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The Prostate

This page is for anyone who wants to know more about the prostate gland. It tells you what the prostate gland is and what changes to look out for. It also describes the three most common prostate problems that affect men – Benign Prostatic Hyperplasia (BPH), prostatitis and prostate cancer.

If you think you may have a problem with your prostate, talk to your GP or call our free and confidential Helpline on 0800 074 8383 to speak to a Prostate Cancer Charity specialist nurse.

Know your prostateThe information on this page comes from our booklet ’Know your prostate: a guide to common prostate problems.’ You can order printed publications about the prostate gland and prostate cancer from our publications page.

You can also download and print a PDF version of the booklet.


What is the prostate gland?

Only men have a prostate gland. The prostate is usually the shape and size of a walnut. It lies underneath the bladder and surrounds the tube (urethra) that men pass urine and semen through. The prostate gland’s main job is to make most of the fluid that carries sperm, called semen.

Image of prostate location

The prostate gland can get bigger with age and may press on the urethra, causing problems with passing urine.

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What changes should I look out for?

The main types of prostate problem are:

  • a non-cancerous enlargement of the prostate called Benign Prostatic Hyperplasia (BPH) – this is the most common prostate problem
  • inflammation or infection of the prostate (prostatitis)
  • prostate cancer

Each of these prostate problems can cause similar symptoms. These may include:

  • A weak or reduced urine flow
  • Needing to urinate more often, especially at night
  • A feeling that your bladder has not emptied properly
  • Difficulty starting to pass urine
  • Dribbling urine
  • Needing to rush to the toilet – you may occasionally leak urine before you get there

Less common symptoms include:

  • Pain when passing urine
  • Pain when ejaculating
  • Pain in the testicles

Some men with prostate cancer may have no symptoms at all.

If you have any of these symptoms, you should visit your GP to find out what is causing the problem.

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What is Benign Prostatic Hyperplasia (BPH)?

BPH is a very common condition that affects many men from the age of about 50. Two out of every five men (41 per cent of men 1 ) over the age of 50 and three out of four men (75 per cent of men 2 ) in their 70s have problems passing urine that may be caused by BPH.

Your prostate gland slowly gets bigger as you get older. In some cases the prostate gland may press on the tube you pass urine through (urethra). If this happens you may find it difficult to pass urine. You may have a weaker stream and find it harder to empty your bladder. However, these urinary symptoms can also be caused by other medical problems such as a urine infection or other prostate problems described in this booklet. If you have any of the symptoms described above you should visit your GP to find out what is causing the problem.

BPH is not a form of cancer and having BPH does not increase your risk of developing cancer 3.

You can find out more by reading our information page for men concerned about benign prostatic hyperplasia (BPH)

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What are the treatment options for BPH?

Treatment depends on how bad the symptoms are and how much they affect your day to day activities and quality of life. If your symptoms are mild, you may not need treatment. Your doctor will keep an eye on your symptoms and talk to you about some simple changes to your lifestyle that may relieve your symptoms. For example, your doctor may ask you about the fluids you drink and advise you to cut down on alcohol and drinks that contain caffeine, such as tea and coffee. These can make urinary symptoms worse.

If your symptoms get worse or are causing you problems, ask your GP about treatment options. Several treatments are available ranging from medicines to surgery. You can find out more by reading our information page for men concerned about benign prostatic hyperplasia (BPH) or by calling our free and confidential Helpline.

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What is prostatitis?

Prostatitis can affect men of any age but is more common in men aged between 30 and 50. It can be caused by an infection or inflammation of the prostate gland.

As well as the symptoms described above, prostatitis can cause:

  • pain or aching in the lower back, abdomen, legs, testicles or the area just behind the testicles (perineum)
  • stinging when you pass urine
  • pain when you ejaculate
  • loss of interest in sex (lack of libido).

In more severe cases it may cause fever and sweating. Prostatitis can be present for a long time, causing occasional pain even after any infection has been treated.

There are different types of prostatitis which are treated in different ways. If you have any of the symptoms described here, talk to your GP. You can also speak to a Prostate Cancer Charity specialist nurse by calling our free and confidential Helpline.

You can also download and print the booklet Prostatitis: A guide to infection or inflammation of the prostate.

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What is prostatic intraepithelial neoplasia (PIN)?

Prostatic intraepithelial neoplasia (PIN) is the name given to certain changes in the cells that line the prostate gland. We do not know what causes PIN but we do know that the risk of finding PIN in the prostate increases with age.4

PIN is not the same as prostate cancer and does not cause any symptoms. However, PIN can be in the prostate gland alongside cancer cells and finding PIN may mean that there is a higher risk of finding prostate cancer cells in the future. 5

We need more research before we can say for sure what the exact relationship is between finding PIN and developing prostate cancer.

PIN is often found because a man has had tests for prostate cancer. This is because some tests for prostate cancer involve studying the prostate cells under a microscope and looking for abnormalities, such as PIN.

