What is the prostate?

The prostate is a gland which sits below the bladder and in front of the rectum.  The urethra is the tube that empties urine from the bladder and it passes through the prostate.  The prostate produces fluid which forms part of semen.

As we age, the prostate generally enlarges.  As a result, the urethra can get narrowed leading to problems with the flow of urine and also the enlarged prostate can irritate the bladder.

Symptoms of prostate conditions can include:

• Poor stream, where the flow of urine isn’t as strong and it takes a bit longer to empty the bladder.

• Hesitancy, which means you find it takes a while before the urine starts to flow.

• Poorer emptying where you might feel like you don’t fully empty your bladder.

• Dribbling, particularly towards the end of passing urine.

• Nocturia, which means getting up at night to pass urine, more than before.

• Frequency of urination; where you have to pass urine more often than before.

• Urgency which is when you have to run to the bathroom quickly when you need to go.

The symptoms often start gradually over months or sometimes years.  This gradual enlargement is known as benign prostatic hyperplasia (BPH).  If you have any symptoms like this, it is important to talk to your GP about them.  The international prostate symptom score (IPSS) is a useful tool used to screen for symptoms from prostate problems, you could complete one and take it to your GP to discuss.

What might your GP recommend?

Your GP can discuss your symptoms and may recommend an examination of the prostate.  This involves inserting a gloved finger into the rectum to feel the prostate.  An ultrasound or MRI is also an option to assess the size of the prostate. Please do not be put off by the examination, you can still review your prostate health without the examination part.

There are treatments which can help.  Commonly used medicines include alpha-blockers which work by relaxing the muscle in the prostate and bladder improving the flow of urine and 5-alpha reductase inhibitors which work by blocking the conversion of testosterone to dihydrotestosterone in the prostate which can help to gradually reduce the size of the prostate.  

In some cases, your GP might recommend a consultation with a urologist who specialises in dealing with the prostate.  

What tests can be done to investigate prostate health?

There is a blood test called the prostate specific antigen (PSA). This test is not a definitive way of determining if you have cancer; you can get a false positive or false negative result in some cases.  It is important to know though that there are other conditions which can cause a raised PSA.  Generally, it is recommended not to have a PSA check if you have an untreated urine infection, have ejaculated in the last 48 hours, exercised heavily in the last 48 hours, had a prostate exam in the last week or have had receptive anal sex in the last 48 hours.

Other conditions can cause the PSA to be raised including:

• Benign prostatic hyperplasia (BPH)

• Urine retention

• Urine infection

• Acute prostatitis

• Recent prostate surgery

• Having a catheter

What about prostate cancer?

Some people who have a positive PSA turn out to have prostate cancer.  Prostate cancer is a common cancer with approximately 1 in 5 people developing prostate cancer before the age of 85.

Prostate cancer is often very slow growing and in many cases, doesn’t require any treatment.  Sometimes it can be more aggressive and need treatment.  It might seem confusing but if you are diagnosed with suspected prostate cancer your health professional may recommend seeing a urologist, who can advise you if you might benefit from treatment. 

There are some risk factors for prostate cancer such as increasing age, family history and diet.  The possible symptoms of prostate cancer are the same symptoms that you can develop from an enlarged prostate.  

If you have any symptoms or concerns please talk to your GP.