Many men keep quiet about their prostate problems, but ignoring the ubiquitous health issue won’t make it go away. King Charles—who is undergoing surgery this week for an enlarged prostate—reportedly announced his condition publicly to encourage other men to get screened.
About one of every eight males will be diagnosed with prostate cancer in their lives, and half of all those between 51 and 60 years old will suffer from a benign enlarged prostate. That number climbs to 70 percent among men ages 60 to 69, and 90 percent among men over 85.
Arvin George, director of the Johns Hopkins Medicine prostate cancer program, says experts don’t know the exact mix of genetic, environmental, dietary, or other factors that play a role in prostate problems as men age. That means there’s no easy path to avoid them. “For both an enlarged prostate and prostate cancer, there’s no ‘apple a day’ to prevent this,” he says.
Fortunately, there are ways to deal with it. Men who suffer urinary problems have many treatment options available. And while prostate cancer remains distressingly common, emerging research suggests that many men can safely delay treatment, or avoid it entirely.
What is the prostate—and an enlarged prostate?
The prostate is a walnut-sized gland that helps to produce semen, the fluid that delivers sperm to the egg after ejaculation. It’s wrapped around the urethra, the tube that carries semen and urine out of the body, which means that a growing prostate can pinch the urethra.
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Benign prostatic hyperplasia (BPH), or enlarged prostate, occurs when the gland doubles or even triples in size in older men—think of that walnut growing to the size of a lemon. This can make it difficult to urinate and to completely empty the bladder. Sufferers may also have to urinate more frequently, especially at night, or may do so involuntarily.
What causes an enlarged prostate and how do you treat it?
The biggest factor in developing an enlarged prostate is simply growing older, most likely because the body undergoes changes in the balance of sexual hormones. BPH is also more common among those with a family history of the condition, and there is some evidence that men who are obese, or who have risk factors for cardiovascular disease and diabetes, may be more likely to have an enlarged prostate. There is absolutely no evidence that having sex causes prostate problems, George says reassuringly.
About half of men with enlarged prostates suffer no symptoms at all. “If it’s not causing symptoms it really is nothing to worry about,” explains Nick Ridgman, head of health information and clinical support at Prostate Cancer UK.
Occasionally BPH can cause health concerns like frequent urinary tract infections or kidney problems. But typical symptoms are a quality-of-life issue and treatments focus on alleviating the inconvenience of urinary problems. Simply reducing intake of fluids, especially in the evenings, or limiting diuretics like caffeine and alcohol can help. For those who need more relief, medications can relax the muscles around the prostate, or even shrink it, and surgical treatments can reduce the size of the prostate.
Treatment decisions, George says, are best driven by how much an individual is bothered by his own symptoms. “Some men wake up to urinate several times a night, but they go right back to sleep, and they are fine,” he says. “Others might not have regular access to a bathroom, and that can really impact their quality of life.”
What are the risks of getting prostate cancer?
Men who live long enough will likely get prostate cancer; 70 percent of those over 70 years old have some cancerous cells in their prostates even if they haven’t been diagnosed. In the United States and the United Kingdom, prostate cancer is the second leading cause of cancer deaths among men, behind lung and bronchus cancer. The average age at diagnosis is 67 and diagnoses are rare among men under 40.
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Scientists are still untangling the genetic mutations related to prostate cancer, but they do know that risk runs in the family. A man who has two or more close male relatives (father or brothers) with prostate cancer is five to 10 times more likely to be diagnosed himself. For reasons not yet entirely understood, men of African descent are at particular risk: Black men are 70 percent more likely to get prostate cancer and are also more likely to die from the disease.
Prostate cancer can also spread to surrounding tissues or, worse, spread more widely through the body. Fortunately most cases are localized and offer excellent outcomes; 95 percent of men diagnosed with prostate cancer survive at least 15 years.
How do you know if you have prostate cancer?
George notes that many men he sees with troublesome urinary symptoms are understandably concerned that they have a serious case of prostate cancer. “That’s probably the single most common misconception among patients and even the medical community,” he says.
In nations like the U.S., where screening has been common for decades, prostate cancer is often caught long before a person develops symptoms, he explains. “Most often when a man has symptoms, it very unlikely to be related to prostate cancer, and most often related to just an enlarged prostate.”
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The American Urological Association recommends that most men ages 55 to 69 get screened for prostate cancer every two years, but speaking with a doctor about your own risk factors can fine tune this recommendation. Those with higher risk factors, like Black men and people whose close relatives have prostate cancer, might screen earlier and more often.
Why some people might be able to leave prostate cancer untreated
Screening can identify prostate cancers at high risk of spreading and allow doctors to treat them early, saving lives.
But some experts say that screening has its drawbacks. The prostate specific antigen (PSA) blood tests, which identify proteins made by the prostate, can produce both false positive and false negative results, which can cause unnecessary stress or treatments. For every thousand men screened between the ages of 55 and 69, about one death will be prevented.
Additionally, many prostate cancers are slow moving and never cause problems. In fact, recent research shows that many men with prostate cancer can benefit from not treating it at all, but simply keeping a watchful eye. A study published in the New England Journal of Medicine in April 2023 showed that active monitoring of prostate cancer has the same high 15-year survival rates as far more aggressive interventions like radiotherapy and surgery.
The same study highlighted the side effects of these treatments, noting that they can cause persistent problems with sexual function and urination for longer than had been believed—up to 12 years. “Those are quite serious long-term things to burden people with,” says Ridgman. “The evidence shows that men can live with localized, low-risk prostate cancer for many years, or decades, without needing active treatment.”
And though their urinary problems usually don’t mean cancer at all, men needn’t suffer in silence when help is available.
“If you’re having symptoms that are bothering you, ask your doctor,” George says. “We don’t want people to resign themselves to think, this is what’s happening to me, and I have to just deal with it.”
Sarah Carter is a health and wellness expert residing in the UK. With a background in healthcare, she offers evidence-based advice on fitness, nutrition, and mental well-being, promoting healthier living for readers.
