A little known side effect with a huge impact

Prostate Problems Are Incredibly Common. Here's Why—and How To Treat Them.

Many men keep quiet about their prostate problems, but ignoring the ubiquitous health issue won't make it go away.

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.

This colored scanning electron micrograph (SEM) depicts two prostate cancer cells in the final stage of cell division (cytokinesis). Although 70 percent of men over 70 will have some cancerous cells in their prostate, survival rates are extremely high.

Micrograph by STEVE GSCHMEISSNER, SCIENCE PHOTO LIBRARY

What is a 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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What causes 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.

A colorized gamma scan of a patient with metastatic prostate cancer (white). Left untreated, prostate cancer can metastasize to the bones, lymph nodes, lungs, and liver tissue. But emerging research suggests some men with slow-moving cancer can delay invasive treatments.

GJLP/CNRI/SCIENCE PHOTO LIBRARY

What are the symptoms of 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. 

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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."

What causes an enlarged prostate?

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.

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."

Editor's note: This story was originally published on January 23, 2024. It has been updated.

6 Symptoms Of Prostate Cancer That Are Easy To Miss As Joe Biden Is Diagnosed With An 'aggressive' Type

Former President Joe Biden has been diagnosed with "aggressive" prostate cancer that has spread to his bones after experiencing urinary symptoms, his private office said on Sunday.

Prostate cancer is the second-deadliest form of cancer in men in the US, after lung cancer, and affects the gland in males that sits beneath the bladder and in front of the rectum. About one in eight men will get prostate cancer, but most will not die of the disease, the American Cancer Society says.

It's a somewhat paradoxical disease: When caught early, it's often curable — but symptoms typically don't appear until it's more developed and harder to treat.

When it's found at more advanced stages, treatment options are more limited, and at stage 4, which is when the cancer has spread from the prostate to other parts of the body, "treatment won't cure your cancer, but it can help keep it under control and manage any symptoms," Chiara De Biase, the director of health services, equity, and improvement at the charity Prostate Cancer UK, told Business Insider.

Biden's team has not shared which stage of cancer he has or his prognosis but said it was "hormone-sensitive," meaning it uses hormones to grow and has the potential to be managed with drugs that block hormones in the body.

Easy-to-miss symptoms of prostate cancer include changes in how a person pees

Changes in urinary habits tend to be the earliest sign that a person has prostate cancer. If the tumor grows near and presses against the urethra, it can change the way the person pees. But early prostate cancer usually grows in a different area, away from the urethra, so it doesn't tend to cause symptoms until much later.

Changes in how a person with prostate cancer pees can include:

Difficulty starting to pee or emptying your bladder.

A weak flow when you pee.

A feeling that your bladder hasn't emptied properly.

Dribbling urine after you finish urinating.

Needing to pee more often than usual, especially at night.

A sudden need to pee or sometimes leaking pee before you get to the toilet.

It's important to note that these changes can also be a sign of an enlarged prostate, a common, noncancerous condition.

If prostate cancer spreads, other symptoms can include:

Back pain, hip pain, or pelvis pain.

Problems getting or keeping an erection.

Blood in the urine or semen.

Unexplained weight loss.

Weakness or numbness in the legs or feet, or even loss of bladder or bowel control, from cancer in the spine pressing on the spinal cord.

On average, men are diagnosed with prostate cancer at 67

The American Cancer Society says the average age at which men are diagnosed with prostate cancer is 67. Biden is 82. The organization recommends that men with an average risk of prostate cancer consider getting screened at 50. The test involves taking a blood sample and checking for higher-than-normal levels of prostate-specific antigen.

"It's so important for men to know their own risk, and what they can choose to do about it," De Biase said.

10 Signs And Symptoms Of Prostate Cancer

Prostate cancer usually does not cause symptoms in the early stages. Signs of prostate cancer can include frequent urination, weak or interrupted urine stream, painful ejaculation, blood in urine or semen, and erectile dysfunction as the disease progresses.

It doesn't necessarily mean you have prostate cancer if you have these symptoms. Other conditions that affect the prostate, such as benign prostatic hyperplasia (enlarged prostate), cause similar symptoms.

