The prostate is a gland. It is usually the size and shape of a walnut and grows as you age. It sits underneath the bladder and surrounds the urethra, the tube that carries urine out of the body. The prostate’s main job is to help make semen – the fluid that carries sperm. 

What makes prostate problems more likely?

Several factors may make prostate problems more likely. 

Strong risk factors

A family history of prostate problems. Figures show that you are two and a half times more likely to get prostate cancer if your father or brother has had it compared to a man who has no relatives with prostate cancer. Your risk of getting prostate cancer may also be higher if your mother or sister has had breast cancer.

Ethnicity. While more research is needed to explain why figures show that African Caribbean men are 2–3 times more likely to develop prostate cancer than their white counterparts and black men are also more likely to develop prostate cancer at a younger age.

Other risk factors

High calcium intake. In many studies, a high calcium intake is linked to a higher risk of prostate cancer.

Smoking

Smoking appears to result in worse diseases. Stopping smoking is always a good idea.

High cholesterol

There is an ongoing debate about a possible link between cholesterol and prostate cancer. This started when several observational studies found that high cholesterol levels were associated with an increased risk of total or advanced prostate cancer.

Some studies reported that those people taking statins, a drug that lowers their cholesterol, appeared to have a lower risk of having advanced prostate cancer. However, the link is far from proven and will need further research before we know if statins could protect against prostate cancer.

What you can do to try to keep your prostate healthy?

You can adopt several lifestyle changes or habits to look after your prostate. These include:

Eat tomatoes as part of a Mediterranean diet

Studies suggest that eating a lot of tomatoes is associated with a reduced risk of prostate cancer. Tomatoes cooked in oil seem to have a more protective effect, so the Mediterranean diet seems to be most suitable.

Eat fish

Studies show a 63% reduction in prostate cancer-specific mortality associated with higher total fish intake.

Do exercise

Among men over 65, those who did vigorous activity had a 77% lower risk of advanced prostate cancer. Physical activity has been linked to improved survival and decreased prostate cancer progression among men diagnosed with prostate cancer. Vigorous and milder exercise appears protective and improves the quality of life.

Lose weight if you are obese

Being overweight appears to make prostate problems more likely and result in worse outcomes.

Drink coffee

Some studies suggest that men who drink many cups of coffee a day are less likely to develop prostate cancer, regardless of whether it contains caffeine. It’s thought this may be down to the chemicals found in coffee: cafestol and kahweol. However, more research is needed.

Vitamin D

There is early evidence that vitamin D may be protective against prostate cancer. More research is needed but getting the right amount of vitamin D to support your overall health is important.

Prostate related problems

Several problems and diseases might affect your prostate. These include:

Benign prostate enlargement

Prostate enlargement is a very common condition associated with ageing. More than one in three of all men over 50 will have some symptoms of prostate enlargement.

It’s unknown why the prostate gets bigger as you get older, but it is not caused by cancer and does not increase your risk of developing prostate cancer. An enlarged prostate can put pressure on the urethra, affecting your urination.

Prostate cancer

In the UK, prostate cancer is the most common type of cancer in men, with more than 40,000 new cases diagnosed yearly. It’s unclear why it occurs, but your risk of developing prostate cancer increases as you get older. The condition mainly affects men over 65, although men over 50 are also at risk.

Prostatitis

Prostatitis is inflammation (swelling) of the prostate gland. It can be very painful and distressing, but it will often improve. Prostatitis can come on at any age but usually between 30 and 50.

Signs and symptoms of prostate problems

There is a range of symptoms that may indicate prostate problems. These can include:

• Difficulty starting or stopping urinating
• A weak flow of urine
• Straining when peeing
• Feeling like you’re not able to fully empty your bladder
• Prolonged dribbling after you’ve finished peeing
• Needing to pee more frequently or more suddenly
• Waking up frequently during the night to pee
• Blood in semen
• Blood in urine

What do my symptoms mean?

If you experience any of the symptoms listed above, you must talk to your GP. It may be a minor issue, but it is impossible to distinguish between cancerous and non-cancerous (benign) prostate enlargement by symptoms alone.

So, you need to see your GP if you notice any problems with, or changes to, your usual pattern of weeing. It’s also very important to talk to your doctor if you see any blood in your urine or semen.

Going to the GP for prostate problems

If you do go to the GP for any of the symptoms mentioned above, here’s what you may experience:

Questions

Your GP may ask you about your medical history, including emotional, physical, psychological, sexual, and social issues.

Your GP may ask questions about any symptoms to better understand your International prostate symptom score (IPSS). This questionnaire can help your GP determine which treatment option is best for you and monitor any improvement.

You may be asked to fill in a urine frequency volume chart over several days.

Review

Your GP may also review all current medication, including herbal or medicine you can buy at the chemist.

Physical examination

Your GP may examine your tummy, external genitals, and examination of your rectum with a finger to feel the size and denseness of the prostate.

Tests

• You may be offered a urine test for possible infection.
• You may also be offered blood tests to check your kidneys are working properly.
• You may be offered a prostate Specific Antigen Test (PSA test), a test to check for cancer of the prostate (read more about this below in the next section).

Further investigation

You can expect to be referred to a team specialising in the management of urological cancer within two weeks if the GP finds:

• A hard, irregular prostate on rectal examination
• A high (or rising) PSA after blood tests
• Significant blood in the urine

You may be offered an MRI scan of the prostate to help doctors decide if you need further tests and treatment. You may need other tests, such as a biopsy. This involves taking small samples of your prostate and checking them for cancer.

Support

Your GP should offer you reassurance and lifestyle advice and provide access to support for relevant physical, emotional, psychological, sexual, and social issues.

The PSA Test

The PSA test is a blood test to help detect prostate cancer. It’s not perfect and will miss about 15% of cancers. About 3 in 4 men with a raised PSA level will not have cancer.

Before deciding to have the PSA test, you may want to talk to a GP and practice nurse, your partner, a friend, or a family member.

A raised PSA level in your blood may be a sign of prostate cancer, but it can also be a sign of other conditions that are not cancer, such as:

An enlarged prostate

• Prostatitis
• Urinary infection
• PSA screening 

There’s currently no screening programme for prostate cancer in the UK, although men over 50 can ask for a PSA test from their GP. The NHS says results can be unreliable, as outlined earlier.

If offered a PSA test, it’s worth talking to your GP and weighing up your options, as it can potentially lead to unnecessary investigations and even treatment.

There is an argument for African-Caribbean men with a family history of prostate cancer to get screened, as they have a particularly high risk. In their case, the benefits of screening may outweigh the risks.

The following people have a prostate:

• Men
• Trans women
• Non-binary people who were assigned male at birth

Some intersex people

• A trans woman was assigned male at birth but identifies as a woman. Trans women can develop prostate problems, even if they have taken hormones. The prostate is not removed during genital reconstructive surgery.
• A non-binary person may not identify as a man or a woman.
• An intersex person may have both male and female sexual characteristics and so might have a prostate.