What is the prostate and where is it located?
The prostate is a gland found in men with prostate cancer. It is located below the bladder, in front of the rectum, and around the first part of the urethra. In younger adults, it is often about the size of a walnut, but its size varies and often increases with age.
The prostate consists of several anatomical zones. This is important in MRI and tissue samples because different changes often occur in different parts.
As the prostate grows, it can press on the urethra and make it harder to empty the bladder. However, size does not always determine how many symptoms a person will experience.
What is the function of the prostate?
The prostate produces some of the fluid that makes up semen. The fluid contains substances that affect the sperm's environment and the consistency of the semen.
Muscles around the prostate and urethra are involved in ejaculation and urine flow. The prostate is influenced by sex hormones, especially androgens, which contribute to its changes throughout life.
It is possible to live without a prostate after surgery, but treatment may affect urinary leakage, erection and ejaculation. Such issues are discussed individually before treatment.
Prostate size and PSA change with age. Decisions about testing in the absence of symptoms should be based on information about potential benefits, overdiagnosis, and follow-up testing. Hereditary factors and previous PSA values influence how follow-up is planned.
Common prostate problems
Benign prostatic hyperplasia can cause a weak urine stream, difficulty starting, post-void dribbling, frequent urges and a feeling of incomplete emptying. Prostatitis or pelvic floor pain can cause pain in the pelvis, abdomen or back.
Prostate cancer often does not cause any symptoms in the early stages. Urinary problems are much more often due to benign enlargement, but need to be assessed. Read more about prostate problems, enlarged prostate and high PSA.
PSA can rise in benign enlargement, inflammation, urinary tract infection and cancer. An abnormal value is therefore a signal for further assessment, not a diagnosis.
Urinary incontinence can affect sleep and quality of life but does not necessarily reflect prostate size. Residual urine and bladder function are therefore important when planning treatment.
When should you seek treatment for prostate problems?
Contact your healthcare provider if you have new or worsening urination problems, blood in your urine or semen, recurring pelvic pain, or an elevated PSA level. Even people without symptoms may want to discuss the pros and cons of PSA testing.
Seek immediate medical attention if you have fever, chills, and pain along with urinary problems, as acute bacterial prostatitis may require prompt treatment. Acute urinary retention, where you are unable to urinate despite a full bladder, should be evaluated immediately.
Bone pain, weight loss or a clearly deteriorated general condition also needs to be investigated.
How is the prostate examined?
The evaluation may include a symptom questionnaire, urine tests, measurement of residual urine, PSA testing, and an examination where the doctor feels the prostate through the rectum. Ultrasound may be used for the bladder and urinary tract.
If prostate cancer is suspected, prostate MRI can provide information about the zones of the gland and suspicious areas. Tissue samples are needed to reliably establish a cancer diagnosis. The results are assessed together with PSA, age, heredity and previous tests.
In case of urination problems, healthcare providers also need to assess other causes in the bladder, urethra and nervous system.
PSA sometimes needs to be re-measured under standardized conditions because infection, urinary retention, and recent procedures can affect the value. Change over time can be as important as a single result. The urologist can use risk models to determine whether an MRI or biopsy is needed.
When can prostate MRI be relevant?
MRI prostate may be relevant in cases of elevated PSA or other suspicion of prostate cancer, to identify areas that may need targeted tissue samples and to assess the spread of a known tumor.
MRI can also show benign enlargement and signs of inflammation, but the findings are not always specific. A normal MRI response does not completely rule out cancer and needs to be interpreted in conjunction with other risk assessments.
MRI is not used as the sole explanation for common urination problems. Urine flow, residual urine, and bladder function may be more important in this regard.
Limitations and next steps
PSA, MRI, and clinical examination all have limitations. PSA can be elevated without cancer, MRI can miss some tumors, and tissue samples may be needed for a definitive diagnosis.
The next steps may include PSA follow-up, medication for benign enlargement, treatment of infection, targeted biopsy, or specialist follow-up. Decisions should be based on overall risk and personal circumstances.
Prostate cancer ranges from slow-growing tumors that can be monitored to more aggressive disease that requires treatment. Early detection does not mean that all findings need to be treated immediately. Active monitoring may be an option in selected cases.