or reduce its size, making it easier to urinate.

In severe cases that fail to respond to medication, the inner part of the prostate gland that is blocking the urethra can be surgically removed.

Prostatitis

Prostatitis is a poorly understood condition where the prostate gland becomes inflamed (red and swollen). Inflammation often occurs as a response to infection, but in most cases of prostatitis no evidence of infection can be found.

Symptoms of prostatitis include:

pelvic pain
testicular pain
pain when urinating (this is less common and more likely with a urinary tract infection)
pain when ejaculating semen
pain in the perineum (the area between the anus and back of the scrotum), which is often worse when sitting, particularly on hard chairs and bicycle saddles

Prostatitis is thought to affect up to 3 in 20 men (15%) at some point in their lives. Although it can affect men of any age, it is more common in men between 30-50 years of age.

Prostatitis can be treated using a combination of painkillers and a type of medication known as an alpha-blocker, which can help relieve the symptoms.

Prostate cancer

In the UK, prostate cancer is the most common type of cancer in men, with over 40,000 new cases diagnosed every year.

Your chances of developing prostate cancer increase with age. Most cases occur in men who are 50 years of age or older.

The causes of prostate cancer are unknown, but risk factors include age, ethnic origin and family history.

The symptoms of prostate cancer are similar to those of prostate enlargement and include:

needing to pee more frequently (often during the night)
needing to rush to the toilet
difficulty starting to urinate (hesitancy)
straining or taking a long time while peeing
weak flow
feeling that your bladder has not emptied fully

The outlook for prostate cancer is generally good because, unlike many other types of cancer, it usually progresses very slowly. Many men die with prostate cancer, rather than as a result of having it.

If treated early, prostate cancer can often be cured. Treatments include:

surgery to remove the prostate gland
radiotherapy - using radiation to kill the cancerous cells
hormone therapy - using medication to block the effects of testosterone (the hormone that stimulates prostate cancer)

These treatments carry the risk of significant side effects including:

loss of libido (sexual desire)
erectile dysfunction (the inability to obtain or maintain an erection)
urinary incontinence (loss of bladder control)

For this reason, many men choose to delay treatment until there is a significant risk of the cancer spreading.

It's usually not possible to cure the cancer if it spreads from the prostate gland to other parts of the body (a process known as metastasis). In this case, the aim of treatment will be to relieve the symptoms and prolong life.