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What Is the Prostate?

The prostate is a small but important gland that plays a key role in male reproductive health. It is located just below the urinary bladder and sits in front of the rectum, which is why it can be felt during a digital rectal examination. One unique feature of the prostate is that it surrounds the urethra; the tube responsible for carrying urine from the bladder out of the body.

Functionally, the prostate contributes to the production of semen. It secretes a fluid that helps nourish and protect sperm, improving their mobility and survival after ejaculation. This prostatic fluid combines with sperm from the testes and secretions from other reproductive glands, such as the seminal vesicles, to form semen. During ejaculation, the smooth muscle within the prostate contracts, helping push semen forward through the urethra.

The prostate is present from birth, but it remains small during childhood. It begins to grow during puberty under the influence of male hormones and continues to enlarge gradually throughout adulthood. While this growth is a normal part of aging, excessive enlargement or abnormal changes in the prostate can lead to urinary, sexual, and general health concerns that may require medical evaluation.

Symptoms of Prostate Problems

Prostate conditions often affect the urinary system because of the gland’s close relationship with the urethra. Symptoms may develop gradually and can range from mild inconvenience to significant disruption of daily life.

Common symptoms include:

  • Difficulty starting urination or a weak urine stream
  • Frequent urination, especially at night (nocturia)
  • A sudden, urgent need to urinate, sometimes with difficulty holding urine
  • A feeling that the bladder is not completely empty after urination
  • Dribbling of urine at the end of urination
  • Burning or pain during urination

Some symptoms require immediate medical attention, such as:

  • Blood in urine or semen
  • Painful ejaculation
  • Persistent pain in the lower back, hips, or pelvic area
  • Difficulty achieving or maintaining an erection

Not all symptoms indicate a serious condition, but any persistent urinary or sexual symptoms should be evaluated by a specialist.

Types of Prostate Conditions

Several conditions can affect the prostate, ranging from benign age-related changes to infections and cancer.

Benign Prostatic Hyperplasia (BPH):

A non-cancerous enlargement of the prostate, commonly seen as men age. BPH can compress the urethra and interfere with normal urine flow.

Prostatitis:

Inflammation or infection of the prostate, which may be acute or chronic. It can occur at any age and is often associated with pain, urinary symptoms, and discomfort.

Prostate Cancer:

A malignant growth arising from prostate tissue. It is one of the most common cancers in men and often grows slowly, especially in early stages.

Prostatic Intraepithelial Neoplasia (PIN):

A precancerous condition where prostate cells appear abnormal under the microscope but have not yet invaded surrounding tissue.

Prostate Cancer:

A malignant growth arising from prostate tissue. It is one of the most common cancers in men and often grows slowly, especially in early stages.

Prostate Cysts:

Fluid-filled sacs that may develop within or on the prostate, usually benign.

Prostate Stones (Calculi):

Hard mineral deposits that can form inside the prostate and may be associated with chronic prostatitis.

Size of the Prostate

While gradual enlargement is considered normal, excessive growth can narrow the urethra and lead to urinary symptoms. Prostate size is assessed through clinical examination and imaging studies such as ultrasound, which help determine whether enlargement is within expected limits or related to conditions like BPH.

In healthy adult men, the prostate typically weighs about 20–25 grams and measures approximately:

  • 3–4 cm in width
  • 2–3 cm in thickness
  • 3–4 cm in length

Prostate growth occurs in two main phases:

  • During puberty, when it roughly doubles in size
  • After the age of 25, when it continues to grow slowly throughout life

By the age of 60, many men have prostates weighing 40–50 grams or more. Enlargement beyond normal limits may suggest BPH or another underlying condition.

Prostate size is typically assessed through:

  • Digital Rectal Examination (DRE)
  • Ultrasound imaging, particularly transrectal ultrasound

Normal Prostate vs Enlarged Prostate

A normal-sized prostate allows urine to flow freely through the urethra without obstruction and usually causes no noticeable symptoms.

