The Facts About the Prostate

The prostate gland plays an important role in male sexual function and overall health.

You can be proactive about taking care of your prostate health. The first step is to understand this gland and the role it plays in a man's well-being.

The prostate is a gland located near the bladder and just in front of the rectum. Though relatively small, this walnut-sized gland has a big job. It's one of the organs responsible for secreting fluid that provides nutrients for sperm as well as serving as a medium for transporting sperm through the genitourinary tract. The seminal fluid produced by the prostate plays an important role in protecting sperm on its way out of the penis during ejaculation.

Since the prostate is an internal organ, you can't touch it directly. However, you can feel it by pressing down on your perineum—the stretch of skin that runs between the scrotum and the rectum—on the side closest to your rectum. You can also feel your prostate internally through the walls of the rectum.

The prostate is made up of five lobes: one in the front and one in the back (the anterior and posterior), two lateral lobes (one on each side) and a median lobe in the middle.

The prostate is composed of connective and glandular tissues, with a prostatic fascia covering up the inner structure of the gland. The prostatic fascia is basically a coat of stretchy connective tissue that surrounds the five lobes of the prostate.

The average weight of a healthy prostate is 1 ounce, according to Cleveland Clinic. To help conceptualize that, it's about the same weight as five U.S. quarters.

The word prostate was first used in a medical sense by anatomists to refer to the prostate gland during the Renaissance, the era from roughly 1450 to 1650. As time has gone on, this once mysterious "glandulous body" has become better understood by medical experts.

Special attention is given to the prostate because of the organ's importance to a man's health.

Prostate cancer, prostatitis and benign prostatic hyperplasia (BPH) are just a few of the most common conditions that can impact prostate health. The Centers for Disease Control and Prevention (CDC) reports that 13 out of 100 men in the United States develop prostate cancer at some point in their life.

While men of all ages are at risk for prostate problems, the older a man is, the higher his risk is for prostatitis, prostate cancer and BPH.

Educating yourself about your prostate, how to take care of it, and how to recognize the signs and symptoms of common conditions is an important first step to becoming proactive about your prostate health.

The prostate produces fluid for semen, which is the whitish-gray fluid that the penis releases during ejaculation. Enzymes, zinc and citric acid are some of the elements that make this fluid so important, because they work to nourish sperm cells and lubricate the urethra, the tube that semen passes through to exit the body.

Not only does the prostate provide nutrient-rich fluid for sperm cells to thrive in, it's also mechanically important during ejaculation. When a man reaches sexual climax, his prostate muscles contract, which helps push semen into, through and, eventually, out of the penis.

The prostate can also be stimulated for sexual pleasure.

Women do not have prostates. Instead, they have Skene's glands on both sides of their urethra. Some medical researchers believe these glands may be responsible for secreting fluid that aids in urination and cleanliness.

Skene's glands may also produce fluid that can be released during sex, resulting in female ejaculation. For that reason, these glands are sometimes referred to as the female prostate.

The prostate is split into different zones:

• Peripheral zone
• Central zone
• Transition zone

The peripheral zone accounts for the largest share of the prostate. Part of this zone is located at the back of the prostate gland, nearest to the rectal wall.

The central zone surrounds the ejaculatory ducts. The transition zone surrounds the urethra where it enters the prostate.

Seventy percent to 80 percent of prostate cancers develop in the peripheral zone, according to the Prostate Cancer Foundation (PCF). This explains why digital rectal exams are such an important part of screening for prostate cancer.

Prostate cancer originates in the central zone much less commonly, accounting for less than 5 percent of prostate cancers.

The PCF reports that about 20 percent of prostate cancers start in the transition zone. It is the zone that continues to grow throughout a man's life, and in some cases can lead to BPH, which can cause problems with urination.

Three conditions and disorders most commonly affect the prostate: cancer, prostatitis and benign prostatic hyperplasia.

Prostate cancer

This disease is the second-most common type of cancer that affects men. Often, prostate cancer can be slow-growing and confined to the prostate gland. In these cases, prostate cancer may not cause serious harm. The disease has higher chances of successful treatment outcomes if detected early, and its five-year relative survival rate is 99 percent when it is detected in the local stage.

Prostate cancer that grows slowly and hasn't spread beyond the gland itself may require minimal treatment, or sometimes no treatment at all, which is called active surveillance. Some types of prostate cancer, however, are more aggressive and quick to spread. They require swift, and sometimes more extensive, treatment.

Prostatitis

Also known as inflammation of the prostate, prostatitis is the most common urinary tract issue impacting men younger than age 50. Prostatitis can have different causes. The four types of this condition include:

1. Asymptomatic inflammatory prostatitis
2. Acute bacterial prostatitis
3. Chronic bacterial prostatitis
4. Chronic pelvic pain syndrome

BPH

The prostate grows as men age, starting in their mid-20s. But for some men, prostate growth can result in BPH, a condition that affects the urethra and can result in problems with urination, among other symptoms.

Conditions and diseases of the prostate can cause similar symptoms, though some differ.

Prostate cancer is often asymptomatic, especially in the early stages of the disease. As it advances, though, it can cause symptoms that include the following:

• Trouble with urination
• Bloody urine
• Bloody semen
• Weak urine stream
• Unintentional weight loss
• Erectile dysfunction (ED)
• Bone pain

Prostatitis symptoms may vary depending on the cause of the condition. For example, patients with asymptomatic inflammatory prostatitis may experience no symptoms at all.

