Prostate Symptoms: What They Mean and When to Get Checked

What the prostate does

The prostate makes part of the fluid in semen. It surrounds the first part of the urethra, the tube that carries urine out of the bladder. That position explains why prostate problems cause urinary symptoms: when the gland grows or becomes inflamed, it can squeeze the urethra or irritate the bladder.

The main prostate symptoms

Doctors group urinary symptoms into two types:

Voiding symptoms point toward a blockage, often from BPH. Storage symptoms can come from BPH but also from an overactive bladder, diabetes, drinking late, or sleep apnea.

Benign prostatic hyperplasia (BPH)

BPH is non-cancerous growth of the prostate with age. It is the most common reason for prostate symptoms. Symptoms build slowly over years: a weaker stream, hesitancy, dribbling and night-time trips. Size does not predict symptoms well; some men with large prostates have few problems.

Complications if untreated include sudden inability to urinate, bladder stones, recurrent infections, bladder damage and, rarely, kidney damage. Cold medicines with decongestants or antihistamines can trigger acute retention in men with BPH.

Prostatitis

Prostatitis is inflammation of the prostate. Types:

• Acute bacterial prostatitis: sudden fever, chills, burning, pain in the perineum or lower back, and difficulty urinating. It needs urgent antibiotics.
• Chronic bacterial prostatitis: recurrent urinary infections with the same bacteria.
• Chronic prostatitis/chronic pelvic pain syndrome: the most common type, in men of any adult age. Pain in the perineum, testicles, penis or lower belly, pain during or after ejaculation, and urinary symptoms for 3 months or more, without infection.

Prostate cancer

Prostate cancer is the most common cancer in men after skin cancer. Early prostate cancer usually grows in the outer part of the gland, away from the urethra, so it rarely causes urinary symptoms. Symptoms that can appear later:

• blood in the urine or semen
• urinary problems similar to BPH
• erectile dysfunction
• bone pain in the back, hips or ribs, weight loss and tiredness, if it has spread

Because symptoms appear late, men are offered the chance to discuss PSA screening. US guidance suggests shared decision-making from age 55 to 69; many urology groups suggest starting the discussion at 50, or 40 to 45 for Black men and those with a father or brother diagnosed before 65.

BPH vs prostatitis vs prostate cancer

How prostate problems are diagnosed

• Symptom score: the International Prostate Symptom Score (IPSS) rates seven symptoms and their impact.
• Urine test for infection and blood.
• Digital rectal exam: a gloved finger feels the prostate's size and texture. An enlarged, smooth gland suggests BPH; a hard or irregular area raises concern for cancer; a very tender gland suggests acute prostatitis.
• PSA blood test: raised in BPH, prostatitis and cancer, so it is interpreted with age and other findings.
• Bladder scan after urinating to check how much is left.
• Urine flow test, ultrasound, MRI or biopsy when needed.

Treatment and self-care

Self-care for mild urinary symptoms

• Cut down on fluids in the 2 hours before bed.
• Limit caffeine and alcohol, which irritate the bladder and increase urine.
• Double voiding: wait a moment after urinating and try again.
• Avoid decongestants and antihistamines if they slow your stream.
• Stay active and manage constipation, which presses on the bladder.

Medicines for BPH

• Alpha-blockers (such as tamsulosin) relax prostate muscle and improve flow within days.
• 5-alpha reductase inhibitors (finasteride, dutasteride) shrink the prostate over 6 to 12 months.
• Tadalafil can help urinary symptoms and erectile dysfunction.
• Anticholinergics or beta-3 agonists for storage symptoms.

Procedures

When medicines do not help or complications occur: transurethral resection of the prostate (TURP), laser procedures, prostatic urethral lift, water vapor therapy, and others.

Prostatitis treatment

Antibiotics for bacterial forms; for chronic pelvic pain syndrome, a combination of alpha-blockers, pain relief, pelvic floor physical therapy and stress management.

Frequently asked questions

What are the first signs of prostate problems?

The first signs are usually a weaker or slower urine stream, waiting for the flow to start, dribbling at the end, and getting up at night to urinate. These are most often due to benign enlargement. Pain, burning or fever suggests prostatitis.

Does an enlarged prostate mean cancer?

No. Benign prostatic hyperplasia is a non-cancerous enlargement that is extremely common with age and does not turn into cancer. The two can exist at the same time, though, so your doctor may discuss a PSA test and rectal exam.

What are the symptoms of prostate cancer?

Early prostate cancer usually causes no symptoms. Later it can cause urinary problems, blood in the urine or semen, erectile dysfunction and, if it has spread, bone pain and weight loss. That is why screening decisions are discussed before symptoms appear.

How can I tell if I have prostatitis?

Prostatitis typically causes pain in the area between the scrotum and anus, lower belly, penis or testicles, painful ejaculation, and burning or frequent urination. Acute bacterial prostatitis also causes fever and chills and needs urgent treatment.

Why do I have to pee so often at night?

Common reasons include an enlarged prostate, drinking fluids or alcohol in the evening, an overactive bladder, diabetes, sleep apnea, heart failure and some medicines such as diuretics. Getting up twice or more each night is worth discussing with your doctor.