What is the prostate gland for?

The prostate is a small male gland about the size of a walnut. The prostate gland produces a thick clear fluid that mixes with sperm to form semen, often known as the ejaculate. It is situated under the bladder, and the urethra (the tube that carries urine out of the bladder) runs through this gland. The prostate is composed of glands and muscle tissue. Its surface is covered with blood vessels and nerves. It is divided into left and right lobes. In addition, it has 2 ‘zones’ – the transitional zone and the peripheral zone. In the case of prostatic disease, benign prostatic hyperplasia (BPH) is more frequently found in the transitional zone and prostate cancer more frequently in the peripheral zone. A number of hormones control its growth and function, including testosterone. As you get older, the prostate can become enlarged, thereby causing problems with the outflow of urine from the bladder.​ For further information see the About the prostate gland page

I have an enlarged prostate. What does this mean?

In many men, the prostate becomes larger as you get older, particularly in men older than 45 and most frequently over the age of 60. The symptoms often include difficulty in urinating, dribbling, a sensation of not quite emptying the bladder, or having to get up several times in the night to urinate. Different kinds of prostate problems can all cause the prostate to become enlarged or inflamed including prostatitis, very commonly benign prostatic hyperplasia (BPH) and sometimes, (mainly in older men), prostate cancer. If you have symptoms, you may wish to take our symptom self examination test  to help gauge the severity of your symptoms. For more information about BPH see the BPH pages 

I find it difficult passing water and get up frequently at night to urinate. Do I have prostate cancer?

There are many possible reasons for finding it difficult to urinate and having to get up frequently at night to urinate. This can often be caused by the enlargement of the prostate, as the prostate continues to grow in most men and this can restrict urinary flow. A frequent condition amongst men over the age of 45 (nearly half) and the majority of men in their sixties is called benign prostatic hyperplasia (BPH). BPH is where non-cancerous growths occur in the prostate, which can affect the urinary flow. Another condition which can affect men is called prostatitis, which is an inflammation of the prostate. This can be a long-standing condition and sometimes is an acute condition that suddenly occurs. Sometimes, mainly in older men, symptoms such as difficulty in urinating might be an indication of prostate cancer. The most important thing is to seek medical advice, so as to rule out the possibility of prostate cancer.

If you have such symptoms, don’t ignore them. Visit your GP, as there is often a treatment that can be considered. You may find it helpful to take our self examination to gauge the severity of your symptoms and take it with you to your doctor.​

I have been told I might have BPH. What is it?

​Benign prostatic hyperplasia (BPH) is a condition which can affect men through an enlarged prostate, due to the growth of non-cancerous tumours. A small amount of prostate enlargement is present in many men over the age of 40 and particularly affects men over the age of 50. Nearly half of men over the age of 65 have either urinary symptoms or a reduced urinary flow due to BPH. Symptoms can include reduced urinary flow, dribbling after finishing urinating or an urgency to go to the toilet. Symptoms may start off as mild, but over time can get more severe and require treatment. Untreated BPH can, in some cases, lead to an inability to urinate or a build up of bladder stones or urinary infections.​ For further information see the BPH pages

I have been told I have Prostatitis. What is it and how treatable is it?

Prostatitis is an inflammation/infection of the prostate and can produce a number of symptoms. It can cause chills, fever, pain in the lower back, leg, genital area and penis, frequent, painful or burning urination, body aches or painful ejaculation. Occasionally the sufferer may be completely unable to pass urine. Prostatitis is often linked to a urinary infection, as evidenced by bacteria in the urine. There may also be discharge from the penis. Prostatitis can be a long-standing condition, but can sometimes occur as a more sudden infection.

Prostatitis is usually treatable. Your doctor may give you a digital rectal examination (DRE), using a gloved finger to check on your prostate, and may also undertake blood and urine tests to check on infection, as well as a semen sample. In some cases, they will undertake a PSA (prostate specific antigen) test to rule out the possibility of BPH or even prostate cancer. As there are different kinds of prostatitis the treatment can vary, but bacterial prostatitis can involve antibiotics to kill the infection. See prostatitis pages​

What is a PSA test?

