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What does the prostate do, where is it, and what can go wrong?

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Hey guys, we know that talking about your prostate can be a little uncomfortable.

You might not know where it is or what it does, or you might have only heard about it in stories about older men having difficulty peeing or the doctor sticking their finger up 'the old you know what’ to check on it.

We’ve got all the details for you, and some extra info on keeping it healthy, how it might change as you age, and any changes or symptoms you should keep an eye on or tell your doctor about.

What and where is it?

Your prostate is a small rubbery gland that lives inside your body, just below your bladder. It's roughly the size and shape of a walnut and sits around the urethra, the tube that carries pee from your bladder through your penis. (The urethra also carries semen when you ejaculate). From the side, the prostate sits between the front of the rectum and the base of the penis. Only men have a prostate.

A grey and white graphic showing the prostate, bladder, urethra, ureters and kidneys in red

What does it do?

You could live without your prostate (it is not essential for life), but it plays a key part in fertility and reproduction, and grows during adolescence under the influence of the male hormone testosterone and its byproducts.

The prostate produces some of the fluids contained in your semen, the liquid that transports sperm.

Healthy semen has to be just the right consistency and contains special enzymes and hormones that help your sperm cells survive and function properly. Semen also contains citrate, zinc and a sugar called fructose. Fructose helps give the sperm the energy to make it to the egg and fertiise it.

About 70 to 80 percent of the fluid in semen comes from the seminal vesicles, two small structures that sit on top of the prostate like rabbit ears.

There are nerves and blood vessels that run along each side of your prostate called the neurovascular bundle. These are involved the process of getting and maintaining an erection.

The muscles in your prostate also help push semen through your urethra when you ejaculate.

Keeping your prostate healthy

Living a healthy lifestyle is the best way to keep your body well and protect against cancer.

Maintaining a healthy body weight, not smoking, exercising regularly, and having a healthy diet can all play important roles in preventing disease, including prostate cancer.

  • A review of research suggests that eating red foods such as tomatoes and watermelon may reduce progression and growth of prostate cancer cells. Red foods contain a powerful antioxidant called lycopene.
  • Eating fruit, especially citrus fruit such as oranges, lemons, grapefruit, limes and mandarins may also slightly lower your risk of prostate cancer, according to some studies.
  • Coffee and green tea may also lower cancer risk, but more studies need to be done to confirm this.
  • A review of research done in 2014 indicated there may be a link between saturated fats and animal fats and prostate cancer risk, so it may pay to reduce intake of these types of fats.

For some ideas about looking after your health at all ages, read through the Queensland Government’s guide to good health for men: Men’s health through the decades.

And one last thing – you may have heard that too frequent masturbation can cause prostate cancer. It’s been studied, and so far there have been no links found between masturbating or having sex too often and prostate cancer. If anything, the effect may be the opposite, but more research is needed to know how and why.

What can go wrong?

Enlarged prostate (benign prostatic hyperplasia)

It’s common for the prostate to get bigger as men age. Around half of men aged over 50 experience ‘benign prostatic hyperplasia’, which means swelling or enlargement of the prostate. This can mean the prostate expands from the size of a walnut to the size of an apricot or even a lemon.

For some men, an enlarged prostate doesn’t cause any symptoms or bother. Others will find that an enlarged prostate causes symptoms, including:

  • difficulty peeing, including getting started or getting a strong or steady ‘flow’
  • needing to pee often
  • needing to pee suddenly, without the normal build up
  • waking up at night to go to the toilet
  • pain or burning when peeing
  • or pain when ejaculating.

It’s important to tell your doctor if you’re experiencing any of these symptoms, even if you’re younger than 50. Some men might worry that these symptoms mean they have cancer, but most of the time, an enlarged prostate doesn’t mean cancer has developed.

Sometimes, an enlarged prostate can be treated with lifestyle changes, like drinking less before you go to bed. Some men will be prescribed medicines to help with the condition, and surgery can also be an option, though this is less common because of the risk of side effects.

Prostatitis

Prostatitis is inflammation of the prostate. It’s different from an enlarged prostate, though some of the symptoms are similar. Prostatitis can cause the prostate to become swollen, tender or inflamed.

Symptoms of prostatitis can include:

  • needing to pee urgently, often in the middle of the night
  • pain when peeing or after you ejaculate
  • blood in your urine
  • lower back pain
  • pain in your rectum
  • a feeling of heaviness behind your scrotum
  • a urinary blockage, which means you can’t pee when you need to.

There are different types of prostatitis. Bacterial prostatitis is caused by a bacterial infection, and can be treated with antibiotics. Then there’s chronic prostatitis, or chronic pelvic pain syndrome. Doctors don’t know yet what causes this condition, but it can be trigged by things like an injury, nerve damage or stress.

