The prostate (from Ancient Greek προστάτης, prostates, literally “one who stands before”, “protector”, “guardian”) is a compound tubuloalveolar exocrine gland of the male reproductive system in most mammals. It differs considerably among species anatomically, chemically, and physiologically.
The function of the prostate is to secrete a slightly alkaline fluid, milky or white in appearance, that in humans usually constitutes roughly 30% of the volume of semen along with spermatozoa and seminal vesicle fluid. Semen is made alkaline overall with the secretions from other contributing glands, including, at least, seminal vesicle fluid. The alkalinity of semen helps neutralize the acidity of the vaginal tract, prolonging the lifespan of sperm. The prostatic fluid is expelled in the first part of ejaculate, together with most of the sperm. In comparison with the few spermatozoa expelled together with mainly seminal vesicular fluid, those in prostatic fluid have better motility, longer survival, and better protection of genetic material.
The prostate also contains some smooth muscles that help expel semen during ejaculation.
Prostatitis is swelling and inflammation of the prostate gland, a walnut-sized gland situated directly below the bladder in men. The prostate gland produces fluid (semen) that nourishes and transports sperm.
Prostatitis often causes painful or difficult urination. Other symptoms include pain in the groin, pelvic area or genitals and sometimes flu-like symptoms.
Prostatitis affects men of all ages but tends to be more common in men 50 or younger. The condition has a number of causes. Sometimes the cause isn’t identified. If prostatitis is caused by a bacterial infection, it can usually be treated with antibiotics.
Depending on the cause, prostatitis can come on gradually or suddenly. It might improve quickly, either on its own or with treatment. Some types of prostatitis last for months or keep recurring (chronic prostatitis).
Acute prostatitis usually clears with a course of antibiotics. It’s important to take the full course to ensure that the infection clears completely.
Rarely, other complications of acute prostatitis can occur. These include:
- acute urinary retention – because passing urine can be very painful, urine can build up in your bladder, causing pain in your lower tummy (abdomen) and inability to pass urine at all; to relieve this, a catheter (a thin, flexible, hollow tube is needed)
- prostate abscess – if antibiotics aren’t effective in treating prostate infection, rarely an abscess can develop in your prostate gland; your doctor may suspect this if your symptoms don’t improve despite antibiotic treatment; further tests will be needed to confirm a prostate abscess, such as an ultrasound scan or CT scan of your prostate gland; if an abscess is present, you’ll need an operation to drain it
Chronic prostatitis can be challenging to treat because little is known about what causes it. Most men will gradually recover with treatment, but this can take several months or years.
Some men with prostatitis find their symptoms return (relapse) later on, which will require further treatment.
Prostatitis isn’t prostate cancer and there’s currently no clear evidence that it increases your chances of developing cancer of the prostate.
Benign prostatic hyperplasia (BPH) — also called prostate gland enlargement — is a common condition as men get older. An enlarged prostate gland can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder. It can also cause bladder, urinary tract or kidney problems.
There are several effective treatments for prostate gland enlargement, including medications, minimally invasive therapies and surgery. To choose the best option, you and your doctor will consider your symptoms, the size of your prostate, other health conditions you might have and your preferences.
The outlook for benign prostatic hyperplasia is good; although it can cause significant discomfort, the condition is benign. As the prostate gland grows in size, symptoms may become worse, warranting medication or surgery. With appropriate medical and/or surgical management, the symptoms of an enlarged prostate gland can be treated effectively.
Prostate cancer is cancer that occurs in the prostate — a small walnut-shaped gland in men that produces the seminal fluid that nourishes and transports sperm.
Prostate cancer is one of the most common types of cancer in men. Usually prostate cancer grows slowly and is initially confined to the prostate gland, where it may not cause serious harm. However, while some types of prostate cancer grow slowly and may need minimal or even no treatment, other types are aggressive and can spread quickly.
Prostate cancer that’s detected early — when it’s still confined to the prostate gland— has a better chance of successful treatment.
Digital rectal examination (DRE)
A digital rectal examination (DRE) is an important element of a clinical examination, performed by a doctor or nurse. It is a direct examination of the rectum and nearby organs, including the anal canal, prostate and bladder. While it can be uncomfortable, a DRE is critical to identifying illnesses such as benign prostatic hyperplasia (BPH), prostatitis (infection of the prostate), haemorrhoids, anal fissures, prostate cancer and anal and rectal cancers. If these diseases are identified early, curative treatments may be possible, particularly in certain types of cancer.
Individuals with anal symptoms (such as itching, pain or bleeding), gastrointestinal symptoms (such as persistent diarrhoea, constipation, rectal bleeding), genitourinary symptoms (such as difficulty passing urine or a weak stream) or other relevant symptoms (such as prolonged back pain) should all have a DRE performed as part of a thorough clinical examination.
A DRE is an essential element of screening for prostate cancer, a very common cancer in men.
Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the level of PSA in a man’s blood. For this test, a blood sample is sent to a laboratory for analysis. The results are usually reported as nanograms of PSA per milliliter (ng/mL) of blood.
The blood level of PSA is often elevated in men with prostate cancer, and the PSA test was originally approved by the FDA in 1986 to monitor the progression of prostate cancer in men who had already been diagnosed with the disease. In 1994, the FDA approved the use of the PSA test in conjunction with a digital rectal exam (DRE) to test asymptomatic men for prostate cancer. Men who report prostate symptoms often undergo PSA testing (along with a DRE) to help doctors determine the nature of the problem.
In addition to prostate cancer, a number of benign (not cancerous) conditions can cause a man’s PSA level to rise. The most frequent benign prostate conditions that cause an elevation in PSA level are prostatitis (inflammation of the prostate) and benign prostatic hyperplasia (BPH) (enlargement of the prostate). There is no evidence that prostatitis or BPH leads to prostate cancer, but it is possible for a man to have one or both of these conditions and to develop prostate cancer as well.
Prostate ultrasound (transrectal ultrasound)
Ultrasound of the prostate uses sound waves to produce pictures of a man’s prostate gland and to help diagnose symptoms such as difficulty urinating or an elevated blood test result. It’s also used to investigate a nodule found during a rectal exam, detect abnormalities, and determine whether the gland is enlarged. Ultrasound is safe, noninvasive, and does not use ionizing radiation.
This procedure requires little to no special preparation. Leave jewelry at home and wear loose, comfortable clothing. You may be asked to wear a gown and to lie on your side with your knees toward your chest. To obtain high-quality images, an ultrasound transducer – a plastic cylinder about the size of a finger – is inserted short distance into the rectum. If a biopsy is planned, you may be told to avoid aspirin and other blood thinners for seven to 10 days prior to the procedure. You may be instructed to use an enema to clean out your bowel.
A prostate biopsy is a procedure to remove samples of suspicious tissue from the prostate. The prostate is a small, walnut-shaped gland in men that produces fluid that nourishes and transports sperm.
During a prostate biopsy a needle is used to collect a number of tissue samples from your prostate gland. The procedure is performed by a doctor who specializes in the urinary system and men’s sex organs (urologist).
Your urologist may recommend a prostate biopsy if results from initial tests, such as a prostate-specific antigen (PSA) blood test or digital rectal exam, suggest you may have prostate cancer. Tissue samples from the prostate biopsy are examined under a microscope for cell abnormalities that are a sign of prostate cancer. If cancer is present, it is evaluated to determine how quickly it’s likely to progress and to determine your best treatment options.