Prostate specific antigen (PSA) is a protein that comes from prostatic tissue, and its level can be checked via a blood test. It is useful in telling doctors which treatments may benefit patients with non-cancerous and cancerous prostate diseases, who needs to be examined further for prostate cancer, and for monitoring treatment for prostate cancer.

The test works by measuring out the amount of the protein in the blood. As an increased level of the protein can be found as a consequence of a number of reasons such as age, non-cancerous prostatic growths and urinary infections, a high PSA does not always mean the presence of prostate cancer.

A PSA test may detect prostate cancer at an early stage when it can be detected by no other means, and even when there are no other symptoms at all. However, not all men who have a raised PSA level will have prostate cancer. If prostate cancer is diagnosed, the PSA test can be very valuable in monitoring the condition as well as the response to all forms of treatment. For further information about the PSA test see the leaflet PSA-testing for you and your prostate or PSA Explanatory-booklet

What are the symptoms of Prostate Cancer?

Symptoms of prostate cancer can be a slowing of urine, dribbling, an urgency to urinate or needing to get up frequently at night to urinate. Often, however, these symptoms can be for benign prostatic hyperplasia (BPH) rather than prostate cancer. However, early prostate cancer may not show any symptoms.

As prostate cancer can spread through the lymph nodes (small parts of the body that help with fluids and support the body’s defences) and the bones, pain may be felt in the hip, lower back or bones.  For further information see the prostate cancer pages

What sorts of investigations is my doctor likely to carry out?

Your doctor may ask you to complete a questionnaire, like the self examination here, to help gauge the severity of your symptoms.

If you have symptoms, you will probably be offered a digital rectal examination (often known simply as a DRE, which involves the doctor inserting a gloved finger into your rectum to check your prostate) and a blood test for prostate specific antigen (PSA). If these suggest that you may have a risk of prostate cancer, you will probably be offered a trans-rectal ultrasound (TRUS) guided prostate biopsy. This involves inserting a probe via your rectum to take small samples of prostate tissue, which can then be analysed in a laboratory. See the investigations and tests page

I have a prostate problem and have been advised to see a specialist to see if surgery is necessary. What is involved?

Your consultant will talk through the situation with you and consider, often following further investigations, what the most appropriate course of treatment is and if surgery is necessary.

In the case of benign prostatic hyperplasia (BPH), a procedure known as a TURP (transurethral resection of the prostate) may be undertaken to remove part of the prostate. This is done through the urethra (the water pipe) to avoid any scars.  Sometimes a procedure known as a TUIP (transurethral incision of the prostate) is undertaken, which is aimed at overcoming blockages in men with a smaller prostate. Recently in some areas there has also been more minimally invasive laser treatments including Green Light Laser or Holmium laser treatment. For more information about surgical treatments for BPH see the  benign prostatic hyperplasia (BPH) pages.  Surgery can also involve open or minimal access (keyhole) prostatectomy – the surgical removal of part or all of the prostate, which may also be the suggested treatment for prostate cancer.

Any procedure may have some risk or side effects. Your treatment will depend on the nature and state of your prostate disease, and, for some conditions, surgery may be the most effective treatment. Sometimes you may be offered a combination of surgery and medicines. Sometimes a minor operation may be necessary to diagnose the nature of the problems prior to treatment options being determined. Your doctor will discuss these options with you.

In the case of prostatitis when the cause is a bacterial infection, your doctor may consider prescribing you antibiotics. In some cases, medications may be prescribed to deal with the symptoms of benign prostatic hyperplasia (BPH). One key group of medicines, known as 5-alpha reductase inhibitors, can be used to block the natural hormone testosterone that makes the prostate enlarge. In some cases, medicines called alpha-blockers are used. These relax the smooth muscle in the prostate gland by blocking so-called alpha-receptors, allowing urine to flow more easily. At times, your doctor may suggest a combination of these.

With prostate cancer, you may be prescribed a course of hormonal therapy in the early stages, prior to any radiotherapy that you may be offered. Usually this is for 3 months for patients with localised disease, but in cases where the patient may have locally advanced disease or their PSA reading is very high, the oncologist (cancer doctor) may suggest that the hormone treatment be continued for a number of years.