As for acute bacterial prostatitis, chronic bacterial prostatitis and chronic pelvic pain syndrome, common symptoms include:

• Painful urination
• Bloody urine
• Difficulty urinating
• Frequent urination, especially at night
• Abdomen, groin and lower back pain
• Urgency
• Pain in the perineum (the area between the rectum and the scrotum)
• Pain or discomfort in the penis or testicles
• Pain during ejaculation
• Fever accompanied by flu-like symptoms

Uncommonly, BPH may lead to urinary tract infections (UTIs), the inability to urinate or the appearance of blood in the urine.

More commonly, BPH can cause symptoms such as:

• Frequent and urgent need to urinate
• Trouble initiating urine stream
• Weak or inconsistent urine stream
• Inability to empty bladder fully
• Dribbling after urination

If you experience any prostate condition symptoms, particularly if they are persistent and/or concerning to you, consult your doctor for further examination. Detecting and treating prostate problems early is key to addressing bothersome symptoms and having a greater chance for successful treatment.

Several different tests may be used to determine prostate health. The digital rectal exam (DRE) is the most common among these and is used as a screening tool for prostate cancer, prostatitis and BPH.

During a digital rectal exam, a doctor inserts a gloved and lubricated finger into the rectum to assess the prostate's size, shape and firmness, and determine whether any abnormal lumps are present. Urine and blood tests are also standard during prostate exams, as they can help reveal whether a patient may have prostatitis or BPH.

The prostate-specific antigen (PSA) test is a screening tool for prostate cancer. PSA is a protein produced by both normal and malignant cells of the prostate gland. Elevated PSA levels in the blood may indicate the presence of cancer, but not always. Experts are divided on when and how often men should get a PSA test, because PSA levels can be high for a number of reasons, not only prostate cancer. While some urologists recommend men get screened starting in their mid-40s, some institutions, including the American Cancer Society (ACS), recommend men at average risk for prostate cancer begin screening at age 50.

Talk to your doctor about your risk level for prostate cancer and when you should start routine screening.

Prostate treatments vary depending on the type and severity of the condition.

Prostate cancer treatments can include the following:

• Active surveillance
• Brachytherapy, or internal radiation therapy
• Focal therapies, such as cryotherapy, laser ablation, photodynamic therapy and high-intensity focused ultrasound, that treat only the cancerous area of the prostate
• Prostatectomy, the surgical removal of all or part of the prostate

Prostatitis treatment can differ depending on the cause of the inflammation. Some common treatments include:

• Medication for any potential infection
• Pelvic floor exercises
• Stress and anxiety management strategies

BPH can be treated in the following ways:

• Medication
• Surgery to mitigate any obstruction blocking the flow of urine
• Water vapor therapy, such as steam vapor to shrink the prostate by killing some of its cells

There is no surefire way to avoid prostate problems, but you can undertake a number of measures to lower your risk. To improve your prostate health, maintain a balanced diet, exercise regularly, maintain a healthy weight and cut back on alcohol consumption.

You can also take a proactive role in your prostate health by talking with your doctor about your risk and undergoing routine screening when you reach the appropriate age. If you notice any abnormal symptoms that could be connected to a prostate issue, talk to your doctor right away. Most prostate issues are highly treatable, especially when addressed early.

If you go through treatment, talk to your doctor about any treatment side effects or concerns you may have.

Recovering from a prostatectomy can take several weeks. During this time, you should avoid lifting heavy objects and gradually work back up to your normal activity level.

In the weeks and months after the surgery, it's important to attend all follow-up appointments so your doctor can ensure you are healing properly and check on your overall health. Fortunately, most men are able to safely have sex again one to two months after the operation. Be sure to talk to your doctor before resuming sexual activity.

It may take time for you to get your groove back, so be patient.

After a simple prostatectomy, an orgasm is often still possible for most patients. Your ejaculate may have less volume or you may not be able to ejaculate at all. It's common for men who have undergone a radical prostatectomy to experience erectile dysfunction following the surgical removal of the prostate. Men often regain erectile function within 18 months, but if the issue persists, be sure to talk to your doctor so they can provide strategies and treatments to help you regain your sexual function.

Clinical trials are an important part of furthering medical research. These trials are often used to research cures and treatments for diseases such as prostate cancer. If you're interested in participating in a clinical trial, be sure to do plenty of research, consult your doctor and take your time to find one that's right for you.

You can find a list of active and recruiting trials at clinicaltrials.gov.

What does a prostate do for a man?

The prostate produces the fluid that, when combined with sperm cells from the testicles and secretions made by other glands, makes up what is known as semen. This fluid plays an important role in protecting and transporting sperm on its way out of the penis during ejaculation. The muscles of the prostate are also responsible for propelling semen through the urethra and out of the penis.

What are the warning signs of prostate problems?

Signs and symptoms of prostate problems can vary depending on their cause. However, some common symptoms include difficulty urinating, painful urination, inability to fully empty the bladder, bloody or cloudy urine, as well as pain in the abdomen, lower back, groin, penis or testicles.

Can you live without a prostate?

Yes, you can live without a prostate. You can continue to have an active and fulfilling sex life without a prostate, though you may experience some sexual dysfunction in the first year following your surgery. You may have a decreased ejaculate volume or no ejaculate fluid at all. Fortunately, men without prostates can still reach orgasm.