How Do I Know If My Prostate Is Bad?

Painful urination and/or ejaculation, trouble with either or both of those, and even blood in urine or semen may indicate a problem with the prostate gland.

The prostate is a gland in men that helps produce fluid that goes into semen. The prostate is located in front of the rectum and just below the bladder. 

The prostate frequently enlarges as men age, and if it gets too big it can cause health problems.

Symptoms of prostate problems may include: 

• Frequent urge to urinate
• Frequent nighttime urination
• Feeling an urgent need to urinate, but being unable to urinate or only urinating a little
• Blood in urine or semen
• Pain or burning urination
• Painful ejaculation
• Recurrent pain or stiffness in lower back, hips, pelvic or rectal area, or upper thighs
• Dribbling of urine
• Leaking urine
• Weak urine stream
• Unusual color or odor to urine
• Long-lasting pain and discomfort in the penis or scrotum, the area between the scrotum and anus, the abdomen, and lower back

Prostate problems can also cause: 

• Problems having sex
• Urinary tract infections (UTI)
• Stress due to chronic pain
• Inflammation in areas near the prostate
• Bladder stones
• Kidney failure

Causes of prostate problems include:

• Enlarged prostate (benign prostatic hyperplasia, or BPH) — common in older men
• Bacterial prostatitis 
  • Acute bacterial prostatitis usually comes on quickly due to a bacterial infection
  • Chronic bacterial prostatitis is recurring infection 
• Chronic prostatitis (chronic pelvic pain syndrome)
• Prostate cancer 

Prostate problems are diagnosed with a patient history and physical examination, which will include a digital rectal examination in which a doctor inserts a gloved finger into the rectum to examine the prostate to check for:

• The size, firmness, and texture of the prostate
• Hard areas, lumps, or growths that spread beyond the prostate
• Pain that occurs when touching or pressing on the prostate

Other tests to diagnose prostate problems include: 

• Urine testing
• Blood test to check prostate-specific antigen (PSA) levels
• Urodynamic tests of the urethra and bladder
• Cystoscopy
• Ultrasound of the prostate
• Biopsy of the prostate if prostate cancer is suspected

Treatment for prostate problems depends on the condition. 

Treatment for benign prostatic hyperplasia (BPH) includes:

• Watchful waiting (active surveillance)
  • If symptoms are not bothersome
  • Have regular checkups
• Lifestyle changes 
  • For mild symptoms 
  • Limit drinking liquids before bedtime or before going out
  • Avoid or limit alcohol or caffeine
  • Avoid medications that can affect the bladder, such as certain cold and allergy medicines
  • Change the timing of certain medicines, such as diuretics (water pills) or high blood pressure drugs
• Medications to help stop prostate growth or shrink the prostate 
  • Finasteride (Proscar) 
  • Dutasteride (Avodart)
• Alpha-blocker medications to relax prostate and bladder muscles to ease symptoms
  • Doxazosin (Cardura) 
  • Tadalafil (Cialis)
• Radio waves, microwaves, or lasers which use different kinds of heat to reduce extra prostate tissue to treat urinary problems caused by BPH
• Surgery 
  • To help urine flow
  • To remove the prostate
     

Treatment for bacterial prostatitis includes:

• Antibiotics 
• Pain medications 
• Drink plenty of fluids

Treatment for chronic prostatitis includes:

• Medications 
  • To reduce pain and inflammation
  • Alpha-blockers such as tamsulosin (Flomax) and silodosin (Rapaflo) to relax the muscles in the prostate and part of the bladder
• Lifestyle changes
  • Warm baths
  • Relaxation exercises
  • Physical therapy 
• Surgery

Treatment for prostate cancer depends on whether cancer is in part or all of the prostate, if it has spread (metastasized) to other parts of the body, and the age and overall health of the patient and may include one or more of the following:

• Watchful waiting (active surveillance)
• Surgery: removal of the whole prostate and some nearby tissue
• Radiation therapy
• Hormone therapy
  • Drugs are used to stop the body from making testosterone