The prostate is a relatively small gland, about the size of a walnut, that plays a key role in the male reproductive system. While it’s a small organ, the prostate can have a much bigger effect on men’s health than its size implies.
So what does the prostate do? Here, we’ll answer that question and share health information about the prostate gland, what it does, potential issues, and tests used for early detection of prostate conditions. In particular, we’ll explain how catching prostate cancer early is very important as it’s usually highly treatable if found in the early stages.
Where Is the Prostate Gland Located?
The prostate gland is part of the male reproductive system. It occupies the space below the bladder, in front of the rectum. It surrounds the urethra (the tube that takes urine out of the body) as it comes out of the bladder. The urethra in men also carries semen out of the penis during ejaculation. The prostate gland is made up of muscular and glandular tissue. The glandular tissues secrete substances made by the prostate.
There are different ways of classifying the different areas of the prostate gland. The most widely used is McNeal’s description of four main areas of the prostate:
- The anterior fibromuscular layer, which is non-glandular and surrounds the prostate.
- The transitional zone, located around the urethra and the innermost layer of the prostate. If there is expansion in this area, it can press on the urethra and cause the symptoms found in conditions such as benign prostatic hyperplasia (BPH).
- The central zone surrounds the transitional zone and is where the ejaculatory duct is found.
- The peripheral zone contains most (about 70%) of the prostate’s glandular tissues. It’s the closest side of the prostate to the rectum and can be felt during a digital rectal exam (DRE). This is the area where prostate cancer and prostatitis are mostly found.
What Does the Prostate Do?
The prostate is an important part of the male reproductive system and is essential for a man’s fertility. Its primary function is to produce a fluid that becomes part of semen (seminal fluid).
Semen is made up of several different components, produced from different parts of the male reproductive system:
- Prostate: Releases prostate fluid and accounts for 20-30% of semen volume
- Seminal vesicle: Produces a variety of components that make up 50-65% of semen volume
- Bulbourethral gland: This pea-sized gland below the prostate produces mucus that makes up 5% of semen volume
- Testicles (testes): Release spermatozoa (sperm), which while a vital ingredient, makes up only 5% of the total volume
All the components of semen are mixed together in the urethra and leave a man’s body through the urethra out of the penis during ejaculation.
The prostate fluid itself is made up of different components, including prostate-specific antigen (PSA). PSA is an important marker of prostate health and is found mostly in the semen, with a little found in the blood.
The prostate fluid makes the semen more watery and is needed for the sperm to function properly. The prostate gets bigger as a person ages and testosterone, the male sex hormone, controls how the prostate works.
Do Women Have a Prostate Gland?
No, women or people assigned female at birth do not have a prostate that is the same as the male prostate. They instead have glands called Skene’s glands that carry out similar functions. Because of this, they’re sometimes referred to as the “female prostate.”
What Are the Warning Signs of Prostate Problems?
The warning signs of prostate issues depend on the type of condition, with overlap between some of the most common conditions. There are a range of conditions that affect the prostate gland and it’s possible to have more than one at once. Below we outline some of the most common prostate issues and their symptoms.
What Are Some Common Prostate Issues?
It’s important to be aware of the symptoms of prostate issues. There is overlap between how these different conditions present, so it’s crucial to see a healthcare practitioner who can thoroughly discuss your medical history, conduct an examination, and order any relevant tests.
Benign Prostatic Hyperplasia (BPH)
Also known as benign prostatic hypertrophy, BPH refers to an obstructed or enlarged prostate. “Benign” refers to the condition being non-cancerous.
The prostate cells in BPH grow abnormally, leading the prostate to become enlarged and push on the urethra, which leads to the bladder wall thickening. It’s more common in older men, affecting around 50% of men between 51-60 years old and about 90% of men 80+ years old.
Symptoms of BPH can be similar to those of prostate cancer but there is no link between the two. BPH symptoms include urinating more often and at night, sudden urges to urinate, a slow or interrupted urine stream, and being unable to fully empty the bladder.
Prostatitis
Prostatitis is inflammation of the prostate and is sometimes caused by a bacterial infection. It’s not currently thought that prostatitis is linked to prostate cancer. However, inflammation has been seen in samples taken of prostate cancer, so research is ongoing to further assess the link between the two. Symptoms of prostatitis include difficulty or pain when urinating, needing to pass urine often, a high fever, and pain in the lower back, abdomen, or groin.
Prostate Cancer
Prostate cancer is caused by changes to the genes that normally control how cells function so that they grow uncontrollably. Some gene changes — or mutations — are inherited from someone’s family and some can be acquired during a person’s lifetime.
Prostate cancer is usually slow-growing and a person may have no symptoms (asymptomatic) for 10-30 years. Eventually, if left unchecked and as the tumor grows, it puts pressure on the surrounding tissues, including the urethra and bladder, causing prostate symptoms.
These symptoms include needing to urinate more (including at night), slow or interrupted urine stream, pain when ejaculating, and blood seen in the urine or semen. There may also be issues getting an erection, leg or foot weakness, loss of bladder or bowel control, unintentional weight loss, or feeling very tired. If the cancer has spread to the local lymph nodes or bones it could cause back, hip, pelvic, or rib pain.
Some of these prostate cancer symptoms are similar to those of BPH or could be caused by other conditions. However, it’s important to seek medical advice from your healthcare practitioner if you’re experiencing any of these symptoms.
According to the American Cancer Society, prostate cancer is the most common of all cancers (after lung cancer) and the second leading cause of cancer death for men. Approximately 1 in 8 men will get diagnosed with prostate cancer in their lifetime and one in 44 will die from it.
