Only men have a prostate gland. The prostate gland's main job is to make some of the fluid that carries sperm, called semen.

The prostate is usually the size and shape of a walnut. It lies underneath the bladder and surrounds the tube (the urethra) that men pass urine and semen through.

The main types of prostate problem are:
• An enlarged prostate - this is the most common prostate problem
• An inflammation or infection in the prostate called prostatitis
• Prostate cancer

If you have any problems with your waterworks, it might be a sign of a prostate problem that may be treatable.

Symptoms to look out for include:

• Needing to urinate more often than usual, especially at night. For example if you often need to go again within two hours
• Difficulty starting to pass urine
• Straining or taking a long time to finish urinating
• A weak flow of urine
• A feeling that your bladder has not emptied properly
• Needing to rush to the toilet - you may occasionally leak urine before you get there Dribbling urine

Less common symptoms of a prostate problem include:

• Pain when passing urine
• Pain when ejaculating
• Problems getting or keeping an erection - this is not a common symptom of a prostate problem and is more often caused by other health conditions
• Blood in the urine or semen

You should not have to put up with problems with your waterworks even if you are an older man. There are treatments for prostate problems and there may be ways for some men to manage them for themselves.

Having an enlarged prostate is a common condition that affects many men from the age of about 50 years.²³ It is also known as benign prostatic hyperplasia (BPH) or enlargement (BPE). It means that your prostate gland to grows in size as you get older, but it is not a form of cancer and it is treatable. In some cases if your prostate gets bigger it can cause the tube you pass urine through (urethra) to narrow and slow down the flow of urine.

Prostatitis can affect men of any age but is more common in men aged between 30 and 50. It can be caused by an infection or inflammation of the prostate gland. It is not a form of cancer. Prostatitis can cause a wide variety of symptoms, which differ from man to man and include those described above.

Prostate cancer is the most common cancer in men in the UK.⁴ Some men with prostate cancer may have some of the symptoms listed in this leaflet and others may have no symptoms at all. Prostate cancer can develop when cells in the prostate gland start to grow in an uncontrolled way. Most prostate cancer grows slowly to start with and may never cause any problems. Some men will have prostate cancer that is more aggressive. This needs treatment to prevent or delay it spreading outside the prostate gland. There are several treatments available for prostate cancer.

The things that may affect your risk of getting prostate cancer are:

Age: Prostate cancer is most common in men over the age of 50 and your risk increases as you get older.⁴ It is still possible to get prostate cancer at a younger age, so if you are under 50 and you have any urinary symptoms or you are worried about your risk go and visit your GP.

Ethnicity: In the UK, African Caribbean men are three times more likely to develop prostate cancer than white men of the same age.¹ The reasons for this increased risk are not yet clear but may be due to genetic changes passed down through generations.^{7 8 9 10 11}

Family: You are two and a half times more likely to get prostate cancer if your father or brother has been diagnosed with it, compared to a man who has no relatives with prostate cancer.¹² There might be a higher chance of you developing prostate cancer your relative was aged under 60 when he was diagnosed or if you have more than one close relative with prostate cancer. ¹²

Diet: No one knows how to prevent prostate cancer yet and there does not seem to be a direct link between an African Caribbean diet and prostate cancer.^{13 14 15} But in general, having a healthy diet and lifestyle may be important in protecting against the disease ^{16 17 18 19 20 21 22} and other health problems.

You can read more about this in the leaflet Diet and your risk of prostate cancer.

If you have any of the symptoms listed here, or if you are worried about prostate problems, visit your GP. You can also call our confidential Helpline. Remember that waterworks problems are often caused by non-cancerous problems such as an enlarged prostate that can be treated.

Your GP or practice nurse will ask if you if you have symptoms and may do a few tests to find out if you have a prostate problem:

• Urine test
You may be asked for a urine sample to check for any infection that could be causing you problems passing urine.

