The prostate is a small gland located below the bladder and in front of the rectum. Its primary role is to produce the seminal fluid that transports sperm through the urethra. During ejaculation, the prostate muscles contract and helps push the fluid out into the urethra, making this tiny gland a critical part of the male reproductive system.

The prostate becomes larger as men get older and can cause a number of health issues and complications. At Profound Medical, we offer the TULSA Procedure, a minimally invasive and safe option that uses directional ultrasound to ablate prostate tissue. The TULSA procedure is shown to be effective at treating symptoms of non-cancerous prostate conditions and as a well-tolerated procedure for localized prostate cancer.

Prostate Conditions

Currently, the cause of prostate enlargement is unknown but researchers have linked prostate conditions to aging, testosterone levels, and changes in the cells of the testicles. Prostate enlargement is common for men over the age of 40 and the probability of developing a prostate condition increases with age. Below, we cover some non-cancerous prostate conditions, prostate cancer, and risk factors.

Benign Prostate Hyperplasia (BPH) – The medical term for a non-cancerous, enlarged prostate that affects almost all men over the age of 50. BPH is caused by an overgrowth of prostate tissues that pushes against the urethra and bladder, leading to symptoms such as restricted urine flow, frequent urination, and difficulty starting to urinate. More than 90% of men over the age of 80 have BPH¹.

Acute Bacterial Prostatitis – A bacterial infection typically caused by common strains of bacteria or an infection that has spread from other parts of the urinary or reproductive systems. Symptoms include frequent urination, pain or discomfort during urination, and pain in the genital area. If you’re experiencing fever and chills along with these symptoms, see your doctor right away.

Chronic Bacterial Prostatitis – Unlike acute bacterial prostatitis that comes on suddenly, chronic prostatitis develops gradually and can last for months or even years. Bacterial prostatitis is considered chronic if symptoms continue for 3 months or more and do not respond to the initial treatments that your doctor recommends. It’s also referred to as chronic pelvic pain syndrome and can cause pain in the lower back and genital area.

Prostate Cancer – Prostate cancer is indicated by the growth of malignant cells in the tissues of the prostate. While some prostate cancers grow slowly and only require minimal or no treatment, some types are aggressive and can spread beyond the prostate gland. Prostate cancer is one of the most common forms of cancer and risk factors include:

• Age – Men over the age of 50 are more likely to develop prostate cancer.
• Race/Ethnicity – African-American men are more likely to develop prostate cancer while Asian-American and Hispanic/Latino men are the least likely to develop prostate cancer. The reason for this is unknown.
• Geography – Prostate cancer is more common in North America, Northwestern Europe, and Australia and less common in Asia, Africa, and South America.
• Family History – Men who have an immediate family history of prostate cancer (such as a father or brother) are at a higher risk of developing the disease.

Symptoms of Prostate Problems

Given its close proximity to the bladder and important role in the male reproductive system, common problems associated with the prostate are challenges with urination and sexual function. The following are common symptoms of prostate problems, which can indicate a non-cancerous prostate condition but can also be linked to prostate cancer.

• A weak or slow urine stream
• Difficulty starting urination
• A urine stream that starts and stops
• Frequent urge to urinate
• Frequent urination at night
• A feeling that the bladder is not completely empty after urinating
• A continued and uncontrolled dribble of urine
• Painful or burning sensation with urination
• Blood in urine or semen
• Pain or discomfort in the lower back, hips, and pelvic area
• Painful ejaculation

Testing For Prostate Conditions

If you are experiencing any of the above symptoms, your doctor will discuss your options with you, including testing for non-cancerous prostate conditions. Depending on the findings, your doctor may request further testing.

• Digital rectal exam (DRE) – This is the most common procedure that involves the doctor inserting a lubricated, gloved finger inside your rectum to identify any lumps or soft or hard spots on the prostate gland. Although a DRE can be uncomfortable, it is a quick test that typically lasts less than a minute.
• Prostate-specific antigen (PSA) test – A PSA test is a blood test that measures the amount of PSA in your blood, which is a specific type of protein produced by the prostate. Patients with prostate cancer have a high amount of PSA in their blood, though it’s important to know that a high PSA count does not necessarily lead to a cancer diagnosis. A PSA test is simply a test that can provide your doctor with more information and help determine whether further testing is needed.
• Prostate Screening – Prostate screening involves looking for prostate cancer before a patient experiences any symptoms. The goal here is to detect cancer early and before it begins to spread. The decision to undergo screening is a personal one and should only be made after you’ve spoken with your doctor about your risk factors and have all of the information you need.
• Urinalysis – involves taking a urine sample to test for abnormal substances or signs of infection. If there is an infection present, your doctor may ask for a second urine sample to identify where the infection is located.
• Abdominal ultrasound – During an abdominal ultrasound, the healthcare provider applies a gel to your abdomen to allow a device called the transducer to glide easily over the skin. The ultrasound images can show any abnormalities in the urinary tract and provide your doctor with more information about your symptoms.
• Transrectal ultrasound – During a transrectal ultrasound, a narrow transducer is inserted into the rectum next to the prostate. The images from a transrectal ultrasound can show the prostate’s size and any abnormalities such as tumors.

While the above tests can help your doctor detect non-cancerous prostate conditions or other complications such as a urinary tract infection, they are not meant to diagnose prostate cancer. Rather, these tests can act as a basepoint for your doctor to determine whether further testing for prostate cancer is needed. These tests can include:

• MRI and CT scan – MRIs and CT scans provide images of the body’s internal organs and soft tissues without the use of X-rays. These detailed radio wave images can identify abnormal structures, but cannot differentiate between cancerous tumors and noncancerous enlargements.
• Prostate biopsy – A biopsy can reveal whether prostate tissues are cancerous. A biopsy involves taking pieces of prostate tissue which are sent to a lab and examined by a pathologist, a doctor who specializes in the diagnoses of disease.

When it comes to your prostate health, one of the best things you can do is be proactive and advocate for your health by gathering information from trusted resources and speaking with your doctor. Discuss with your doctor whether prostate screening is right for you, including factoring in your risk of prostate cancer, age, overall health, and any symptoms you may be experiencing. While your doctor can make recommendations, ultimately, the choice to investigate and maintain your prostate health is yours.