A Gleason score is assigned to a person’s prostate cancer to grade it in terms of how abnormal the prostate tissue looks. A higher grade indicates more abnormal-looking cells and prostate cancer that’s more likely to grow quickly and spread from the prostate.
However, when detected at an early stage, prostate cancer has excellent treatment outcomes. In fact, more than 99% of men treated for early-stage prostate cancer survive at least five years.
What Are the Risk Factors for Prostate Cancer?
There are a few factors that have been shown to increase someone’s risk of developing prostate cancer and for other factors — such as obesity — the jury is still out. Known risk factors for prostate cancer include:
- Age: Older men are more likely to develop prostate cancer; it’s rare for those under 40 and 6 in 10 cases are among men over the age of 65.
- Ethnicity: African American and Caribbean men with African ancestry are at a higher risk compared to men of other ethnicities. It could be a combination of factors, from genetics to access to care. The reasons for this, however, are not definitively known.
- Family history: If someone has a father or brother who had prostate cancer, their risk of developing it more than doubles — and the risk is even higher if multiple close relatives have been affected, particularly if at a young age. However, most men with prostate cancer do not have a family history of it.
Take Ezra’s five-minute questionnaire to evaluate your general risk of cancer. You can also read more about calculating your risk of prostate cancer.
Prostate Cancer Screening
Prostate cancer screening involves monitoring PSA levels with or without a digital rectal examination when a person does not have any symptoms of prostate cancer. The decision to have this screening is a complex one as the PSA test can be raised in other prostate conditions (a false positive test) or in some cases could be normal when the person has prostate cancer (a false negative).
Other points to consider are overdiagnosis and overtreatment in some cases where the prostate cancer never caused symptoms in the person’s lifetime or led to the person’s death as a slow-growing cancer. This might particularly be the case in much older men and their quality of life could be affected by side effects from a biopsy or treatment they might not otherwise have had.
The screening recommendations from the U.S. Preventive Services Task Force (USPSF), which are currently under review, advise that men ages 55-69 should make a decision after discussion with their healthcare provider, taking into account their age, general health, family history, ethnicity, and having weighed up risks and benefits. The USPSF’s guidance for men 70+ is not to have a PSA-based screening.
Research into improving the accuracy of PSA testing and developing other screening tests is ongoing and may improve the accuracy of screening in the future.
What Tests Can Be Carried Out for Prostate Symptoms?
Several tests are available for those with prostate-related symptoms, including:
- PSA blood test: This test can show raised PSA levels in prostate cancer but it can also show raised levels in BPH and prostatitis, so it’s not specific enough by itself. The test can be used in screening for those without symptoms and to aid in diagnosis for those with symptoms. It can also be a marker for assessing treatment success and monitoring for recurrence after treatment.
- Prostate biopsy: This involves taking small samples of the prostate to look for cancerous cells under a microscope. This type of biopsy is used to confirm a diagnosis of prostate cancer. It’s used to confirm a diagnosis of prostate cancer.
- Imaging: This includes transrectal ultrasound, Magnetic resonance imaging (MRI) scan, positron emission tomography (PET) scan, and computerized tomography (CT) scan.
- Bone scan: A bone scan shows any abnormalities in the bones — if prostate cancer spreads, it is often to the bones first.
- Lymph node biopsy: This isn’t often carried out in prostate cancer but can be done at the same time as prostate surgery or separately to see if the cancer has spread to nearby lymph nodes.
In the current U.S. health system, most men have to first get a prostate biopsy rather than a prostate MRI as their health insurance won’t cover this in the first instance.
This is unfortunate because an MRI is non-invasive while a prostate biopsy can cause complications such as infection, bleeding, and in some cases, erectile dysfunction. At least one study showed results indicating that if a multi-parametric MRI showed no abnormalities, this could stop the person from needing an unnecessary prostate biopsy.
What Are the Options for Prostate Cancer Treatment?
Prostate cancer treatment options include active surveillance or watchful waiting for those with low to intermediate risk, where the cancer is monitored to check if it grows before treatment is considered. Other options are surgery, radiation therapy, cryotherapy, hormone therapy, chemotherapy, immunotherapy, or targeted therapy.
Can You Live Without a Prostate?
Yes. Removal of the whole prostate is sometimes needed in conditions such as prostate cancer. This is known as a radical prostatectomy. This leads us to the question of what happens if the prostate is removed.
The answer is that in some cases it can lead to side effects, including urinary incontinence, which means unintentionally passing urine. In time, this can improve for many people and there are muscle exercises or medications to help.
Another complication of surgery can be difficulty getting an erection, known as erectile dysfunction or impotence. Treatment is available in the form of medications and men can be referred to a specialist clinic. For men wanting to conceive children in the future, sperm storage before the operation can be offered.
Early Detection of Prostate Issues Is Key
In asking “what does the prostate do?” we find that it plays a key role in a man’s reproductive health by providing the right conditions in semen for sperm to function well. Visiting a healthcare professional for prostate symptoms and getting the right treatment can improve your quality of life.
Picking up any potential signs of prostate cancer early can also improve the chance of successful treatment, so it’s important to know which symptoms to look out for. However, you don’t have to wait until symptoms appear before taking action. The Ezra prostate MRI scan is a valuable screening test for those who are asymptomatic to catch abnormalities before symptoms happen. It takes just 30 minutes and is followed by a detailed follow-up consultation.
There’s also the option of Ezra’s Full Body MRI to screen for any signs of prostate issues or abnormalities in up to 12 other organs. If you’d like to find out more about Ezra’s different scan options, schedule a call today.