An enlarged prostate, most commonly due to BPH, develops primarily in the transition zone surrounding the urethra. As it grows, it compresses the urethra, leading to urinary difficulties.

Key differences include:

  • Normal prostate causes no urinary symptoms, while an enlarged prostate leads to lower urinary tract symptoms
  • Enlarged prostate may raise PSA levels compared to a normal gland
  • Risk of urinary retention, infections, and bladder stones is higher with enlargement
  • Quality of life and sleep may be significantly affected in men with BPH

Diagnosis is based on a combination of symptoms, physical examination, urine flow tests, blood tests, and imaging studies.

Treatment for Prostate Conditions

Treatment depends on the type of prostate condition, symptom severity, prostate size, age, and overall health.

Conservative and Medical Management

For mild to moderate symptoms:

  • Watchful waiting with regular monitoring
  • Alpha-blockers (such as Tamsulosin or Alfuzosin) to relax prostate and bladder muscles
  • 5-alpha reductase inhibitors (Finasteride, Dutasteride) to reduce prostate size
  • Combination therapy for better symptom control
  • Antibiotics for bacterial prostatitis
  • Anti-inflammatory medications for chronic prostatitis

Minimally Invasive Procedures

Suitable for selected patients, including those with significant comorbidities:

Prostatic Urethral Lift (UroLift): Holds enlarged tissue away from the urethra; daycare procedure; suitable for patients with severe comorbidities

Water vapor therapy (Rezūm): Uses steam to reduce prostate size; can be performed in high-risk patients

iTind: Used for bladder neck obstruction in younger patients while preserving ejaculation

Transurethral Microwave Therapy (TUMT): Heat-based treatment (rarely performed now)

Transurethral Needle Ablation (TUNA): Radiofrequency-based treatment (rarely performed now)

Surgical Options

For severe symptoms or complications:

  • Transurethral Resection of the Prostate (TURP) – gold standard surgical treatment for BPH
  • Holmium Laser Enucleation of the Prostate (HoLEP) for large prostates
  • Laser vaporization procedures (GreenLight, Thulium)
  • Robotic prostatectomy for very large prostates or prostate cancer

Surgical Options

For severe symptoms or complications:

  • Transurethral Resection of the Prostate (TURP) – gold standard surgical treatment for BPH
  • Holmium Laser Enucleation of the Prostate (HoLEP) for large prostates
  • Laser vaporization procedures (GreenLight, Thulium)
  • Robotic prostatectomy for very large prostates or prostate cancer

Risk Factors for Prostate Cancer

Several factors increase the risk of developing prostate cancer:

  • Increasing age, especially after 50
  • Family history and inherited genetic mutations (BRCA1, BRCA2, Lynch syndrome)
  • Race and ethnicity, with higher risk in African American men
  • Hormonal influences, particularly testosterone and DHT
  • Diet high in red meat and high-fat dairy
  • Obesity and metabolic syndrome
  • Chronic prostate inflammation
  • Exposure to certain chemicals and heavy metals such as cadmium
  • Sedentary lifestyle and limited physical activity

When Is Prostate Surgery Recommended?

Surgery may be advised when:

  • Symptoms are severe and unresponsive to medication
  • Complete urinary retention occurs
  • Recurrent urinary tract infections develop
  • Bladder stones form due to poor emptying
  • Kidney damage or hydronephrosis is detected
  • Recurrent visible blood in urine occurs
  • Prostate cancer requires surgical removal
  • Quality of life is significantly affected despite other treatments

Tests for Prostate Cancer

Diagnosis involves a combination of blood tests, physical examination, imaging, and tissue sampling.