• Prostate specific antigen (PSA) blood test
PSA is a protein produced by the prostate gland. Prostate problems, such as an enlarged prostate and prostate cancer, can cause your PSA level to rise. A PSA blood test alone cannot tell you whether you have prostate cancer. Your GP will need to look at your PSA level together with other test results, like the DRE. You are entitled to a PSA test as long as you have talked through the pros and cons of the test with your GP. You can read about this in our booklet Understanding the PSA test: A guide for men concerned about prostate cancer.

• Digital rectal examination (DRE)
The GP will feel the prostate for any hard or irregular areas and to feel if it is enlarged. The DRE is an important way for the GP to work out if you have a prostate problem.

For more information about these tests read our booklet, Know your prostate: A guide to common prostate problems.

It is natural to feel worried or embarrassed about having tests and check-ups. But you should not let that stop you going to your GP. Remember, the tests will make sure that your GP can get the best idea whether you have a problem that needs treating.

Call our confidential Helpline to order our free leaflets about prostate problems or cancer or to speak to a specialist nurse.

Reviewers
• Joey Ancheta, Prostate Cancer CNS, Barts and The London NHS Trust & Newham University Hospital NHS Trust, London
• Frank Chinegwundoh, Consultant Urological Surgeon, Barts and The London NHS Trust & Newham University Hospital NHS Trust, London
• Ruth Jack, Epidemiologist / Research Associate, Thames Cancer Registry, King's College London
• Judith Nembrahd, Clinical Transformation Lead (Health Visiting), Birmingham Community Healthcare Trust
• Innocent Muza, Health Improvement Specialist - Health Inequalities, NHS Luton
• Dorothy Wilson, Health Visitor, Birmingham Community Healthcare Trust
• Prostate Cancer Voices
• The Prostate Cancer Charity African and Caribbean Policy and Development Manager
• The Prostate Cancer Charity Support & Information Specialist Nurse (African Caribbean Communities)

Written and edited by:
The Prostate Cancer Charity Information Team

References to sources of information used to produce this page:

1 Ben-Shlomo Y, Evans S, Ibrahim F, Patel B, Anson K, Chinegwundoh F, Corbishley C, Dorling D, Thomas B, Gillatt D, Kirby R, Muir G, Nargund V, Popert R, Metcalfe C, Persad R; PROCESS study group.The Risk of Prostate Cancer amongst Black men in the United Kingdom: The PROCESS Cohort Study, European Urology 53 (2008) 99-105

2 Roehrborn CG. BPH progression: concept and key learning from MTOPS, ALTESS, COMBAT, and ALF-ONE. BJU International. 2008; 101 (supp 3): 17-21.

3 Trueman P, Hood SC, Nayak USL et al. Prevalence of lower urinary tract symptoms and self-reported diagnosed 'benign prostatic hyperplasia', and their effect on quality of life in a community-based survey of men in the UK. BJU Int 1999; 83: 410-415.

4 From the Cancer Research UK statistical information team, compiled from: Northern Ireland Cancer Registry. Cancer Incidence and Mortality. 2010; Welsh Cancer Intelligence and Surveillance Unit.2010, ISD Online Information and Statistics Division, NHS Scotland. 2010; Office for National Statistics, Cancer Statistics registrations: Registrations of cancer diagnosed in 2007, England Series MB1 no.38. 2010, London: National Statistics
http://info.cancerresearchuk.org/cancerstats/types/prostate/incidence/

5 Xu J, Kibel AS, Hu JJ, Turner AR, Pruett K, Zheng SL, Sun J, Isaacs SD, Wiley KE, Kim ST, Hsu FC, Wu W, Torti FM, Walsh PC, Chang BL, Isaacs WB.Prostate cancer risk associated loci in African Americans Cancer Epidemiol Markers Prev 2009; 18(7) 2145-49).

6 Hooker S, Hernandez W, Chen H, Robbins C, Torres JB, Ahaghotu C, Carpten J, Kittles RA.Replication of prostate cancer risk loci on 8q24, 11q13, 17q12, 19q33, and Xp11 in African Americans Prostate 2010 Feb 15;70(3):270-6).

