Prostate health after 40: what the symptoms mean

The prostate is a small gland below the bladder that surrounds the urethra. As it enlarges with age it can press on that tube, which is why urinary symptoms are the usual first sign of a prostate problem.

Symptoms to notice

• A weak or interrupted urine stream
• Difficulty starting, or straining
• Dribbling at the end
• Needing to pass urine more often, especially at night
• A sudden urge that is hard to delay
• A feeling the bladder has not emptied

Three common causes

Benign prostatic enlargement is a non-cancerous increase in size that is very common with age, and treatable with medicines or, in some cases, surgery.

Prostatitis is inflammation or infection, which can cause pain in the pelvis, painful urination, fever and feeling unwell. It is often treated with antibiotics and can affect younger men too.

Prostate cancer frequently causes no symptoms early on. When symptoms do occur they can be identical to benign enlargement, which is why assessment matters rather than self-diagnosis.

About PSA testing

PSA is a blood test that can be raised in prostate cancer, but also in benign enlargement, infection, after cycling or after sex. A raised result does not mean cancer, and a normal result does not completely exclude it. That is why the decision to test should follow a conversation about your risk, what the result would mean, and what would happen next. Men with a family history of prostate cancer, or of African ancestry, carry higher risk and should discuss testing earlier.

Examination

A clinician may offer a digital rectal examination to feel the gland. It takes seconds, and while it is not comfortable, it is not usually painful. Many men avoid it out of embarrassment and lose time as a result.

See a clinician promptly for

• Inability to pass urine at all — this is an emergency
• Blood in urine or semen
• Pain in the pelvis, back or hips that persists
• Fever with urinary symptoms
• Unexplained weight loss

Everyday measures

Reducing caffeine and alcohol, not drinking large volumes late in the evening, and emptying the bladder fully can ease mild symptoms. They do not treat the underlying cause, so they are not a substitute for assessment if symptoms persist or worsen.