What is the Prostate?
The prostate is an organ found in the male reproductive system. Its main role is to produce fluid that protects and feeds sperm.
Where is the prostate?
The prostate is about the size of a walnut and shaped like a doughnut. It sits underneath the bladder and surrounds the top part of the urethra, the tube which urine passes through on its way from the bladder to the penis.
How it changes with age
The prostate relies on the male sex hormone, testosterone to grow. At puberty, when testosterone levels increase, the prostate grows 8 times in size and then doubles in size between the ages of 21 to 50. From 50 to 80 years of age the prostate will double again in size.
Benign Prostatic Hyperplasia (BPH)
BPH is a non-cancerous enlargement of the prostate gland. It is common for all men and usually starts around the age of 40.
Prostate cancer is suspected if there is an abnormal blood test (PSA) and/or rectal examination (DRE result). Caught at an early stage, there is a good chance it can be cured. The causes of prostate cancer are largely unknown. It is clear that the chances of developing prostate cancer increases with men over 50 years of age. Close relatives of men who have prostate cancer are also more likely to be affected.
Symptoms for BPH or Prostate Cancer
The symptoms for BPH or Prostate cancer are the same.
A number of men have no symptoms. Men who do have symptoms usually find there are noticeable changes in urination.
Some symptoms are:
- difficulty in starting to pass urine
- weak and poorly directed stream of urine
- dribbling of urine before and after urinating
- a need to get up several times during the night to urinate
- a feeling that the bladder is not completely empty
- rarely blood is in the urine
How is BPH or Prostate Cancer diagnosed?
It is diagnosed by a physical examination by a doctor (DRE), PSA test, urine test, biopsy or scan.
Digital rectal examination (DRE)
The doctor will insert a finger into your rectum; tumours can often be felt by this method. Even though you might feel embarrassed, this procedure could save your life.
PSA blood test
The doctor will take a sample of your blood which will be tested for the amount of prostate-specific antigen (PSA). PSA plays an important part in the early detection of prostate cancer. A high PSA reading may indicate prostate cancer; however it may also indicate other prostate disease such as BPH as this test is not cancer specific.
Urine is tested to look for blood or infection.
The urologist may perform a prostatic biopsy (remove a small piece of tissue from the prostate). Biopsies can be uncomfortable and you may be given a mild sedative or local anaesthetic. This sample is then checked by a pathologist, if cancer is detected then it is graded as to how quickly your cancer is likely to progress.
This is to establish if the cancer has spread to the bones.
Sexual Dysfunction & Radical Prostatectomy
Erectile Dysfunction is common after a radical prostatectomy. Urologists, where possible, will attempt to perform nerve sparing surgery in an attempt to reduce erectile dysfunction. Erectile dysfunction treatments have proven to be effective. There is some debate and some supportive research that early erectile dysfunction treatment, within the first two mouths after surgery, is of better benefit to the return of penile erections. These treatments maybe oral tablets, injections, penile vacuum pump.
After a radical prostatectomy it is common for the man to experience absence of ejaculation, although he usually still experiences orgasm. Some men report some degree of orgasmic pain interfering with sexual intimacy. The penis may also appear shorter.
Partners may express concern and worry that sexual activity could be harmful for their partner. They may also feel frustrated that after the shock of their partner being treated for cancer they now have to live with sexual dysfunction. It is also common for partners to feel that they should “be happy their partner has been saved”. The time after life saving surgery can be confusing and changing, from stressful to intimate. Partners need to remember that they and their partner have gone through an uncertain time, which has involved visits to specialist, hospitalisation of their partner, separation from their partner and dealing with issues around death. Some relationships grow stronger, others may grow apart. Professional support is available for men and their partners.
Concerned about your prostate?
If you have any concerns about your prostate, regardless of your age, discuss this with your doctor. Your doctor may refer you to a urologist (genital specialist) when:
- your prostate is abnormally large or on examination your prostate has an unusual texture
- you experience persistent urine frequency
- you have an elevated PSA and/or abnormal DRE result.
Fact Sheet: Impotence Australia
Raelene Stokes is WA Coordinator for Impotence Australia and she specialises in Men’s Sexual Health and has worked with men and their partners for over a decade with prostate cancer and sexuality. Raelene works from the first onset of the diagnosis, around grief and trauma, intimacy issues, relationships problems, sexual rehabilitation and sexuality after. If you would like further information or to make an appointment with Raelene please email: firstname.lastname@example.org.