The most frequently asked questions about prostate problems

Prostate problems are, in many ways, still a taboo subject. Which is strange, because most men get prostate problems at a certain point in their lives. What’s more, they can usually be treated effectively. So, there’s no better time than the present for an open and honest discussion about prostate conditions. Browse the FAQs below to get answers to some pressing questions you might have.

What are prostate problems?

The prostate is a gland that makes prostatic fluid. Together with sperm cells from the testicles, the prostatic fluid makes up semen. The prostate gland is located directly below the bladder and around the urethra. It is common for the prostate gland to become enlarged as men age. In most cases, this enlargement is benign, which is why the condition is called benign prostatic hyperplasia (BPH).

A benign prostate enlargement is part of ageing. Up to 90 percent of men in their eighties have BPH. An enlarged prostate does not necessarily lead to additional problems with the prostate. However, if the prostate irritates or restricts the urethra, this can result in urinary complaints. More than 25 percent of men over the age of 50 suffer from urinary problems as a result of an enlarged prostate.

The prostate can become infected, leading to a condition where the tissues of the prostate become inflamed (prostatitis). And of course, there is prostate cancer, the most common form of cancer in men.

How do I recognise prostate problems?

Men who have prostate problems typically have the following symptoms:

Symptoms of benign prostatic hyperplasia (BPH):

An enlarged prostate can cause irritation or even obstruction. BPH can cause uncomfortable urinary symptoms, such as:

• Increased need to urinate, also in the night.
• Passing small amounts of urine.
• Dribbling of urine after urinating.
• Difficulty starting to urinate.
• An interrupted urinary stream or weak urinary stream.
• Sensation of urine left in the bladder after urinating.
• Involuntary discharge of urine (incontinence).

Symptoms of prostatitis

Prostatitis, inflammation of the prostate gland, is caused by a bacterial infection in the prostate. The infection can be acute. Most cases of acute prostatitis will clear up with antibiotic treatment. Prostatitis can also be chronic. Prostatitis is characterised by the symptoms below.

Symptoms of acute prostatitis:

• Fever.
• Abdominal pain, typically between the testicles and the anus.
• Lower back pain.
• Muscle ache.
• Malaise

Symptoms of chronic prostatitis:

• Long-term lower back pain.
• Abdominal pain, typically between the testicles and the anus.
• Increased need to urinate, pain or burning sensation when passing urine.
• Fatigue, lack of energy.

Symptoms of prostate cancer

Prostate cancer is a slow-progressing disease. Therefore, early prostate cancer is usually asymptomatic. And if there are symptoms at all, they are similar to BPH. In other words, urinary problems. Increased level of prostate specific antigen (PSA) in the blood can also be a sign of prostate cancer. PSA is a protein produced by prostate cells. If you have prostate complaints, a doctor will most likely perform a prostate-specific antigen blood test (PSA test).

Are prostate problems a warning sign of prostate cancer?

Urinary problems and an increased level of PSA are not necessarily tell-tale signs of prostate cancer. These complaints can also be caused by BPH or prostatitis.

In the majority of cases, urinary problems are caused by BPH. However, because of the similarity in urinary symptoms, prostate cancer must be ruled out before treating BPH. This way, if prostate cancer is found, it can be treated early. If you have a raised PSA level, the doctor will do other tests (e.g. a scan, biopsy or echography) to find out what is causing it.

Therefore, you should always see a GP if you have persistent urinary issues or symptoms that could be caused by prostatitis. Your GP will be able to diagnose the cause of your complaints. For example, some bacteria that cause STDs such as chlamydia can also cause acute bacterial prostatitis. In this case, the STD needs to be treated, too.

The GP can further treat your prostate problems or he can refer you to a urologist.

Are prostate problems linked to erectile dysfunction?

Urinary tract problems caused by an enlarged prostate are not associated with erectile dysfunction (ED). However, men with ED often also have urinary tract symptoms, and vice versa. Doctors do not understand how the two are associated. What they do know is that both conditions become more common as men age. Further research is needed to establish whether the two issues are related or simply a by-product of age.

What are the forms of treatment?

Fortunately, there are many different treatments for prostate complaints. Some of them are listed below.

Treatments for urinary problems caused by an enlarged prostate:

Alpha blockers (e.g. tamsulosin or alfuzosin). These medicines help the muscles of the bladder neck and urethra to relax, which allows urine to flow more easily.

5-alpha reductase inhibitors (e.g. dutasteride or finasteride). These medicines reduce prostate size and thereby the risk of an enlarged prostate blocking urine flow.

Phosphodiesterase inhibitors (e.g. sildenafil and tadalafil). These medicines are widely used first-line therapy for erectile dysfunction, but they also induce smooth muscle relaxation in the prostate and bladder. They are prescribed to treat men who suffer from ED as well as urinary problems.

Prostate problems can also be treated with alternative medicines, such as homeopathic remedies made from saw palmetto extract. These medicines do not require a prescription. Alternative treatments have not been proven to work through scientific testing although they are believed to be effective in treating urinary problems.

Treatments for prostatitis:

Prostatitis can be treated effectively with:

• Painkillers such as paracetamol or NSAIDs (e.g. diclofenac, aspirin or ibuprofen) to suppress pain.
• Antibiotics, such as ciprofloxacin, to kill bacteria.

Treatments for prostate cancer:

In many cases, the doctor will opt for a wait-and-see policy for older patients with prostate cancer. This means that patients stay under supervision and are monitored regularly, but they are not treated. This is because prostate cancer generally develops very slowly and has a good prognosis, as long as it gets diagnosed early. When the tumour cells spread to surrounding areas and other parts of the body, the doctor can decide to start treatment. Common treatments for the illness include radiation, chemotherapy or hormone therapy. In some cases, doctors need to surgically remove the prostate gland.

Is there anything I can do myself to reduce the chance of prostate problems?

There are a number of things you can do to reduce your risk of prostate issues.

You can start by making sensible lifestyle choices. Here are some tips:

Keep your weight balanced and healthy. Weight gain is associated with an increased risk of developing urinary problems and prostate cancer. If you are overweight, then losing weight is the best way to reduce this risk.

Eat healthily. Choose a healthy diet of vitamins and minerals that contribute to prostate health. For example, the mineral selenium. Studies indicate that selenium deficiency might be related to cancer.

Have an active sex life! Frequent ejaculation decreases prostate cancer risk.

Go to the toilet frequently to empty your bladder.

Avoid constipation. Constipation can cause urinary problems. Choose foods that are high in fibre, drink sufficient fluids (at least 1.5 litres a day) and exercise on a regular basis.

Do you have prostate problems? Don’t wait for them to get worse. Your problems can be treated effectively!

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