In the case of advanced prostate cancer, treatment is often in the form of hormone therapy, utilising a group of drugs to reduce the production of testosterone, as testosterone can promote the growth of prostate cancer cells. Your treatment will depend on the nature and state of your prostate disease, and, for some conditions, surgery may be the most effective treatment. Sometimes you may be offered a combination of surgery and medicines. Sometimes a minor operation may be necessary to diagnose the nature of the problems prior to treatment options being determined. Your doctor will discuss these options with you.

In the case of prostatitis when the cause is a bacterial infection, your doctor may consider prescribing you antibiotics. In some cases, medications may be prescribed to deal with the symptoms of benign prostatic hyperplasia (BPH). One key group of medicines, known as 5-alpha reductase inhibitors, can be used to block the natural hormone testosterone that makes the prostate enlarge. In some cases, medicines called alpha-blockers are used. These relax the smooth muscle in the prostate gland by blocking so-called alpha-receptors, allowing urine to flow more easily. At times, your doctor may suggest a combination of these.

With prostate cancer, you may be prescribed a course of hormonal therapy in the early stages, prior to any radiotherapy that you may be offered. Usually this is for 3 months for patients with localised disease, but in cases where the patient may have locally advanced disease or their PSA reading is very high, the oncologist (cancer doctor) may suggest that the hormone treatment be continued for a number of years.

Is surgery always the likely treatment for prostate disease or are there medicines I might be prescribed?

Your treatment will depend on the nature and state of your prostate disease, and, for some conditions, surgery may be the most effective treatment. Sometimes you may be offered a combination of surgery and medicines. Sometimes a minor operation may be necessary to diagnose the nature of the problems prior to treatment options being determined. Your doctor will discuss these options with you.

In the case of prostatitis when the cause is a bacterial infection, your doctor may consider prescribing you antibiotics. In some cases, medications may be prescribed to deal with the symptoms of benign prostatic hyperplasia (BPH). One key group of medicines, known as 5-alpha reductase inhibitors, can be used to block the natural hormone testosterone that makes the prostate enlarge. In some cases, medicines called alpha-blockers are used. These relax the smooth muscle in the prostate gland by blocking so-called alpha-receptors, allowing urine to flow more easily. At times, your doctor may suggest a combination of these.

With prostate cancer, you may be prescribed a course of hormonal therapy in the early stages, prior to any radiotherapy that you may be offered. Usually this is for 3 months for patients with localised disease, but in cases where the patient may have locally advanced disease or their PSA reading is very high, the oncologist (cancer doctor) may suggest that the hormone treatment be continued for a number of years.

In the case of advanced prostate cancer, treatment is often in the form of hormone therapy, utilising a group of drugs to reduce the production of testosterone, as this can promote the growth of prostate cancer cells.

Can I change my diet and lifestyle to improve my prostate health?

It is likely that certain foods have a protective effect when it comes to prostate cancer. A diet rich in vegetables (especially tomatoes), cereals and fish (and with limited research) broccoli is thought to be a useful means of reducing the risk of prostate cancer. However, there is, as yet, no definitive proof and there are still some trials ongoing into specific aspects of diet, food and cancer. It would seem that by eating a healthy, balanced diet as well as keeping yourself fit and taking exercise as a means of contributing to your general health, you can help reduce the cancer risk and assist your body’s defences.

Lycopene which is found predominantly in tomatoes (but also in some other red pigmented food), is regarded as having a beneficial effect in reducing the risk of prostate cancer.

Antioxidants, which are substances in the body and in foods which have protective effects through helping to protect cells and tissue from free radicals which can attack them, can also play a role in reducing the risk of cancer. There are a number which appear beneficial in reducing the risk of prostate cancer, of which Vitamins D, E and selenium are significant ones. For further information see the diets supplements and lifestyle page

My father/brother had prostate cancer. Does this mean I am more at risk?

