Key Points
- The prostate is a small gland that sits below the bladder in men
- Prostate problems are very common, especially as men get older
- An enlarged prostate (BPH) is not cancer and is very treatable
- Prostate cancer is now the most common cancer in the UK — but most men don't die from it
- There's no routine screening for prostate cancer, but you can request a PSA test
What Is the Prostate?
The prostate is a walnut-sized gland that sits just below the bladder. The urethra (the tube that carries urine) passes through the middle of it.
The prostate produces some of the fluid in semen. It's controlled by testosterone and tends to grow larger as men age.
Because of its position, an enlarged prostate can squeeze the urethra and cause urinary symptoms.
men get prostate cancer
of men over 50 have BPH
of men over 80 have BPH
Benign Prostatic Hyperplasia (BPH)
BPH means an enlarged prostate. It's extremely common and is not cancer. Having BPH doesn't increase your risk of prostate cancer.
Symptoms of an Enlarged Prostate
Voiding Symptoms
- Weak or slow urine stream
- Difficulty starting to urinate
- Straining to urinate
- Stopping and starting
- Dribbling at the end
Storage Symptoms
- Needing to urinate more often
- Getting up at night to urinate
- Sudden urges to urinate
- Feeling like bladder isn't empty
Treatment Options for BPH
Lifestyle Changes
Reduce caffeine and alcohol, don't drink before bed, "double void" (urinate twice)
Alpha-Blockers
Tamsulosin, alfuzosin — relax prostate muscle, improve flow quickly
5-Alpha Reductase Inhibitors
Finasteride, dutasteride — shrink the prostate over months
Surgery
TURP or other procedures — if medications don't work or symptoms severe
When to Seek Urgent Help
- Unable to pass urine at all — This is called urinary retention and is an emergency
- Blood in your urine — Needs investigation
- Pain when urinating with fever — May be an infection
If you can't urinate, go to A&E or call 999.
PSA Testing
PSA (Prostate-Specific Antigen) is a protein produced by the prostate. It can be measured with a blood test.
Important: PSA Is Not a Perfect Test
A raised PSA does not mean you have prostate cancer. Many things raise PSA:
- Enlarged prostate (BPH)
- Prostate infection
- Recent ejaculation
- Recent exercise (especially cycling)
- Age (PSA naturally rises with age)
Equally, some men with prostate cancer have a normal PSA.
Should I Have a PSA Test?
There's no routine screening programme for prostate cancer in the UK because the PSA test isn't accurate enough — it leads to many unnecessary biopsies and can miss some cancers.
However, if you're over 50 (or over 45 with risk factors), you can request a PSA test from your GP. You should have a conversation about the pros and cons first.
Who Is at Higher Risk?
- Age — Risk increases significantly after 50
- Family history — Father or brother with prostate cancer
- Black African or Caribbean heritage — 1 in 4 will get prostate cancer
If you're in a higher-risk group, consider discussing PSA testing with your GP.
Prostate Cancer
Prostate cancer is now the most common cancer in the UK, with around 52,000 men diagnosed each year.
The Good News
Most prostate cancers are slow-growing. Many men diagnosed with prostate cancer will die with it, not from it. When caught early, survival rates are excellent.
Symptoms
Early prostate cancer often has no symptoms. When symptoms occur, they can be similar to BPH:
- Difficulty urinating
- Blood in urine or semen
- Erectile dysfunction
- Pain in the back, hips, or pelvis (if advanced)
Diagnosis
- PSA blood test — First step, but not definitive
- Digital rectal exam — Doctor feels the prostate through the back passage
- MRI scan — Now usually done before biopsy
- Prostate biopsy — Confirms diagnosis if cancer is suspected
Treatment Options
- Active surveillance — Monitoring low-risk cancers closely without immediate treatment
- Surgery (prostatectomy) — Removing the prostate
- Radiotherapy — External beam or brachytherapy (internal seeds)
- Hormone therapy — Reducing testosterone to slow cancer growth
- Chemotherapy — For advanced cases
Looking After Your Prostate
While you can't completely prevent prostate problems, healthy habits may help:
- Maintain a healthy weight — Obesity is linked to aggressive prostate cancer
- Eat well — A diet rich in vegetables, especially tomatoes (lycopene)
- Stay active — Regular exercise is beneficial
- Know your risk — Especially if you have family history or are Black
- Don't ignore symptoms — See your GP if you have urinary problems
Questions to Ask Your GP
- Should I have a PSA test given my risk factors?
- What do my PSA results mean?
- Do I need to see a urologist?
- What treatment options are best for my situation?
- What are the side effects of treatment?