Understanding prostate changes

It’s important to understand that changes to the prostate may happen over time, potentially causing health issues. While many men worry that prostate issues mean cancer, there are many other prostate health issues that are more common—most changes don’t mean prostate cancer. This guide may help patients understand prostate changes and how to manage them.

What are prostate changes, and why do they happen?

The prostate is a gland that makes up part of the male reproductive system, and it plays an important role in the production of semen. It’s about the size of a walnut and is located below the bladder and in front of the rectum. The prostate also wraps around part of the urethra, which is a tube that urine travels through to leave the body.

Like all parts of the body, the prostate gland is subject to growth or change.

• With age, the prostate continues to grow, increasing in size or changing shape.
• The prostate may also develop an infection or tumor, which may cause health problems.
• Because the prostate surrounds the urethra, it sometimes squeezes the urethral tube and causes urinary problems. The most common urinary problems include:
  • Urinating more frequently
  • Having an urgent need to urinate
  • Noticing less urine flow
  • Waking up frequently in the night to urinate

If a patient notices these prostate changes, or has other concerns about incontinence, it’s always a good idea to visit a doctor to find out more.

Risk factors for prostate changes

The biggest risk factor for prostate changes is age. The prostate continues to grow over time, so older men are more likely to experience prostate changes.

When it comes to prostate cancer specifically, age is still a risk factor—as the older a man is, the more likely he is to develop the disease. However, other risk factors for prostate cancer include:

• Race. African-American men are more likely to develop prostate cancer. They’re also more likely to get the disease at a younger age and to be diagnosed with a more advanced stage of prostate cancer.
• Family history. Men who have a first-degree relative with prostate cancer (such as a father, son or brother) face an increased risk.

Prostate changes that aren’t cancer

The most common noncancerous prostate changes are prostatitis and benign prostatic hyperplasia (BPH).

Prostatitis

Prostatitis is an inflammation of the prostate, often caused by a bacterial infection. It’s common, with at least half of all men experiencing it at some point, according to the National Cancer Institute.

While some men experience prostatitis with no symptoms, most are diagnosed because they present to their doctor with one or more of the following symptoms:

• Trouble urinating or pain while passing urine
• Fever or body chills
• Pain in the lower abdomen, scrotum, rectal area or groin
• Strong need to urinate, but only passing a small amount of urine
• Painful ejaculation or other sexual problems

Those concerned about prostatitis should visit their doctor, who may conduct tests, such as a urine test or digital rectal exam (DRE), to diagnose the problem.

A prostatitis diagnosis falls into one of four categories:

• Acute bacterial prostatitis is a bacterial infection that comes on suddenly (acutely). The patient may experience severe fever, chills and blood in the urine. While it’s the least common type of prostatitis, it may generally be treated with antibiotics.
• Chronic bacterial prostatitis is less acute but also caused by bacteria. The patient may notice recurring bladder infections. To treat chronic bacterial prostatitis, a long course (four to 12 weeks) of antibiotics is typically prescribed.
• Chronic prostatitis or chronic pelvic pain syndrome isn’t as well understood and may be found in men of any age. Symptoms such as bladder and groin discomfort come and go, but it’s not thought to be a bacterial infection. Treatment varies depending on the symptoms, but may include anti-inflammatory drugs, warm baths or alpha-blockers, which relax the muscles in the prostate and make it more comfortable to urinate.
• Asymptomatic inflammatory prostatitis presents no symptoms. Instead, it’s found via tests for other conditions such as prostate cancer. It usually doesn’t require treatment, but doctors may repeat the test later to monitor for changes.

Benign prostatic hyperplasia (BPH)

Benign prostatic hyperplasia is a noncancerous enlarged prostate. While the symptoms of both BPH and prostate cancer are similar, having BPH doesn’t increase cancer risk. However, in severe cases, it may cause more serious concerns, such as a weakened bladder and kidney infections.

Because BPH puts pressure on the urethra as the prostate grows, it may cause a number of urinary issues. Symptoms, most often seen in men older than 50, may include:

• Difficulty starting and stopping the flow of urine
• Frequent need to urinate at night
• Feeling of bladder not emptying after urination
• Weak or slow flow of urine
• Need to strain or push to urinate

The most common treatment options for BPH include:

• Watchful waiting
• Medication
• Surgical or minimally invasive procedures

Prostate cancer

Another prostate change is prostate cancer. About one in eight men is diagnosed with prostate cancer, according to the American Cancer Society. Many treatment options are available for prostate cancer, especially if it’s detected early.

Prostate cancer occurs when cells in the prostate grow out of control, forming tumors. When the cancer is contained within the prostate, it’s known as localized. If the cancer spreads into other parts of the body, such as the lymph nodes or bones, it’s referred to as advanced. While some men have no symptoms, common signs include:

• Difficulty urinating, such as a weak flow or burning sensation
• Frequent need to urinate
• Blood in semen or urine
• Painful ejaculation
• Ongoing pain in the back, pelvis and hips

If prostate cancer is suspected, tests that may be recommended include:

• Prostate-specific antigen (PSA) test, a blood test that measures the amount of PSA in the bloodstream. If PSA levels are abnormal, further tests may be performed.
• DRE, in which a doctor gently feels for bumps or abnormalities on the prostate, via the rectum.

However, the only way to get a definite diagnosis of prostate cancer is via a biopsy. If the results from the PSA and/or DRE are abnormal, doctors may perform a biopsy, which is when tissue cells are removed from the prostate and examined under a microscope.

Learn more about prostate cancer

How can I learn more about prostate changes?

For questions about symptoms, risk factors or body changes, your care team is a great starting point. Doctors may also suggest additional resources for more details on prostate health.