Prostate Diseases: Prostatitis, Enlarged Prostate and Prostate Cancer

The prostate is a gland of the male reproductive system. It sits just below the bladder and makes fluid that forms part of semen. Anyone with a prostate can develop problems with it, and the three main kinds are inflammation, enlargement and cancer.

Prostatitis

Prostatitis is inflammation — swelling and pain — of the prostate, and it is the most common prostate problem in people younger than 50. It comes in several forms:

• Chronic prostatitis, also called chronic pelvic pain syndrome, is the most common type.
• Acute bacterial prostatitis comes on suddenly from a bacterial infection and is treated with antibiotics. It is uncommon.
• Chronic bacterial prostatitis is a bacterial infection that keeps coming back. Its symptoms usually start slowly, and it can take longer to treat than the acute form.
• Asymptomatic prostatitis causes no symptoms and usually needs no treatment. It is often found during tests for something else.

Prostatitis is more likely with an infection of the lower urinary tract (the bladder and urethra), which can lead to acute or chronic bacterial prostatitis; with nerve damage in the lower urinary tract from surgery or injury; or with emotional stress. The last two can lead to chronic prostatitis.

Enlarged prostate

An enlarged prostate is also called benign prostatic hyperplasia (BPH). The gland tends to grow with age, so BPH is very common in older people and rare before 40. As it grows, it can press on the urethra and cause trouble urinating. The risk is higher for people who are 40 or older, have relatives who have had BPH, have obesity, heart disease, circulation problems or type 2 diabetes, or do not get enough physical activity.

Prostate cancer

Prostate cancer is a common cancer in people 50 and older. Most prostate cancers grow slowly and may never cause health problems, but some are serious. The risk is higher for people who are older than 50, who have a parent, sibling or child who has or had prostate cancer, or who are African American.

Symptoms

Common signs of prostate trouble include:

• needing to urinate often;
• rushing to the bathroom but being unable to urinate, or passing only a little;
• leaking or dribbling urine; and
• a weak urine stream.

Depending on the problem, there may also be difficulty starting or controlling urine flow, waking often at night to urinate, blood in the urine or urine of an unusual smell or color, fever, chills or body aches, and marked discomfort or pain — while urinating or after ejaculation, in the belly, between the scrotum and anus, or in the scrotum or penis.

Being unable to urinate at all is a medical emergency. Any of the other symptoms is a reason to contact a provider.

Diagnosis and treatment

A provider will ask about symptoms and personal and family health history and do a physical exam, which may include a digital rectal exam, in which the provider inserts a gloved finger into the rectum to feel the prostate's size and condition. Tests, if needed, may include:

• blood and urine tests for infection;
• urodynamic testing of how well urine is held and released;
• cystoscopy to look inside the urethra and bladder;
• ultrasound images of the prostate and urinary tract;
• a PSA (prostate-specific antigen) blood test; and
• a prostate biopsy to diagnose or rule out cancer.

Treatment depends on which prostate disease a person has and which symptoms trouble them most.

Sources

• MedlinePlus, U.S. National Library of Medicine, "Prostate Diseases" (summary from the National Institute of Diabetes and Digestive and Kidney Diseases): https://medlineplus.gov/prostatediseases.html