Samples of prostate cells are gathered during a trans-rectal ultra sound (TRUS) biopsy. You may have a TRUS biopsy if there is a concern that you might have prostate cancer. Another way that PIN may be detected is after a trans-urethral resection of the prostate (TURP). This is an operation to treat benign prostatic hyperplasia (BPH). The operation involves removing the parts of the prostate gland that have overgrown. The prostate tissue is checked under a microscope for any abnormal cells.

Will I need treatment?

PIN has no symptoms and does not need to be treated. However, because there may be an increased risk of prostate cancer if you have PIN, you might see a specialist at the hospital for regular follow up tests. For example, if PIN is detected you may have routine PSA blood tests or, in some cases, further biopsies. There are no guidelines for how often men with PIN should have follow up tests. You should discuss the possible options with your doctor.

Some studies have looked at whether certain drugs can reverse or stop the development of PIN in the prostate. 6 7 We need more research to show that these treatments work before they become available to men with PIN. Having PIN may increase your risk of developing prostate cancer in the future. No one knows how to prevent prostate cancer but diet and a healthy lifestyle may be important in protecting against the disease 8.

You can also download and print the booklet Prostatic Intraepithelial Neoplasia (PIN).

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What is prostate cancer?

Prostate cancer is the most common cancer in men. In the UK, 35,000 men are diagnosed with prostate cancer every year 9. Prostate cancer can develop when cells in the prostate gland start to grow in an uncontrolled way. In most cases this is a slow growing cancer that men will be unaware of throughout their lifetime because it may never cause any symptoms or problems. However, some men will have a fast growing cancer that needs treatment to prevent or delay it spreading outside the prostate gland.

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What are the risk factors for prostate cancer?

Prostate cancer mainly affects men over the age of 50. Younger men can be affected but this is rare. The risk of developing prostate cancer rises with age. Your risk also increases if a close family member (father or brother) has prostate cancer. The risk increases further if more than one close relative has prostate cancer, or if your relative was under the age of 60 when they were diagnosed.10 In the UK, African Caribbean men are three times more likely to develop prostate cancer than white men 11 .

No one knows how to prevent prostate cancer but diet and a healthy lifestyle may be important in protecting against the disease. If you would like more information, you can read our information on diet and prostate cancer.

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What are the symptoms of prostate cancer?

Most men with early prostate cancer have no symptoms at all. However some men may have the symptoms described above. Other symptoms you may get include:

  • New pain in the lower back, hips or pelvis
  • Problems getting or keeping an erection
  • Blood in the urine or semen – but this is rare.

You do not need to have all of these symptoms to have a problem. These symptoms can also be caused by other problems such as BPH, so it is important to see your doctor to find out what is causing your symptoms.

We have further information about diagnosing prostate cancer and treatment options. You can order printed copies of our publications free of charge from the publications page. If you have any questions about prostate cancer you can also speak to a Prostate Cancer Charity specialist nurse by calling our free and confidential Helpline.

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What will happen at the doctor’s?

If you notice any of the symptoms described in this booklet or you think you might have a prostate problem, go and see your GP. You can talk to your doctor about your symptoms and you can ask any him/her any questions you may have.

Your doctor may ask you to fill out a questionnaire about your symptoms to see how much bother they are causing in your daily life. There are a few tests that your doctor may carry out to find out if you have a prostate problem.

Common tests, explained in more detail below, are:

  • A urine ‘dipstick’ test to check for infection
  • A blood test called a Prostate Specific Antigen (PSA) test – usually done once an infection has been ruled out
  • A physical examination called a Digital Rectal Examination (DRE) – usually done after the urine and blood tests
  • A test to measure the force of your urine flow
  • An ultrasound scan to check whether your bladder is emptying properly

You may not have all of the tests described here. Your GP may do some of these tests or you may need to visit a doctor who specialises in urinary problems (urologist) at the hospital. Ask your doctor for more details about which tests you will have and what they involve. You can also call our free and confidential Helpline.

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Urine tests

If your GP thinks that you might have a urine infection, they will test a sample of your urine. The GP will do this before the PSA test because a urine infection can affect your PSA level.

PSA and other blood tests

The prostate gland makes a protein called PSA (Prostate Specific Antigen). It is normal to have some PSA in the blood. The PSA level rises as you get older, so a man aged 70 will have a higher PSA than a man aged 50.

Your GP can measure the amount of PSA in your blood by taking a sample of your blood and sending it off to a laboratory to be tested. If there is a problem in the prostate, caused by BPH, prostatitis or prostate cancer, the levels of PSA in the blood can go up.

Before you decide whether to have the PSA test you may like to read about the advantages and disadvantages of the test. You can find out more from our booklet called ‘PSA and beyond: a guide for men concerned about prostate cancer’. You can order a free copy from our publications page.

You may also have a blood test to check that your kidneys are working properly. This is because some undiagnosed prostate problems can affect your kidneys.

Digital Rectal Examination (DRE)

A DRE is a simple test which can be done at the GP surgery. The DRE is usually done after the PSA test because it can affect your PSA level.

You will be asked to lie on your left side on an examination table with your knees brought up to your chest. If you find it easier, you can stand and lean forward over the back of a chair or across the examination table instead.

