What is the prostate, and why does it cause so many problems for men?


So, what is the prostate and why does it cause so many problems for men?

It’s a topic most people don’t want to discuss. But it can have a big impact on your life.

The prostate is a small organ that sits just beneath the bladder. Its main function is to provide a nourishing fluid that helps transport sperm.

As men age, the prostate tends to increase in size. And as the gland enlarges, it can block the flow of urine from the bladder. In plain English, that can make it harder to pee, and lead to a lot of middle-of-the-night trips to the bathroom.

That’s what King Charles has: an enlarged prostate, also called BPH, or “benign prostatic hyperplasia.” The key word here is “benign,” with symptoms that are rarely life-threatening.

A bigger problem is when the prostate becomes cancerous. Prostate cancer is the second-leading cause of cancer death in men, and is what Defense Secretary Lloyd Austin was diagnosed with.

What makes this tricky is that, while about 1 in 8 men will be diagnosed with prostate cancer, it often grows so slowly that about 80% of those men, if untreated, would end up dying of another cause, including old age.

But sometimes prostate cancer is fast-growing, and a real threat.

So, what to do?

You may be familiar with a screening blood test called PSA, or prostate specific antigen. There are limitations to using PSA testing to screen for prostate cancer, since this protein is made by both BPH (an enlarged prostate) and cancerous prostate tissue.

Since both BPH and prostate cancer lead to increasing levels of PSA, there are concerns PSA screening leads to overdiagnosis and overtreatment. That, in turn, has prompted disagreement among medical professionals about its overall benefits.

Tests can sometimes yield a false positive: you suspect you have cancer when you actually don’t, leading to an unnecessary biopsy; or, you diagnose and over-treat a slow-growing cancer.

Bottom line: Talk to your health-care provider and have a careful discussion about the risks and benefits of screening, taking into account individual factors like family history, age, race, and more.

If your PSA is elevated, other tests may help decide if a biopsy is needed. 

If cancer is suspected, a biopsy can confirm it, and a wide range of approaches can be considered: from active surveillance (just monitoring the tests and seeing if the cancer grows), to zapping only the part of the prostate where cancer has been found, to removing or destroying the entire gland.

In Secretary Austin’s case, his cancer led doctors to remove his prostate entirely. [Prostate cancer is more common in Black men.]

For King Charles, the enlarged prostate will be treated in the hospital this coming week and he should be fine.

Two men, two common diagnoses, and two very different treatments, which offer lessons for all of us.

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Story produced by Alan Golds. Editor: Carol Ross. 

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