The prostate is a small gland found only in men. Located just below the bladder, it is about the size and shape of a walnut and is traversed by the urethra. Understanding its role and the most common diseases associated with it helps in better recognizing the signs to watch for and the necessary examinations.
Anatomy and main functions
The prostate gland surrounds the urethra in its initial portion. Because the urethra passes through it, any prostatic abnormality can alter the passage of urine and lead to stream disorders, frequent urges, or incomplete bladder emptying.
From a reproductive standpoint, the prostate is the organ of ejaculation. It produces prostatic fluid rich in enzymes and PSA (prostate-specific antigen), which nourishes and protects sperm. At the moment of orgasm, the prostate contracts to expel semen.
What the prostate does not do
- The prostate gland does not directly play a role in continence. Continence depends on the urinary sphincters located around the prostate.
- It is not responsible for erections. The erectile nerves are attached to the prostate but are separate from it.
PSA: not just a blood marker
PSA is often presented as a simple marker measured in the blood, especially after age 50. In reality, it has a physiological function: in semen, PSA helps to liquefy the sperm after ejaculation, thus releasing the sperm for potential fertilization.
A high PSA level in the blood can indicate inflammation, an adenoma, or cancer, but it is not specific. Therefore, PSA levels are interpreted in conjunction with a digital rectal exam, symptoms, and, if necessary, imaging studies.
Is it possible to live without a prostate?
Yes. It is possible to live without a prostate while remaining continent and retaining the ability to have erections, as the urinary sphincters and erectile nerves can be preserved depending on the situation. However, prostate removal results in the loss of ejaculation.
The main prostate diseases
- Prostatitis : infection or inflammation of the prostate gland. Symptoms and treatment vary depending on the form (acute or chronic).
- Prostate adenoma / Benign prostatic hyperplasia (BPH) : a common increase in size with age. From the age of 50, approximately 70% of men experience an increase in prostate volume, which can obstruct the flow of urine.
- Prostate cancer : most often appearing after age 50. It is the disease that causes the most concern, but its screening and treatment can be tailored to each man.
How I examine the prostate
Here are the key steps I use to assess the prostate:
- Interview : searching for urinary symptoms (frequency, urgency, weak stream, night awakenings).
- Digital rectal examination : allows palpation of the prostate to assess its size, consistency and the presence of a suspicious nodule.
- PSA testing : generally carried out annually from age 50, or earlier depending on family risk factors.
- Prostate ultrasound : useful for measuring prostate volume.
- Prostate MRI : provides a more precise tissue image and improves the detection of aggressive cancers.
- PET scan : a highly specialized examination, used in specific situations for the detection of recurrence or extension.
Treatment options and modern approaches
Treatment depends on the diagnosis. For prostate adenoma, there are drug treatments and minimally invasive techniques that reduce symptoms without major surgery. Recent techniques include the Holmium laser, the REZUM procedure, and UROLIFT.
For prostate cancer, approaches range from active surveillance to surgery. Robotic prostatectomy has transformed treatment by allowing for more precise interventions, sometimes performed on an outpatient basis depending on the center’s protocols and experience.
Practical advice
- Monitor your urinary symptoms : a change in stream, more frequent urges, or nighttime awakenings warrant a consultation.
- Get checked out from age 50 : annual rectal examination and PSA testing are common benchmarks.
- Don’t panic if you see an isolated PSA : the result must be interpreted in its context and supplemented by other tests if necessary.
- Discuss family history : a history of prostate cancer in a close relative may warrant earlier monitoring.
In summary
The prostate plays a central role in reproduction and ejaculation. It is not responsible for continence or directly for erections, but its location explains why certain procedures can alter these functions. The main conditions are prostatitis, benign prostatic hyperplasia (BPH), and cancer. Regular clinical monitoring, digital rectal examination, PSA testing, and imaging tests such as ultrasound and MRI allow for accurate diagnosis and treatment guidance.
If you have questions about the prostate or symptoms that concern you, speak to a specialist to establish a personalized assessment.
