Many men only think about their prostate when something goes wrong. Knowing what this small gland does, and how it changes over a lifetime, makes it easier to spot problems early and to have confident conversations with a doctor.
Where the prostate sits
The prostate is a gland about the size of a walnut in younger men. It sits just below the bladder and in front of the rectum. The urethra, the tube that carries urine from the bladder out through the penis, runs straight through the middle of it.
That position explains why so many prostate problems show up as changes in passing urine. When the prostate grows or becomes inflamed, it can press on the urethra and affect the flow.
What the prostate does
The main job of the prostate is to produce fluid that forms part of semen. This fluid helps to nourish and protect sperm, and it contains a protein called prostate specific antigen, or PSA. Small amounts of PSA pass into the bloodstream, which is why a blood test can measure it.
The muscles of the prostate also help to push semen into the urethra during ejaculation. At the same time, a ring of muscle near the bladder closes so that urine and semen do not mix.
The prostate depends on male hormones, mainly testosterone, to grow and work normally. This link with hormones is important later in life, because some treatments for prostate conditions work by lowering testosterone.
How the prostate changes with age
The prostate grows during puberty and then stays much the same size for many years. From around the age of 40 to 50, it often starts to grow again. This is a normal part of ageing and is called benign prostatic enlargement, or BPE.
An enlarged prostate is not cancer and does not raise the risk of cancer. It can, however, cause symptoms such as:
- needing to pass urine more often, especially at night
- a weak or stop-start flow
- difficulty starting to pass urine
- a feeling that the bladder has not fully emptied
Our page on benign prostatic enlargement explains the condition and the treatments available, including Aquablation therapy.
Three common prostate conditions
Doctors usually think about three main conditions that affect the prostate:
- Benign prostatic enlargement: a non-cancerous increase in size, very common in older men.
- Prostatitis: inflammation of the prostate, which can cause pain and urinary symptoms and can affect men of any adult age.
- Prostate cancer: the most common cancer in men in the UK, which often grows slowly but sometimes needs prompt treatment.
The symptoms of these conditions can overlap, which is why it is always worth getting new urinary symptoms checked rather than guessing at the cause. The NHS guide to prostate problems gives a helpful overview.
Prostate health at different ages
In their 20s and 30s, most men have no prostate symptoms at all. Prostatitis is the condition most likely to cause problems at this stage.
In their 40s and 50s, men may start to notice small changes in urine flow. This is also the time to learn about personal risk factors for prostate cancer, such as family history and ethnicity. Prostate Cancer UK offers a short online risk checker.
From the 60s onwards, an enlarged prostate becomes very common, and the chance of prostate cancer rises with each decade. Regular conversations with a GP about urinary symptoms and PSA testing become more useful.
When to seek advice
You do not need to wait for symptoms to become severe. Speak to your GP if you notice changes in how you pass urine, blood in your urine or semen, or pain in the lower back, hips or pelvis that does not settle.
Early prostate cancer usually causes no symptoms, so a lack of symptoms is not a guarantee that all is well. Our prostate cancer page explains how the disease is assessed and treated.
Professor Prokar Dasgupta sees men with all kinds of prostate concerns at The London Clinic, 145 Harley Street. You can read more about Professor Dasgupta, or contact the clinic to arrange a consultation.