Men who have had close family members (fathers/brothers) diagnosed at a young age (under 55) can be at increased risk of prostate cancer. Studies show that the risk of developing prostate cancer can be as much as 3 times greater if a man has a first–degree relative with the disease. If you have a close relative who has had prostate cancer, it is sensible to maintain a healthy lifestyle and, if you start to experience prostate problems, ensure that you see your doctor at the earliest opportunity. Depending on the age at which your brother or father developed their cancer (especially if a younger age), it might be sensible to ensure that your doctor is aware so that, if appropriate, regular monitoring can be undertaken. There is a very high rate of cure for prostate cancer which is treated early.

Will treatment for my prostate problem affect my sex life?

Some treatments for prostate conditions may have side effects and could impact on a man’s sex life, although the percentage affected is small and there are some ways of minimising the impact.

Some treatments for prostate cancer and benign prostatic hyperplasia (BPH) can lead to a man becoming impotent. In the case of BPH, after a transurethral resection of the prostate (TURP), a small number of men become impotent and have erectile dysfunction, but some report better sexual function.

Surgery to remove part or all of the prostate because of prostate cancer, in common with a TURP, can lead to retrograde ejaculation. This is when the semen is deposited into the bladder at orgasm, rather than through the penis. This doesn’t stop a man having an orgasm, but he may not ejaculate. In certain cases, especially with keyhole surgery and where the tumours are small, it is possible to develop a procedure to avoid impacting on a man’s erectile function.

Men receiving hormone therapy for advanced prostate cancer may find that their sex drive is reduced, and have problems with erectile function. Once, or if, hormone treatment finishes, a man’s sex drive may return or increase, as the body starts producing testosterone again.

Should you experience erectile problems, it may be worth discussing this with your doctor/nurse. They will advise you on treatment options and help you decide upon which treatment may be the most suitable for you.

For men with erectile dysfunction, there are a number of ways to overcome it by using oral tablets, pellets, self-injections of medication, vacuum pumps, or occasionally (usually as a last resort), surgical implants. There are a number of medications these days which have been shown to often help. These include sildenafil (brand name Viagra®), tadalafil (Cialis®) and (Levitra®). Prostate scotland has produced a booklet on prostate conditions and erectile dysfunction – this can be viewed by clicking here or going to our downloads page

In the case of wearing a condom, the normal safe sex rules should apply. Also, for men who have had brachytherapy, it is advisable to wear a condom for the first few occasions of sex, in case some of the ‘seeds’ for the treatment are passed in the semen.

There are also websites for female partners of men with erectile dysfunction, one of which can be found at www.lovelifematters.co.uk (please note Prostate Scotland is not responsible for external content)

Does drinking alcohol increase my risk of prostate cancer?

There has not been a large amount of research into prostate cancer and alcohol consumption. However, the studies that have been undertaken suggest a mixed picture. There is one study which suggests that there could be an increased risk from the consumption of spirits, whilst others suggest that there are no clear associations with beer or spirits.

Of particular interest has been red wine, with one research study finding that a moderate consumption of red wine had a protective effect, and another showing that there did not appear to be a link between drinking red wine and prostate cancer. The study showing a reduced risk suggests that this may be because of a compound called reservatol, which is a strong antioxidant. This does not mean, however, that men should increase their consumption of red wine, as drinking too much can have other health effects including on the liver and increasing the effects of other diseases.

Can prostate cancer be passed on through intercourse?

Whilst we still do not sufficiently know what causes prostate cancer and there is much research underway into it, we do know quite a lot about the process that happens when cells turn cancerous. There is some research which suggests that chronic inflammation of the prostate may be tied to prostate cancer.

Some research has shown that some virus infections can transmit tumour growth by integrating into the chromosomes of host cells or by altering cells (as is the case with cervical cancer and certain stomach cancers). In such instances, it would appear to be the passing on of a virus that can lead to the cancer development, rather than cancer itself (which isn’t a virus) being passed on. We don’t know sufficiently about the causes of prostate cancer, but so far it does not appear to be the case that prostate cancer is passed on via a virus or bacteria. However, we do know that there can be a genetic link, as there is a familial form of prostate cancer which can be passed on from father to son, and occurs in around a tenth of cases.

Some recent research has suggested that there may be higher risk of prostate cancer in younger men who are more sexually active, although the level of risk fell in those aged over 40.

