The prostate gland is an accessory gland in males sitting beneath the bladder and encircling the urethra. It produces and secretes prostatic fluid into the urethra which makes up about 20% of the semen. This fluid is essential to activate the sperm cells and maintaining normal motility and functioning. Like any organ, the prostate is prone to infections, inflammation and tumor development. Prostate problems are common, particularly in men over 55 years of age, but not all of these conditions are serious.
Types of Prostate Problems
There are three main conditions that frequently affect the prostate gland :
- Prostatitis which is inflammation of the prostate gland that can be acute or chronic.
- Benign prostatic hyperplasia (BPH) which is the nodular enlargement of the prostate gland (not malignant).
- Prostate cancer which is a malignant tumor of the prostate gland and is the most serious prostate problem.
The different prostate problems often present in a similar manner, especially in the early stages, with varying degrees of urinary problems and urinary pain commonly reported. Imaging studies, like a CT scan or MRI, may be helpful in identifying prostate problems. Further investigation like cytology and culture of urine or expressed prostatic secretions, measuring and monitoring the PSA levels or a prostate biopsy may be necessary to conclusively identify the type of prostate problem.
Symptoms of Prostate Problems
Prostate problems can sometimes be asymptomatic meaning that there are no symptoms. At other times prostate problems are mistaken for bladder problems based on many overlapping symptoms, like difficulty urinating, frequent urination or blood in the urine. The prostate lies immediately below the bladder in men. Urine that empties out of the bladder has to pass through the ureter which runs through the prostate gland. Therefore prostate problems can cause urinary symptoms.
Discomfort and Pain
There may be varying degrees of prostate discomfort and even prostate pain that may occur in the different prostate problems. Due to the location, prostate pain may be mistaken for bladder pain and vice versa. The prostate is also located in front of the colon so it can also be mistaken for colon pain. Typically prostate pain is felt low in the pelvis but may sometimes cause referred back pain.
Read more on prostate pain.
As mentioned, urinary symptoms are common in prostate problems due to the proximity of the prostate and bladder. These symptoms are non-specific meaning that it occurs in bladder problems and urethral problems as well. However, when urinary symptoms arise in men over 50 years of age especially if there was a history of prostate problems then it could be an indicate of a prostate disease or disorder.
These symptoms may include:
- Difficulty initiating urination.
- Weak urine stream.
- Inability to empty the bladder.
- Straining to urinate.
- Frequent urination.
- Urging to urinate even after urination.
- Dribbling after urination.
- Blood in the urine.
Read more on urine problems.
Erectile dysfunction (ED) may be associated with prostate problems¹. Although the prostate problem may not cause the erectile dysfunction, studies have shown that there is a link between severe prostate symptoms and the ability to get and maintain an erection. As a consequence of pain and urinary symptoms, men with prostate problems may experience difficulty sleeping and it can also affect daily functioning.
Prostatitis is inflammation of the prostate gland. It may be due to infectious or non-infectious causes but infections are by far the most common cause. In most cases it arises with a bacterial infection although a viral or fungal infection can occur but is rare. Usually there is a pre-existing disorder of the prostate or urinary tract that increases the risk of an infection. Prostatitis can be classified as :
- Acute bacterial prostatitis
- Chronic bacterial prostatitis
- Chronic prostatitis without infection / chronic pelvic pain
- Asymptomatic inflammatory prostatitis
The symptoms of prostatitis are similar although asymptomatic inflammatory prostatitis and some cases of chronic prostatitis may be asymptomatic meaning that there are no symptoms despite the inflammation. Some of the common symptoms of prostatitis includes :
- Dysuria – pain or burning sensation upon urination
- Straining to urinate and post-micturition dribble
- Frequent urination, particularly at night (nocturia)
- Urinary tenesmus – urgency to urinate
- Pain upon ejaculation
- Pelvic pain in and around the prostate gland as described under prostate pain
- Hematuria – blood in urine
Fever, chills and malaise may be seen in acute infections.
Benign Prostatic Hyperplasia (BPH)
Benign prostatic hyperplasia is a nodular enlargement of the prostate gland due to an abnormal increase of cells. It is common in men over the age of 50 and it is often seen as a normal part of the process of aging. BPH is a chronic condition marked by episodes of acute flare ups and occasional infections (prostatitis). It may remain asymptomatic for long periods of time with symptoms of varying intensity present in acute exacerbations.
The main symptoms associated with BPH are a result of compression of the urethra and bladder. Some of the symptoms of benign prostatic hyperplasia includes :
- Difficulty urinating, specifically initiating urination.
- Persistent urge to urinate with small volumes of urine.
- Frequent urination with an sensation that the bladder is not empty.
- Dribbling, specifically after passing urine (post-micturition dribble).
- Prostate discomfort although pain may arise with a flare up, particularly when there is an infection.
- Blood in the urine (hematuria) especially during an infection.
Prostate cancer is a malignancy of the prostate gland and is one of the common cancers seen in men over the age of 50. Cancer is characterized by the presence of rapidly dividing abnormal cells, unlike benign prostatic hyperplasia where there is abnormal increase of normal cells. There are different types of prostate cancer but the most common type is an adenocarcinoma. Other types such as small cell and squamous cell carcinoma are rare.
Some of the symptoms of prostate cancer includes :
- Difficulty urinating
- Weak urine stream
- Urinary retention
- Blood in the urine (hematuria)
- Blood in the semen (hematospermia)
- Pelvic pain or discomfort
Other symptoms such as unintentional weight loss, back pain, bone pain and swelling of the legs may also be seen in more advanced cases of prostate cancer.