The prostate gland is a small, solid gland roughly the size of a walnut, located behind the pubic bone. It is situated beneath the bladder, surrounding the first part of the urethra. Approximately 0.5ml of each ejaculate is fluid made by the prostate, containing a number of substances that nourish the sperm and are necessary for fertility. Two small pouches, the seminal vesicles, sit directly behind the prostate, and provide a further 2ml of ejaculatory fluid via small tubes that run through the prostate into the urethra.

What diseases can affect the prostate?

The three most common are benign prostatic hyperplasia (BPH), prostatitis (inflammation), and cancer (link). Only the first two conditions are discussed in this section.

Benign prostatic hyperplasia (BPH):

This is a gradual enlargement of the central portion of the prostate that compresses the urethra and causes obstruction to urine flow, giving rise to various symptoms including a weak flow of urine, urgency and nocturia (getting up from sleep to urinate). BPH is not cancer, and does not turn into cancer. BPH seems to be a normal part of ageing in men, but the degree of enlargement, as well as the severity of symptoms varies greatly. The most important aspect of BPH and the symptoms it causes is how much it bothers the man. Many men have minor symptoms which are of no concern to them and therefore treatment is not required. However, for those whose quality of life is being affected, there are several highly effective treatment options available. Medications can relax or shrink the prostate, whereas surgical treatments remove the obstructing prostate tissue. The most commonly performed operation for BPH is a TURP (trans-urethral resection of prostate), in which a telescope is passed through the urethra to the prostate, which is then shaved away from the inside.

Sometimes BPH can lead to retention of urine in the bladder, causing more than just bothersome symptoms. Bladder stones, recurrent urine infections and impaired kidney function may all be due to bladder outlet obstruction caused by BPH. In these cases, surgery is required. Alternatives to TURP include laser prostatectomy (link), and open (not radical) prostatectomy, where the inner portion of a very large prostate is removed via an incision in the lower abdomen.

Importantly, BPH is the most common cause of an elevated PSA between 4 and 10. It can therefore be difficult to distinguish it from prostate cancer unless a biopsy of the prostate is performed, as cancer typically raises PSA also.

Prostatitis:

Prostatitis indicates inflammation of the prostate and covers a whole spectrum of clinical entities. It is not always due to infection and does not always cause symptoms. At one end of the spectrum is acute bacterial prostatitis, which presents with fever, feeling acutely unwell and sudden difficulty urinating. This is a medical emergency, requiring intravenous antibiotics and drainage of the bladder via a catheter. At the other end of the spectrum is chronic non-bacterial prostatitis, characterized by pain in the pelvic area. It is often not certain whether these symptoms are due to prostatitis at all, and is now termed chronic pelvic pain syndrome. Such symptoms may be relieved by treatments such as anti-inflammatory medication or pelvic physiotherapy. In addition, sometimes prostatitis is diagnosed on a prostate biopsy without the patient having any symptoms at all.

Like BPH and prostate cancer, prostatitis can also elevate the PSA, as well as cause it to fluctuate.

For a consultation with one of our urologists, please call 03 8506 3600 to make an appointment.