The prostate is a small gland, about the size of a walnut, that is located just below the bladder and wraps around the upper part of the urethra in men and people assigned male at birth (AMAB). 

A healthy prostate is important for both sexual health and urinary function. The prostate plays a key role in reproduction, as it produces fluid that mixes with sperm to make semen. 

When the prostate becomes enlarged (a condition called BPH), suffers from infection or inflammation (a condition called prostatitis), or develops cancer, it can affect both urination and sexual function.

Related: The new proactive health standards for men

Common prostate conditions

"What is good prostate health?" is a common question asked by men seeking to maintain their overall well-being as they age. A healthy prostate usually means normal sexual function and the ability to urinate without issues. But as men get older, the prostate can suffer from three common conditions: prostatitis, enlarged prostate (BPH), and prostate cancer. 

Prostatitis

Prostatitis is inflammation or swelling of the prostate, and is the most common prostate complaint in men under the age of 50. There are two main types of prostatitis: bacterial and chronic.

Bacterial prostatitis

Some prostatitis is caused by bacteria, tiny organisms that can lead to infection. If you suffer from a urinary tract infection (UTI), you may be more likely to get bacterial prostatitis.

Bacterial prostatitis symptoms sometimes come on quickly, may come on slowly, and sometimes last a long time. If you have bacterial prostatitis, you may not be able to fully empty your bladder, and you may suffer from a fever, chills, or body aches.

The most common treatment for bacterial prostatitis is antibiotics. Your healthcare provider might also recommend dietary changes or an increase in fluid consumption.

Chronic prostatitis

The exact cause of chronic prostatitis remains unknown. Some researchers believe that an infection of tiny organisms, though not bacteria, can cause chronic prostatitis. Other causes may include chemicals in the urine, a response to a previous urinary tract infection (UTI), or nerve damage in the pelvic area.

The symptoms of chronic prostatitis may include long-lasting pain and/or discomfort in:

• the penis or scrotum;
• the area between the scrotum and anus;
• the belly;
• the lower back.

Common treatments for chronic prostatitis will attempt to decrease pain, discomfort, and inflammation. The medicine most frequently prescribed for chronic prostatitis is called an alpha-blocker, and it relaxes the muscles in the prostate and part of the bladder. Two commonly used alpha-blockers include tamsulosin (Flomax) and silodosin (Rapaflo). Your healthcare provider might also recommend warm baths, relaxation exercises, and physical therapy exercises. 

Enlarged prostate, or benign prostatic hyperplasia (BPH)

Benign prostatic hyperplasia (BPH) is a condition that causes the prostate to enlarge. This can cause problems with urination, including pain, burning, and obstruction. BPH is the most common prostate problem in men and people assigned male at birth (AMAB). By age 70, most men will have some prostate enlargement.

BPH is caused by an overgrowth of cells in the prostate. Some of the factors that can increase the risk for developing BPH are family history, age, obesity, lack of physical activity, erectile dysfunction, heart disease, and Type 2 diabetes. Dihydrotestosterone (DHT) — the primary metabolite of testosterone in the prostate — also plays a part in risk for BPH. Studies have shown a relationship between significantly higher DHT levels and extensive inflammation in the prostates of people with BPH.

Signs and symptoms usually start in people over 40. The enlarged prostate puts pressure on the urethra and bladder, which narrows or blocks the urethra, making it harder to urinate, and sometimes causes pain or discomfort. 

BPH is a non-cancerous condition which won’t spread to other parts of the body and is not usually life-threatening. BPH doesn't increase the risk of prostate cancer and it isn't considered a health problem unless it causes symptoms.

There are several treatment options for BPH, including watchful-waiting (also known as active surveillance or observation), medications (such as alpha blockers), minimally invasive procedures, and/or surgery. Your healthcare professional and you can discuss the severity of your symptoms and how they affect your quality of life when considering treatment options. Some patients might even forego treatment for BPH if their symptoms aren't bothersome.

Prostate cancer

Prostate cancer occurs when cancerous cells form in the tissues of the prostate. It is different than enlarged prostate (BPH), although the two conditions can have similar symptoms. 

Prostate cancer is second only to skin cancer as the most commonly diagnosed type of cancer in the US. According to the American Cancer Society, 1 in 8 men in the USA will be diagnosed with prostate cancer at some point in their lives.

