What is the prostate?
The prostate is a gland made of solid tissue that sits right under a man’s bladder and surrounds its outlet. The prostate’s job is to make semen so sperm that are shot up from the testes at ejaculation have got transport and food for their journey to the promised land of the female fallopian tube.
The prostate is normally about the size of a walnut, but once men hit their 50s and beyond it’s very common for their prostate to grow. This is not cancer and appears to have nothing to do with cancer. We don’t know exactly why the prostate decides to grow at this point, but it appears to be due to some interplay between hormones.
Because the prostate surrounds the bladder outlet, when it enlarges it sometimes constricts the outlet, causing a weak flow of urine and incomplete bladder emptying. This can lead to other symptoms such as urgency and frequency of urination, commonly at night (nocturia). All together, we call these lower urinary tract symptoms.
The worst-case scenario in benign prostate hyperplasia is when the bladder blocks off altogether (acute retention). This is excruciatingly painful and requires urgent insertion of a catheter, which externally drains the urine.
The classic presentation is a middle-aged or older man complaining of these lower urinary tract symptoms. A doctor’s rectal examination, where the back of the prostate can be felt, or an ultrasound will usually then reveal an enlarged prostate. Incidentally, prostate cancer rarely causes lower urinary tract symptoms, but is common in exactly the same age group, complicating its diagnosis.
Symptoms raising a red flag that plain old benign prostate hyperplasia may not be the underlying cause of lower urinary tract symptoms are painful urination (dysuria) and blood in the urine (haematuria). Either of these may indicate cancer or infection of the urinary tract and always require further tests to rule them out. If symptoms are just standard lower urinary tract symptoms such as urgency and frequency of urination, no further tests are required.