7 Wang Y, Ray AM, Johnson EK, Zuhlke KA, Cooney KA, Lange EM. Evidence for an association between prostate cancer and chromosome 8q24 and 10q11 genetic variants in African American men: The flint men's health study† Prostate 2010 Aug 17).

8 Lavender NA, Benford ML, VanCleave TT, Brock GN, Kittles RA, Moore JH, Hein DW, Kidd LC.Examination of polymorphic glutathione S-transferase (GST) genes, tobacco smoking and prostate cancer risk among Men of African Descent: A case-control study BMC Cancer 2009 9: 397)

9 Mason TE, Ricks-Santi L, Chen W, Apprey V, Joykutty J, Ahaghotu C, Kittles R, Bonney G, Dunston GM.Association of CD14 variant with prostate cancer in African American men Prostate 2010 Feb 15;70(3):262-9)

10 Johns LE, Houlston RS. A systematic review and meta-analysis of familial prostate cancer risk. BJU International 2003; 91: 789-794.

11 Park, S-Y, Murphy, S.P., Wilkens, L.R., Henderson, B. E. and Kolonel, L.N. (2007) 'Fat and meat intake and prostate cancer risk: The Multiethnic Cohort Study', International Journal of Cancer, Vol. 121, Issue 6, pp 1339-1345

12 Chinegwundoh F, Enver M, Lee A, Nargund V, Oliver T, Ben-Shlomo Y. (2006) 'Risk and presenting features amongst African Caribbean, South Asian and European Men in North-East London', BJU International, Vol. 98, Issue 6, pp 1216-1220

13 Jackson, M., Walker, S., Simpson, C., McFarlane-Anderson, N. and Bennett, F. (2009) 'Are food patterns associated with prostate cancer in Jamaican men', Infectious Agents and Cancer, 4(Suppl1): S5

14 Giovannucci E, Liu Y, Platz EA et al. Risk factors for prostate cancer incidence and progression in the health professionals follow-up study. Int.J Cancer 2007; 121 (7):1571-8

15 Orsini N, Bellocco R, Bottai M, Pagano M, Andersson SO, Johansson JE, Giovannucci E, Wolk A. A prospective study of lifetime physical activity and prostate cancer incidence and mortality Br J Cancer. 2009 Dec 1;101(11):1932-8. Epub 2009 Oct 27.

16 World Cancer Research Fund/American Institute for Cancer. Food, Nutrition, Physical Activity and the Prevention of Cancer: A Global Perspective. Washington DC:AICR, 2007

17 Ma RW, Chapman K . A systematic review of the effect of diet in prostate cancer prevention and treatment. Journal of Human Nutrition and Dietetics : the Official Journal of the British Dietetic Association [2009, 22(3):187-99; quiz 200-2]

18 Allen NE, Key TJ, Appleby PN et al. Animal foods, protein, calcium and prostate cancer risk: the European Prospective Investigation into Cancer and Nutrition. Br J Cancer. 2008 May 6;98(9):1574-81.

19 Gao X, LaValley MP, Tucker KL Prospective Studies of dairy product and calcium intakes and prostate cancer risk: A meta-analysis. J Natl Cancer Inst. 2005;97(23):1768-77

20 Ma RW, Chapman K . A systematic review of the effect of diet in prostate cancer prevention and treatment. Journal of Human Nutrition and Dietetics : the Official Journal of the British Dietetic Association [2009, 22(3):187-99; quiz 200-2]

21 Allen NE, Key TJ, Appleby PN et al. Animal foods, protein, calcium and prostate cancer risk: the European Prospective Investigation into Cancer and Nutrition. Br J Cancer. 2008 May 6;98(9):1574-81.

22 Gao X, LaValley MP, Tucker KL Prospective Studies of dairy product and calcium intakes and prostate cancer risk: A meta-analysis. J Natl Cancer Inst. 2005;97(23):1768-77