Derek Burnett
Derek Burnett is a Contributing Writer at Bottom Line Personal, where he writes frequently on health and wellness. He is also a contributing editor with Reader’s Digest magazine.
About half of all adults have a prostate, yet most men have only a hazy understanding of what it does. We know that it’s involved in reproduction, and we know that when things go wrong with it, it can make life very miserable and, in some cases, even cost us our lives. Familiarizing yourself with the organ’s functions and the main types of prostate problems can help you make smart decisions for treatment and care if you begin to experience trouble in this area.
The prostate is located beneath the bladder and above the rectum, with part of it wrapping around the urethra, the narrow tube through which urine flows to the penis. Roughly the size of a walnut in a healthy young man, it consists of a right and left lobe, with a wider base. Confusingly, the prostate’s base actually sits higher up in your body, against the bladder. In most contexts, the term “apex” refers to something’s highest point, but when it comes to the prostate, the apex is the portion of the gland that sits low and close to the rectum. The section of the organ between the base and apex is known as the “mid-gland.” It’s helpful to understand these three terms…base, apex, and mid-gland…because they often become part of the discussion when something goes wrong with the prostate.
The prostate’s role is purely reproductive…but what specific part does it play in sex? A common misconception is that it is the organ that produces sperm. This false idea may stem from a confusion about the definition of sperm. In biology, “sperm” doesn’t refer to ejaculatory fluid but rather to the reproductive cells that travel to the egg to fertilize it. Those sperm cells are produced by the testicles, not by the prostate. The viscous fluid in which sperm travel is called semen. When you ejaculate, a series of ducts located in the prostate secretes prostatic fluid into the urethra. There, it unites with the sperm that the testicles have produced and with other seminal fluids generated by the seminal vesicles (a set of narrow glands on either side of the prostate). Ejaculation is a mixture of fluids from these three sources. Without the contribution of the prostate, sperm cells would die upon entry to the acidic environment of the vagina. Since prostatic fluid is alkaline, the vagina’s acids are neutralized and the sperm cells survive.
Proper functioning of the prostate requires precise levels of hormones produced by the adrenal glands…which sit on top of your kidneys…by the testicles, which produce testosterone…and by the pituitary gland, which sits at the base of the brain.
Sometime around age 50, most men begin to experience changes to their prostates. What was once a walnut-sized gland begins growing, sometimes to the size of a ping-pong ball and in some cases even larger than a lemon, doubling and even tripling in mass during the late decades of life. When this excessive growth is non-cancerous, it’s known as Benign Prostatic Hyperplasia (BPH), or, informally, as an “enlarged prostate.”
Unfortunately, “benign” does not necessarily mean asymptomatic. While growth of the prostate is a normal part of aging, about half of men begin to experience problems with their lower urinary tracts.
An expanding prostate can put pressure against the urethra, pinching it off so that urine no longer flows freely from the bladder. This forces the bladder to work harder to expel urine and can result in disrupted flow, dribbling, the constant urge to urinate, and even urinary tract infections caused by urine pooling in the bladder.
Another misconception regarding the prostate is that “prostatitis” and “enlarged prostate” are interchangeable terms. In fact, they refer to two different conditions.
Here’s one clarification: The “-itis” suffix refers to inflammation. Prostatitis is an inflamed gland. This condition is fairly common, affecting somewhere between 9% and 16% of men at some point in their lives and resulting in some 2 million doctor visits annually in the U.S. While the risk of enlarged prostate and prostate cancer increases with age, prostatitis is just as common in younger men as it is in older men.
Prostatitis usually causes a burning pain during urination. Many patients also experience increased urinary urgency, trouble fully emptying the bladder, pain when they ejaculate, and discomfort in their lower backs and pelvic floors.
Somewhere between 5% and 10% of prostatitis cases are caused by bacteria. But experts are unsure what accounts for the remaining majority of cases. Some may be attributable to bacteria or fungi that escape standard detection methods. Or in some cases, it may be that the immune system has mistaken the prostate for a threat and has begun attacking it with the sorts of inflammatory compounds normally deployed to combat infections. Yet another possibility is that the prostate responds to triggers which could include certain foods, stress, chronic pain, pelvic/groin trauma, and excessive prostate biopsies.
Doctors place prostatitis cases into four categories based on what is known about their causes and their symptoms. Those categories are: Acute bacterial prostatitis, chronic bacterial prostatitis, chronic nonbacterial prostatitis, and asymptomatic inflammatory prostatitis.
As with other cancers, prostate cancer is an abnormal growth of cells. And just as with other cancers, a prostate cancer may remain localized in the gland itself or it may spread into surrounding tissues.
The American Cancer Society estimates some 299,000 new prostate-cancer diagnoses were given in 2024, with more than 35,000 deaths, making it the second leading cause of cancer deaths among men in the U.S. (after lung cancer). Roughly one in eight men are diagnosed with prostate cancer during their lifetimes, and one in 44 will die of it.
That’s the bad news. The good news is that improved detection and treatment make prostate cancer more survivable than ever. Today, about 98% of men live for 10 years after diagnosis and 96% survive 15 years.
Researchers are still investigating the causes of prostate cancer but have not yet identified a single obvious culprit. We do know that almost a fourth of men with aggressive prostate cancers have defects in certain inherited genes. We also know that prostate-cancer risk increases with age (The median age of diagnosis is 67 years). And African Americans have a higher risk of prostate cancer than any other group in the U.S. Prostate cancer has also been linked to obesity and to a diet high in red meat and saturated fats. Some studies suggest also that men who ejaculate infrequently are at higher risk.
Men with early-stage prostate cancer seldom experience symptoms. In most cases, the cancer’s first signs are detected when routine blood testing shows elevated levels of a hormone called prostate-specific antigen (PSA). Normally, this prompts a biopsy, which can confirm a diagnosis if the high PSA is indeed caused by cancer.
When men do experience signs of prostate cancer, the primary symptom tends to be trouble urinating. Once the cancer has spread, many men begin to feel pain in their bones or in their backs.