The risk of prostate cancer can vary based on age, family history, race/ethnicity, genetic mutations (such as mutations in the BRCA2 gene, Lynch syndrome, or HNPCC), and other factors. The risk for prostate cancer risk is highest in African American men and in Caribbean men of African ancestry.

Prostate cancer is often slow-growing over many years. Prostate cancer survival rates are high, with the CDC stating that 97% of prostate cancer patients survive 5 years later. It has one of the best survival rates when detected early and promptly treated. Over the past two decades, thanks to improvements in screening, early detection, and treatment, prostate cancer mortality rates have dropped by over 40% (from 89.87 per 100,000 in 1999 to 52.92 in 2020).

There are several treatment options for prostate cancer, and the stage or severity of the cancer will likely dictate the course of treatment. Not all cancers are the same, and cancers can grow at different rates. Your healthcare professional and you can discuss the severity of your cancer and severity of your symptoms when planning treatment options. 

Related: Early detection cancer screens aren't just for high-risk people

Treatment options include:

Active surveillance and observation: For men with slow-growing prostate cancers, especially older men or those with other serious health problems, healthcare professionals may recommend active surveillance or observation (also known as watchful waiting).

Surgery and radiation therapy: Surgery is often used when ‌prostate cancer is localized within the prostate gland. In a radical prostatectomy, the surgeon removes the prostate gland and some of the surrounding tissues, including the seminal vesicles. Lymph nodes are often removed as well. Radiation therapy uses radioactive rays or particles to target and kill cancer cells.

Hormone therapy, chemotherapy, and immunotherapy: Hormone therapy, also known as androgen deprivation therapy (ADT), seeks to reduce levels of androgens in the body to stop or slow them from fueling prostate cancer cell growth. Chemotherapy, or chemo for short, uses oral or intravenous anti-cancer drugs to reach cancer cells throughout the body. Chemo can be used to treat advanced prostate cancer, especially if there is also cancer outside the prostate gland. Immunotherapy uses medicines to stimulate the immune system to recognize and destroy cancer cells more effectively.

Emerging treatments and clinical trials: As researchers learn more about prostate cancer, new drugs and therapies are being developed and tested through clinical trials.

Signs of an unhealthy prostate 

An enlarged prostate (BPH) and prostate cancer both cause a range of symptoms, the earliest of which are similar across both conditions. Both can cause issues with urination, including: 

• Difficulty urinating, including pain, and/or a weak or interrupted stream;
• Increased frequency of urination, especially at night;
• Urinary incontinence;
• Less commonly, blood in the urine or semen.

Talk to your healthcare provider if you experience any of these symptoms.

Asymmetrical prostate gland

During a digital rectal examination (DRE) performed by a healthcare provider, some men are diagnosed with having an “asymmetrical prostate gland.” An asymmetrical prostate could signal several conditions:

• Cancer, particularly if the prostate is firm, asymmetrical, and has nodules present;
• Other conditions, such as prostatitis or BPH.

If your healthcare provider diagnoses you with an asymmetrical prostate gland, they might recommend additional testing for your condition. 

Prostate health screening and preventative care

Men over 50 in particular should discuss prostate health care with their healthcare provider. If you are experiencing any symptoms, your healthcare provider may ask you about:

• Symptoms you are experiencing, including onset and frequency;
• History of recurrent urinary tract infections (UTIs);
• Prescriptions and over-the-counter medications you take;
• Amount of liquid consumed daily, including water, caffeine, and alcohol; 
• History of significant illnesses or surgeries;
• Prostate problems among immediate family members.

Additional screening may include a physical examination and/or diagnostic testing, including checking your PSA and other tests.

Physical exam

During a physical exam, your provider may perform an examination of your prostate through a digital rectal exam (DRE). They might also check for an enlarged bladder, urethral discharge, and/or enlarged or tender lymph nodes in your groin.

It is important to note that the DRE is not a completely accurate test, as your provider won’t be able to feel the whole prostate, and since someone with a prostate that feels normal may still have prostate cancer.

Diagnostic tests

Your healthcare provider may refer you to a specialist, such as a urologist, for more thorough diagnostic testing. Such testing may help diagnose lower urinary tract symptoms (LUTS) related to BPH and may help determine your treatment options. 