Prostate cancer

Prostate cancer is the most commonly diagnosed cancer in Australian men. In Australia, prostate cancer kills more men than breast cancer kills women, so it’s really important for men to be aware of what it is, what the symptoms are, and what tests are available to assess their prostate health.

Your risk of developing prostate cancer increases as you age. When you’re under 75, the chance of developing it is 1 in 7. By 85, this increases to 1 in 5. The Prostate Cancer Foundation of Australia recommends that all men over 50 discuss testing for prostate cancer with their GP.

Other factors that might increase your risk of developing prostate cancer include:

  • family history: if you have a father or brother who has had prostate cancer
  • hereditary genetic mutations in the BRCA1 or BRCA 2 genes
  • having the genetic condition Lynch syndrome.

Symptoms of prostate cancer

In its early stages, prostate cancer doesn’t necessarily cause symptoms. Men with prostate cancer might experience some of the following symptoms:

  • needing to pee frequently or suddenly
  • finding it difficult to pee, including trouble getting started or maintaining a strong or steady flow
  • feeling like you haven’t completely emptied your bladder after going to the toilet
  • pain, burning or discomfort when peeing
  • blood in pee or semen
  • or pain in the lower back, upper thighs, hips or chest
  • feelings of weakness or numbness in the legs or feet
  • unexplained weightloss
  • feeling tired, short of breath or dizzy
  • a rapid heart beat
  • pale skin.

You’ll notice a lot of these symptoms are similar to symptoms of other conditions, including an enlarged prostate or prostatitis, which is why it’s important to always see your doctor if you notice any of these symptoms or changes.

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Types of prostate tests

There isn’t one, simple test that can be used to diagnose prostate cancer. Below, we’ve explained the types of test your doctor might recommend to check your prostate health.

Digital rectal exam (DRE)

Nope, that’s not digital like your high-def TV signal, it’s digital as in fingers (or digits).

A digital rectal exam (DRE) is the kind you’re probably used to seeing as the “butt” of jokes in movies. It’s where a doctor uses their finger to feel the prostate through the wall of the rectum (the tube that carries poo out of your body). Using a glove and some lube for cleanliness and comfort, they’ll feel for swelling, bumps or anything odd that might be a sign of a problem with your prostate.

This test can’t diagnose prostate cancer. It can only give your doctor an indication of your prostate health and may help them feel any abnormalities or changes in your prostate.

Prostate Specific Antigen (PSA) testing

Prostate Specific Antigen (PSA) is a protein made by the cells in your prostate. Your PSA levels can be measured using a blood test and give an indication of your prostate health.

A PSA test isn’t a test for cancer. Higher levels of PSA might indicate prostate cancer, but a high reading could also be caused by other conditions. It is also possible to have low level readings and have prostate cancer. This means that a PSA test isn’t enough to definitively diagnose or rule out prostate cancer. Your PSA levels can vary, so your doctor might run this test a few times to compare your results and help determine your risk of prostate cancer.

Ultrasound

An ultrasound is a test that uses sound waves to create a picture of the inside of your body. When looking at your prostate, a small ultrasound probe is put into the rectum to get an image of the prostate. An ultrasound can be used to guide a biopsy procedure.

Prostate biopsy

A prostate biopsy is used to diagnose prostate cancer. It will be done if there are signs of cancer or prostate abnormalities to either diagnose or rule out cancer.

A biopsy involves taking a tiny sample of the prostate for testing, which can be looked at under a microscope. If you need a biopsy, it will be done by a specialist doctor. It can be done under general or local anaesthetic, and either through the urethra, rectum or perineum, depending on what area of your prostate needs testing.

MRI

An MRI, or magnetic resonance imaging, is a type of scan that uses magnets and radiofrequency pulses to create radio signals that form pictures of your body.

An MRI can also be useful for screening and diagnosis of prostate cancer, and can be ordered by a urologist.

Prostate cancer diagnoses and treatment

All cancer is complex, but prostate cancer testing and treatment is particularly complicated.

In some men with prostate cancer, the cancer will grow very slowly, and won’t significantly affect them during their lifetime. Other men’s prostate cancer can grow and spread very quickly. At the moment, there is no test that can tell what type of prostate cancer a man has when he is diagnosed.

Because some treatments for prostate cancer can cause side effects which might impact on quality of life, it’s important for men to discuss with their doctor all their options for testing and treatment, and to discuss these with their partners and families. These might include ‘watchful waiting’, which means waiting to see what the cancer does over time, radiation, surgery or taking medications.

You can read more about what kinds of questions to ask your doctors about prostate cancer testing and treatment on the Cancer Council website.

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Last updated: 27 May 2022