The doctor or nurse feels your prostate through your back passage (rectum) with a gloved, lubricated finger. They are looking for any swelling or hard areas on the back surface of your prostate. The DRE should not be painful. Some men find it uncomfortable or embarrassing but it is over quickly.

Urine flow test

This test involves passing urine into a machine that measures the speed and force of your urine flow. If you are passing urine slowly, it may mean that your prostate is pressing on the urethra.

Ultrasound scan

An ultrasound scan can show whether your bladder is emptying properly. You may have the scan after the urine flow test, described above, when you have finished passing urine. The scan will show any urine that is left in the bladder.

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What happens next?

It can take one or two weeks to get the test results. If your PSA is low for your age and your DRE result is normal you may not need to have any further tests. However, some men choose to have regular PSA tests, because a prostate problem may still develop in the future. You may like to discuss this with your GP.

If you are diagnosed with a prostate problem your doctor will discuss your treatment options with you. For more detailed information about treatment options for BPH, prostatitis and prostate cancer you can call our free and confidential Helpline to speak to a specialist nurse.

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More information

The following organisations can give you support and information on prostate problems:

NHS Choices
www.nhs.uk
Includes an A-Z of treatments and conditions and information on NHS health services in your local area.

Patient UK
www.patient.co.uk
This website contains information that GPs use with members of the public. Includes information on prostate problems.

Prostate UK
www.prostateuk.org
Telephone: 020 8877 5840
For information on prostate problems.

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Written and edited by:
The Prostate Cancer Charity Information Team

Reviewed by:

  • Mr James Catto, Consultant Urological Surgeon, Royal Hallamshire Hospital, Sheffield
  • Dr. Elwyn Davies, GP Partner, Cheddar Medical Centre
  • Joe Kearney, Urology Oncology CNS , Buckinghamshire Hospitals NHS Trust
  • Natalie Mart, Urology Oncology Clinical Nurse Specialist, Urology Outpatients Kings Treatment Centre, Derby Hospitals NHS Foundation Trust
  • Patricia McClurey, Specialist Nurse Prostate Cancer, James Cook University Hospital, Middlesbrough.
  • Dr. James Phillips. GP Partner, Maclean Medical Practice, Glasgow
  • Dr Lucy Thompson, GP Partner, Lovemead Group Practice, Trowbridge
  • Kevin Wardlaw, Urology-Oncology Clinical Nurse Specialist (Macmillan), Aberdeen Royal Infirmary, Aberdeen
  • The Prostate Cancer Charity Support & Information Specialist Nurses
  • The Prostate Cancer Charity Information Volunteers

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References used in the production of this page

1. Trueman P, Hood SC, Nayak USL et al. Prevalence of lower urinary tract symptoms and self-reported diagnosed ‘benign prostatic hyperplasia’, and their effect on quality of life in a community-based survey of men in the UK. BJU Int 1999; 83: 410-415.

2. Wei JT, Calhoun E, Jacobsen SJ. Urologic diseases in America project: benign prostatic hyperplasia. Journal of Urology 2005; 173: 1256-1261.

3. Young JM, Muscatello DJ, Ward JE. Are men with lower urinary tract symptoms at increased risk of prostate cancer? A systematic review and critique of the available evidence. BJU Int. 2000; 85: 1037-1048.

4. Godoy G and Taneja SS. Contemporary clinical management of isolated high grade prostatic intraepethial neoplasia (Review). Prostate Cancer and Prostatic Diseases 2008 11, 20-31

5. Zynger D L and Yang X. High-grade prostatic intraepithelial neoplasia of the prostate: the precursor lesion of prostate cancer (Review). Int J Clin Exp Pathol 2009; 2(4) 327-338

6. Thompson IM, Lucia MS, Redman MW et al. Finasteride decreases the risk of PIN. J Urol 2007; 178: 107-109.

7. Price D, Stein B, Sieber P et al. Toremifene for the prevention of prostate cancer in men with high grade prostatic intraepithelial neoplasia: results of a double-blind, placebo controlled phase IIB clinical trial. J Urol 2006; 176: 965-970.

8. Sonn GA, Aronson W, Litwin MS. Impact of diet on prostate cancer: a review. Prostate Cancer and Prostatic Diseases 2005;8(4): 304-10.

9. Office for National Statistics http://www.statistics.gov.uk. The Welsh Cancer Intelligence and Surveillance Unit http://www.wales.nhs.uk. ISD Scotland www.isdscotland.org. N. Ireland Cancer Registry www.qub.ac.uk

9. Office for National Statistics http://www.statistics.gov.uk. The Welsh Cancer Intelligence and Surveillance Unit http://www.wales.nhs.uk. ISD Scotland www.isdscotland.org. N. Ireland Cancer Registry www.qub.ac.uk

10. Johns LE, Houlston RS. A systematic review and meta-analysis of familial prostate cancer risk. BJU International 2003; 91: 789-794.

11. Ben-Shlomo Y, Evans S, Ibrahim F, et al The Risk of Prostate Cancer amongst Black Men in the United Kingdom: The PROCESS Cohort Study. Eur Urol 2008; 53(1):99-105.

Page last updated: July 1st 2010