Blood Tests

  • PSA (Prostate-Specific Antigen) test
  • Free PSA ratio for borderline PSA levels
  • Prostate Health Index (PHI)
  • 4Kscore test

Physical Examination

  • Digital Rectal Examination (DRE)

Imaging

  • Multiparametric MRI (mpMRI)
  • Transrectal ultrasound (TRUS)
  • PSMA PET-CT scans
  • Bone scan in advanced disease

Biopsy

  • TRUS-guided biopsy
  • MRI-targeted fusion biopsy
  • Gleason score grading

Advanced Testing

  • Genomic tests (Oncotype DX, Prolaris, Decipher)
  • Liquid biopsy

Difference Between Female and Male Prostate

While the prostate is a distinct and important gland in men, women do not have a true prostate.

  • Males have a well-developed prostate gland with significant reproductive and clinical importance
  • Females have Skene’s glands, also called paraurethral glands or the female prostate
  • These glands are much smaller and located near the lower end of the female urethra
  • Skene’s glands are not clinically significant compared to the male prostate

Surgery may be advised when:

  • Symptoms are severe and unresponsive to medication
  • Complete urinary retention occurs
  • Recurrent urinary tract infections develop
  • Bladder stones form due to poor emptying
  • Kidney damage or hydronephrosis is detected
  • Recurrent visible blood in urine occurs
  • Prostate cancer requires surgical removal
  • Quality of life is significantly affected despite other treatments

Stages of Prostate Cancer

Prostate cancer staging describes how far the disease has spread and helps guide treatment decisions.

Stage I

  • Cancer confined to a small area of the prostate
  • Low-grade tumor with Gleason score 6
  • PSA levels usually below 10 ng/mL
  • Excellent prognosis with treatment

Stage II

  • Cancer confined within the prostate but more extensive
  • May be detectable on examination or imaging
  • Gleason score 7 or PSA levels between 10–20 ng/mL
  • Still considered localized disease

Stage III

  • Cancer spread beyond the prostate capsule
  • May involve seminal vesicles
  • No distant spread
  • Requires more aggressive treatment

Stage IV

  • Spread to nearby lymph nodes (Stage IVA) or distant organs such as bones (Stage IVB)
  • Considered advanced or metastatic disease
  • Treatment focuses on disease control and quality of life

Latest Advances in Prostate Cancer Treatment

Modern prostate cancer care focuses on precision, effectiveness, and quality of life.

Surgical Advances

  • Robotic-assisted prostatectomy
  • Nerve-sparing and Retzius-sparing techniques

Radiation Therapy Innovations

  • Stereotactic Body Radiation Therapy (SBRT)
  • Proton beam therapy
  • Advanced brachytherapy
  • MRI-guided radiation

Focal Therapies

  • High-Intensity Focused Ultrasound (HIFU)
  • Cryotherapy
    • Focal laser ablation
  • Irreversible electroporation (NanoKnife)

Systemic Therapies

  • Next-generation hormone therapies
  • PARP inhibitors
  • Radium-223
  • Lutetium-177 PSMA therapy
  • Immunotherapy

Personalized Medicine

  • Genomic profiling
  • Liquid biopsy monitoring
  • Clinical trials and precision treatment approaches

Our Urology Doctors

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Frequently asked questions:

  • Frequent urge to urinate
  • Urinary incontinence
  • Problems with erection and ejaculation
  • Pain in the lower back or hip
  • Blood in urine

Yes, it’s a serious disease, but most people survive the cancer if it’s detected at an early stage.

There’s no known cause of prostate cancer, but your age, race, and family history might increase your risk.

Yes, prostate cancer is curable.

More than 80% of patients survive for more than 10 years after a prostate cancer diagnosis.

Prostate cancer is the abnormal growth of cells in the prostate gland, which can range from slow-growing tumors to aggressive cancers.

Common prostate cancer symptoms include frequent urination, weak urine flow, blood in urine or semen, and pelvic pain.

The exact cause is unknown, but age, family history, genetics, and lifestyle factors increase the risk.

Men over 50, those with a family history, and certain ethnic groups are at higher risk.

Diagnosis includes PSA tests, digital rectal exams, MRI scans, and biopsy.

There are four stages, ranging from cancer confined to the prostate (Stage I) to advanced cancer spreading to other organs (Stage IV).