Prostate Problems

The prostate is a walnut-sized gland below the bladder that adds fluid to semen. Three conditions account for nearly all prostate problems: benign enlargement (BPH), which is a normal part of ageing; prostatitis, inflammation or infection that mainly affects men under 50; and prostate cancer, which is mostly found in men over 50.

Their symptoms overlap, and early prostate cancer usually causes no symptoms whatsoever, so symptoms cannot tell you which condition you have. A short, structured assessment can. This page gives an overview and points to what separates the three; each has its own detailed page.

Symptoms

• Weak flow, hesitancy, dribbling and night-time urination, typical of enlargement
• Urgency and frequency
• Pain in the perineum, pelvis, testicles or penis tip, or pain on ejaculation, typical of prostatitis
• Fever, chills and painful urination in acute bacterial prostatitis
• Blood in urine or semen
• Usually nothing at all in early prostate cancer
• Bone pain, weight loss or leg swelling in advanced cancer

Causes and risk factors

Benign enlargement is driven by age and male hormones. Acute and chronic bacterial prostatitis are caused by bowel bacteria such as E. coli reaching the prostate, sometimes after a catheter, biopsy or urinary infection. The much more common chronic pelvic pain syndrome has no infection and involves pelvic floor muscle tension, nerve sensitisation and stress. Prostate cancer risk increases with age, in men of Black African or Caribbean ancestry, with a father or brother affected, and with inherited BRCA2 and related gene variants. Vasectomy, sexual activity and benign enlargement do not cause cancer.

How it is diagnosed

• History and symptom scores: IPSS for urinary symptoms and the NIH-CPSI for prostatitis pain.
• Digital rectal examination: Assesses size, tenderness and any hard nodule.
• Urine tests: Dipstick, culture, and in chronic prostatitis samples taken before and after prostate massage.
• PSA blood test: Raised by cancer, enlargement, infection, recent ejaculation and cycling. A single raised value should be repeated, and not measured during infection.
• Flow test and ultrasound: Measure obstruction, residual urine and prostate volume.
• Multiparametric MRI: Now performed before biopsy when cancer is suspected. It shows suspicious areas and allows many men to avoid biopsy.
• Targeted biopsy: Preferably by the transperineal route, which carries a lower infection risk. Pathology gives the Gleason grade group.

Treatment options

• For enlargement: Lifestyle changes, alpha blockers, 5-alpha reductase inhibitors, and procedures ranging from Rezum to TURP and HoLEP.
• For acute bacterial prostatitis: Antibiotics that penetrate the prostate for 2 to 4 weeks, with hospital care if severe.
• For chronic bacterial prostatitis: A 4 to 6 week course of a fluoroquinolone or trimethoprim guided by culture.
• For chronic pelvic pain syndrome: A combined approach: alpha blocker, anti-inflammatory, pelvic floor physiotherapy, nerve pain medicines and stress management. Repeated antibiotic courses do not help.
• For low-risk prostate cancer: Active surveillance with PSA, MRI and repeat biopsy, avoiding treatment side effects for as long as the disease stays low risk.
• For cancer needing treatment: Robotic prostatectomy or radiotherapy for localised disease, and hormone therapy with newer agents for advanced disease.

When it is urgent

Seek emergency care locally if you cannot pass urine, have high fever and shaking with urinary pain, pass heavy blood or clots, or develop new back pain with leg weakness, numbness or loss of bladder or bowel control, which in a man with known prostate cancer can signal spinal cord compression.

Travelling to Türkiye for treatment

A prostate assessment is compact: consultation, PSA, flow test, ultrasound and MRI can be completed in 2 or 3 days, and a targeted biopsy adds 1 day plus about a week for pathology, which can be sent to you. Planned operations for enlargement or localised cancer also suit a trip. Active surveillance, hormone therapy and chronic pelvic pain need continuity with a local urologist. Do not travel with fever or retention; have those treated first.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

Frequently Asked Questions