Might cycling affect the prostate?

Whilst prostate problems and benign prostatic enlargement (BPH) can affect nearly one in two men over the age of fifty (and as many as 9 out of 10 men in their seventies and eighties may have some symptoms of BPH) and one in eleven men may get prostate cancer making it the most common cancer in men, there does not appear, from the literature that we are aware of, to be a causal link between cycling and prostate enlargement or prostate cancer. However there is some evidence (see Mayo Clinic) that trauma from bicycle riding can irritate a man’s prostate and could exacerbate, and some suggest lead, to prostatitis (inflammation of the prostate) or chronic pelvic pain syndrome. A recent study by published in the Journal of Men’s Health (Volume 11:2:2014) lead by researchers at University College London on erectile dysfunction and infertility and prostate cancer in regular cyclists found no link between cycling and infertility and or between erectile dysfunction and cycling. It did however find that there was an increased risk of being diagnosed with prostate cancer in those men over 50 who cycled over 3.76 hours per week and particularly in those men who cycled more than 8.5 hours per week.

The authors of this study indicated that this may be because men who cycle frequently may be more health conscious, leading to more regular check-ups and a greater chance of being diagnosed, or that as cycling increases levels of PSA which in turn lead to increased rates of investigation for prostate cancer, or that cyclists are more likely to suffer urogenital abnormalities such as blood in the urine or pain around the prostate making them more likely to be tested for prostate cancer or that cycling time and prostate cancer are both associated with an unknown factor that was not accounted for by the study or that there could be a genuine biological link between trauma in the area of the prostate associated with bike riding. They stated that they ‘were quite surprised by the size of the finding for prostate cancer, so it that it does warrant further research but that we can’t draw any conclusions from this study ’ They have also stated: ‘We cannot say on the basis of our results that prostate cancer is caused by cycling. We would not recommend that people reduce their cycling volume. Cycling has many physical and mental health benefits that at present outweigh any risks it may cause’

Also it is known that cycling may transiently increase a man’s prostate specific antigen (PSA) level – PSA levels are often used as a key test of possible prostate problems – so men who are due to have a prostate test should avoid significant levels of cycling before a PSA test to avoid a possible false reading.

Although cycling is not directly linked to the development of prostate problems if you have prostate problems and you cycle frequently you may find it helpful to discuss the potential impact with your doctor, particularly if you are going to have a PSA bloodtest. Also some literature suggests than men should consider avoiding cycling during episodes of prostatitis or chronic pelvic pain syndrome. The key issue in regard to cycling and prostate problems is to find ways of reducing pressure on the perineum, or groin area (as the prostate is located just below the bladder and in front of the rectum). This can be done in a number of ways – from wearing padded shorts, regularly standing on the pedals, considering the adjustment and position of the saddle, to actual saddle choice. A study in the British Journal of Urology International in 2007 (99:135-140) showed that a grooved seat produced less pressure and numbness in the penile area and impact on erectile dysfunction, but also that rider position was very important.

A particular approach that has been taken has been to utilise saddles which aim to reduce pressure on the perineum. These tend to fall into three groups: those with grooves and holes cut in them to reduce pressure on the perineum or groin area, saddles with holes cut out of them and a cutaway at the back, and more recently ‘split saddles’ which have two sections and no central area or noseless saddles. (In regard to saddles with holes cut in them you should check to ensure that the edges are not shaped in such a way as to inadvertently increase pressure or pinch).

Many saddle manufactures today make saddles with grooves, cut out holes and cutaways – and these are now much more available and numerous bicycle riders websites suggest different models and styles and are probably too numerous to list. Readers should remember however that the most expensive is not always the best answer – the answer is to look for a saddle which is most likely to reduce pressure for you and enables you to adjust it best for your shape and riding style and if possible try it out. There are also a growing number of companies which produce saddles with either split seats/dual pad or differently shaped saddles some of which have no noses (including several with contact addresses in the UK).

A couple of articles and discussion fora that it may be interesting to look at include:

http://www.livestrong.com/article/386549-prostate-pressure-bicycle-seats/.