Prostate problems

How common are prostate problems?

Prostate problems are very common, especially in men over 50 (approx 1 in 3), as the prostate tends to get bigger with age.

What conditions can cause prostate problems?

There are a number of different conditions that can affect the prostate gland, including:

Benign prostatic hypertrophy

Benign prostatic hypertrophy (BPH) is non-cancerous enlargement of the prostate gland, which can cause reduced urinary flow, hesitancy when starting to pass urine, frequent urination and needing to pass urine during the night.

There are various treatments for the symptoms of BPH, including drugs such as alfuzosin/doxazosin (alpha-blockers), dutasteride/finasteride (5-alpha reductase inhibitors), oxybutinin/tolterodine/fesoterodine/darifenacin/solifenacin/trospium (antimuscarinics), mirabegron (for overactive bladder) and desmopressin (for frequent night-time urination)

Prostatitis

Acute prostatitis is usually caused by an infection, which can be severe, and requires antibiotic treatment. Symptoms include:

• Painful, frequent urination with urgency.

• Pain of the genitals, rectum and/or perineum (the area between the scrotum and anus) .

• Difficulty passing urine.

• Lower back pain.

• Pain on ejaculation.

• Fevers, aches and feeling unwell.

Chronic prostatitis is long-standing inflammation of the prostate gland. The exact cause is not known but it may be due to inflammation or infection. It can cause:

• Pain or discomfort in the genital area.

• Problems passing urine - eg, hesitancy, poor flow.

• Problems with erection, ejaculation, libido.

• Associated stress, depression and anxiety.

• Symptoms that are usually present for three months or longer.

Prostate cancer

Prostate cancer can cause the same symptoms as many non-cancerous prostate conditions, such as frequent urination, hesitancy, poor flow, needing to pass urine overnight, and dribbling at the end of passing urine. The symptoms are common in older men with enlarged non-cancerous prostate glands, and do not usually start in early prostate cancer, but can be a sign of obstruction in a more advanced cancer. Most men with these urinary symptoms will not have prostate cancer.

Other symptoms can include:

• Back or other bony pain.

• Tiredness.

• Erection problems.

• Blood in the urine (haematuria).

• Weight loss.

Again, these are usually symptoms of more advanced prostate cancer. Unfortunately, prostate cancer often only causes symptoms when it has become more advanced, but in a lot of cases it is a very slow-growing disease and there are many effective treatments for it. See the separate leaflet on Prostate Cancer for further information.

To assess all the above conditions, a prostate examination maybe required - this involves a doctor or nurse inserting a gloved finger into the rectum to assess if the prostate gland is enlarged or tender. It can be a little uncomfortable but does not take long and can give the doctor or nurse important information to aid diagnosis and treatment.

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Acute prostatitis

When the prostate gland becomes infected with a germ (a bacterial infection), the condition is known as acute prostatitis. 'itis' means inflammation, so prostatitis is inflammation of the prostate - not all forms of prostatitis are bacterial, but this leaflet will mainly cover bacterial prostatitis. Symptoms include pain, mainly at the base of the penis and around the anus. A bladder infection commonly occurs at the same time. Treatment includes a four-week course of antibiotic medication.

by Dr Toni Hazell, MRCGP

Types of urethral problems in men

Urethral stricture

The urethra - the tube that urine flows out of from your bladder - can sometimes become narrowed. See the separate leaflet called Urethral Stricture for more details.

Urinary tract infection

One of the most common causes of urethral pain is urinary tract infection. It is usually accompanied by other symptoms such as a frequent and urgent need to pass urine.

Urethritis

This is inflammation of the urethra. It's usually due to an infection which has been acquired sexually, most commonly gonococcus. Again, other symptoms often accompany urethral pain, such as a discharge from the penis or pain passing urine.

See the separate leaflet called Urethritis and Urethral Discharge in Men for more details.

Trauma

The most common type of injury to the urethra is by the insertion of a tube to drain the bladder (a catheter). You may require this procedure if you develop urinary retention, usually as a result of swelling of the prostate gland.

Bleeding from the urethra

Urethral bleeding may have a number of different causes.

• Infection is a common cause - either in connection with a urinary tract infection or associated with urethritis. It often presents as blood in the urine (haematuria) rather than blood oozing from the urethra.

• Trauma - injury from a catheter can cause bleeding as well as pain.

• Cancer - urethral cancer is very rare in men. Cancer of the bladder or kidney is more common. You may notice bleeding from the urethra, or blood in the urine. Treatment of urethral cancer is usually surgical. It may be necessary to remove the penis entirely, although in some cases it can be preserved.