Diagnostic testing may include:

• Urinalysis; 
• Prostate tests, such as a prostate-specific antigen (PSA) blood test or prostate biopsy;
• Urodynamic tests;
• Cystoscopy;
• Transrectal ultrasound;
• MRI.

Historically, MRI has been primarily used to rule out prostate cancer in patients with clinical suspicion of prostate cancer.

However, a recent study in the American Journal of Roentgenology (AJR) notes that emerging data supports the use of MRI for BPH to support preoperative interventions due to MRI’s ability to help identify prostate volume and BPH types and to better predict outcomes.

Prenuvo’s Whole Body MRI has been shown to improve measurement accuracy by 23.59%, compared with traditional volume estimates, aiding in the identification of patients with BPH. It has also had success in helping identify early-stage (stage 1 / 2) cancers.

Additionally, Prenuvo’s imaging of the prostate gland is equivalent to a dedicated MRI of the prostate, with the added benefit of no intravenous contrast or needles.

How to maintain prostate health

There are several things you can do to help keep your prostate healthy and prevent prostate problems. They include exercise (particularly brisk walking), some dietary supplements, and changing to a diet rich with plant-based foods for prostate health.

Diet and nutrition

A literature review published in the journal Nutrients examined the relationship between diet, enlarged prostate (BPH), and erectile dysfunction. The researchers found “encouraging data” that a diet like the Mediterranean diet (predominantly plant-based, heavy in fruits and vegetables, and including nuts, legumes, and fish with less red meat) may help improve prostate health naturally, benefit erectile function, and help with BPH.

Supplements

An article in Harvard Men’s Health Watch explored the efficacy of prostate health supplements, many of which contain saw palmetto, selenium, zinc, and/or beta-sitosterol. There is no real consensus about how well these supplements might work to promote prostate gland health. Dr. Quoc-Dien Trinh, a urological surgeon at Harvard-affiliated Brigham and Women's Hospital, is quoted in the article stating that "Research has explored supplements' role in prostate health, suggesting positive results. But the findings are often observational, showing only an association, and are far from conclusive."

However, a double-blind study published in BMC Urology in 2020 saw positive results in both urinary stream and overall BPH from a 12-week treatment of a combination of saw palmetto enriched with beta-sitosterol. Saw palmetto blocks the DHT pathway, which is the major pathway causing BPH. 

Finasteride is a medication that is used to treat both BPH and male pattern baldness by impeding the conversion of testosterone to dihydrotestosterone (DHT), one of the major pathways to BPH. However, side effects of finasteride can include symptoms of lower testosterone, particularly lower libido, erectile dysfunction (in 2% to 4% of those taking it), a decrease in ejaculatory volume, and gynecomastia (enlarged breasts).

Exercise and lifestyle change 

Numerous studies have shown the benefits of exercise for prostate health. 

A study from the late 1990s found an inverse relationship between exercise and BPH, meaning that the risks for BPH decreased as exercise increased. The authors concluded that men who were more physically active had less chances of developing lower urinary tract symptoms (LUTS).

The Prostate Cancer Foundation notes researcher Dr. June M. Chan of UCSF’s extensive work demonstrating links between vigorous exercise and a reduction of the chances of dying from prostate cancer. According to Chan and her co-authors, “A modest amount of vigorous activity such as biking, tennis, jogging, or swimming for 3 or more hours a week may substantially improve prostate-cancer specific survival.”

The U.S. Department of Health and Human Services recognized the importance of exercise in cancer prevention and longevity in its 2018 “Physical Activity Guidelines for Americans,” stating that: “Cancer survivors should engage in regular physical activity for its many health benefits. For adults with breast, colorectal, or prostate cancer, greater amounts of physical activity after diagnosis help to substantially lower the risk of dying from their cancer.”

Studies have also looked at the benefits of yoga for those with prostate cancer. One recent study published in the journal Nature concluded that “Peri-operative yoga exercise improved quality of life, promoted an immune response, and attenuated inflammation in men with prostate cancer.”

How the Prenuvo scan can impact care

Most prostate conditions are manageable with early detection, proper diagnosis, and care. Whether you're experiencing symptoms or exploring treatment options, understanding your condition is the first step toward relief. Regular whole body MRI scans, like Prenuvo, can help you monitor your health proactively and help identify hundreds of conditions, including BPH and prostate cancer.

To learn more about the benefits of a whole body MRI—and what makes Prenuvo different—book a call with a member of our care team.