The prostate makes a thin, milky fluid that mixes with sperm from the testicles to make semen, the fluid produced during an orgasm. It also swells around the urethra to prevent semen from going into the bladder instead of out the penis.

What can go wrong with the prostate?

As men age, the prostate usually continues to grow. This growth, called benign prostatic hypertrophy or BPH, seems to be caused by the male hormone testosterone. If the prostate gets large enough, it can slow the flow of urine and cause a group of symptoms called prostatism. This trouble usually starts when men are in their forties and fifties. Men report that they have trouble starting to pee, that the stream of urine is slower than before, and that they dribble after they feel they are done. Other symptoms include peeing more often, having a sudden urge to pee, and having to get up often at night to pee.

Prostate cancer is also a growth in the prostate, but in this case the growth is more dangerous. Cancer is caused by cells that grow and divide out of control. They start in the prostate, but can spread by growing directly into organs neighbouring the prostate. Prostate cancer cells can also spread to lymph nodes through lymph channels. (Both are part of the body’s immune or defence system.) The disease can also spread through the blood to bones and other organs. As cancer grows in the prostate, prostatism symptoms may appear.

As the flow of urine is further slowed by growth in the prostate, other problems can start to occur. The bladder may not empty completely, and urine pooling in the bladder can become infected with bacteria. Stones can form in the bladder. The kidneys can be damaged if the bladder doesn’t empty well. Finally, the flow of urine can stop completely, so the bladder has to be drained by a nurse or a doctor using a tube called a catheter.

What is the PSA?

PSA stands for Prostate Specific Antigen. PSA is a protein released by the cells that make up the prostate. The protein winds up in the blood where it can be measured by a blood test. Any problem that causes damage or inflammation in the prostate will cause more PSA to be released, which shows up at a higher number in the blood test.

Normally, the PSA test gives a number less than four: anything over that suggests a problem with the prostate. The problem might be BPH, prostate cancer, infection, or a less common cause. A high number on a PSA test is not specific for prostate cancer - it may be high for other reasons. It is also possible for men with prostate cancer to have a normal PSA test number. Since the PSA test is not perfect, it should be combined with other tests like a rectal exam to diagnose problems of the prostate.

What is a rectal exam?

The front wall of the rectum (the last part of the large intestine before the anus) is just behind the prostate. During a rectal exam, a doctor puts on a rubber glove and inserts a finger through the anus into the rectum to feel the prostate gland. A lubricant is used to minimize discomfort for the patient. The doctor can also check for cancers growing in the lining of the rectum at the same time. The normal prostate gland is smooth and rubbery. It has two halves, called lobes, which can be felt during a rectal exam. Problems affecting the prostate can make it feel different when examined. Prostate cancers usually start in the lobes close to the rectum, and they feel hard and lumpy. The prostate of a person with BPH is larger and softer than normal. If the prostate is infected, it will be very tender.

Who needs to have a rectal exam and a PSA test?

Since problems of the prostate become more common as a man ages, there is little reason to do rectal exams or PSA tests on younger men. Many doctors recommend starting rectal examinations when a man reaches 40. Testing blood for the PSA level usually starts when a man is 50 years old.

If a man has symptoms that suggest prostate problems, or if he is at higher risk for prostate cancer (such as a man of African heritage or with close relatives with prostate cancer), the rectal exam and PSA test may be done at an earlier age. If a man has serious health problems and is not expected to survive long, or doesn’t want to know if he has prostate cancer, then neither procedure may be needed.

What about erectile dysfunction?

The medical term for trouble getting or maintaining erections is erectile dysfunction. Erections are controlled by nerves that come from the brain, down the spinal cord, through the area of the prostate, and into the penis. They make blood vessels in the penis relax and fill with blood. Blood filling the penis makes it become erect. Sometimes problems with the prostate can damage the nerves to the penis. As well, men sometimes need surgery for BPH or prostate cancer which can also damage the nerves. Damage to the nerves often results in erectile dysfunction, but some treatments can help in this situation.

Many men wonder if medications advertised on TV such as Viagra™, Cialis™ and Levitra™ can help with erections. These medications work by making the blood vessels respond better to signals from the nerves. Often with the use of drugs, even if the signal is weaker the penis can still respond with an erection. You can discuss these medications with your family doctor. The article about erectile disfunction of this issue also looks at their use.

Do I need to see my doctor about my prostate?

See your doctor if you have symptoms of prostatism, trouble with erections, or are worried about prostate cancer. It is recommended that all men over the age of 50 have a rectal exam once a year. It is always better to find out sooner than later if there is a problem with the prostate.

Prostate Health What men should know