HeroImages / Getty Images

The prostate is a walnut-sized gland located in the lower pelvis in front of the rectum and just below the bladder in the male reproductive system. The prostate wraps around the urethra, a tube that empties urine from the bladder. A tumor can press on or constrict the urethra, causing frequent urination, urinary urgency, and difficulty urinating. Frequent Urination and Nocturia  Frequent urination is the need to urinate more than usual. Most people don't know how many times they urinate each day. People with prostate cancer may notice they are making more bathroom trips than normal.  Nocturia, or excessive nighttime urination, is when you wake up more than once a night to urinate. The body slows down urine production at night, which allows most people to sleep between six to eight hours without waking to use the bathroom. Nocturia can be a symptom of prostate cancer, but there are many other causes, such as aging.  Urinary Urgency  Prostate cancer can cause a sudden, overwhelming need to urinate right away. Urinary urgency can make it difficult to "hold it" and may be accompanied by discomfort in the bladder or urinary tract.  Difficulty Urinating  Having trouble urinating, known as urinary hesitancy, can include problems with starting the stream of urine, a weak or slow stream, or a stream that frequently starts and stops. Feeling like the bladder is not completely emptied and dribbling (leaking) urine are also possible signs of prostate cancer. Other symptoms of prostate cancer may also occur. These less common symptoms include painful ejaculation, blood in the urine or semen, and erectile dysfunction. Painful Ejaculation  Pain during or immediately after ejaculation can be a sign of prostate cancer. You may feel pain in the penis, testes, rectum, or lower abdomen. Painful ejaculations range from mild discomfort to excruciating and may last a few seconds or longer. Blood in the Urine or Semen  Blood in the urine (hematuria) or in the semen (hematospermia) can occur when a tumor in the prostate gland presses on the urethra or surrounding glands and blood vessels. A tumor can irritate or block these structures, causing blood to appear in urine or semen. Sudden Onset Erectile Dysfunction  Erectile dysfunction is when it is difficult to get or keep an erection. Aging is a common cause, but it is typically gradual in onset. Sudden onset erectile dysfunction, in contrast, may be a sign of prostate cancer. This can occur when a tumor compresses or damages nerves that control blood flow to the penis. Other symptoms can occur if the cancer has metastasized (spread) outside of the prostate. Advanced symptoms include pain, swelling in the legs or feet, unintentional weight loss, and numbness and weakness. Pain in the Back, Hips, or Chest The bones are almost always the first part of the body affected when prostate cancer spreads. This is known as bone metastases. Cancer can spread to any area of the body, but the back, hips, and ribs are the most common sites of bone metastases. Swelling in the Legs or Feet Swelling in the legs and feet may occur when prostate cancer spreads to the lymph nodes in the pelvis. The lymph nodes are part of the lymphatic system, which collects excess fluid from body tissues and organs, filters it, and returns it back to the bloodstream. Fluid can build up and lead to swelling when cancer cells enter lymph nodes and block lymph drainage channels.  Unintentional Weight Loss Unintentional weight loss is often a sign of advanced prostate cancer. Cancer cells demand a lot of the body's energy supply, causing the body to burn more calories than normal. Fatigue is common in advanced prostate cancer and can also contribute to weight loss. Numbness and Weakness in Limbs A tumor may compress the spinal cord and cause a range of symptoms when cancer spreads to the spine. Symptoms include numbness, tingling, and weakness in the arms and legs. Loss of control of the bladder and bowel may also occur. This can lead to incontinence (leaking urine or feces) or difficulty emptying the bladder or bowel.  See a healthcare provider if you have prostate cancer symptoms. Not everyone who experiences these symptoms has prostate cancer. Other conditions that affect the prostate, such as benign prostatic hyperplasia (enlarged prostate), cause similar symptoms. A healthcare provider can investigate to determine the cause and provide treatment. Prostate cancer is a slow-growing disease that does not usually cause symptoms in the early stages. More advanced prostate cancer may cause symptoms such as frequent urination, a weak urine stream, erectile dysfunction, and blood in the urine or semen. Other prostate conditions, such as an enlarged prostate, cause similar symptoms.  It's important to make an appointment with a healthcare provider if you have prostate cancer symptoms. They can find and treat the cause. 

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