Prostate health: What men need to know

How can you tell if there is something wrong with your prostate?

Typical signs of prostate problems often relate to urination, as the prostate is situated directly beneath the bladder and surrounds part of the urethra. Pain may also occur in the lower abdomen, in the area between the scrotum and the anus, or during ejaculation.

Look out for the following symptoms:

• frequent or suddenly strong urge to urinate, even at night
• a weak or interrupted urine stream
• frequent urination, each time passing only small amounts of urine
• difficulty starting to urinate
• Pain or a burning sensation when passing urine
• uncontrolled dribbling after passing urine
• a feeling that the bladder has not been completely emptied
• Pain during or after ejaculation
• Blood in the urine or semen

Many of these symptoms can be attributed to a benign cause, such as an enlarged prostate. The prostate often grows as a man gets older. This can cause it to constrict the urethra and obstruct the flow of urine. However, it is not just the size that matters: even a slightly enlarged prostate can cause symptoms. Other symptoms, such as blood in the urine or in the semen, point to less benign causes, and in any case, you should consult your doctor if you experience any symptoms.

What are the most common prostate conditions?

Various prostate conditions can occur, particularly as men get older. These include benign conditions such as benign prostatic hyperplasia (BPH) and inflammation of the prostate (prostatitis), as well as malignant conditions such as prostate cancer (prostate carcinoma), which are also the most common prostate conditions. The symptoms described above may indicate a condition. However, prostate cancer usually causes no symptoms in its early stages. The most appropriate treatment depends on the condition and its progression.

Benign prostatic hyperplasia (BPH), also known as benign prostate enlargement

In many men, the prostate begins to enlarge from around the age of 40. This is a normal part of the ageing process and, provided there are no symptoms, BPH does not require medical treatment. If the benign enlargement causes symptoms when passing urine, specialists refer to this as benign prostatic syndrome (BPS).

If the bladder does not empty completely, residual urine may remain. This increases the risk of recurrent urinary tract infections and bladder stones. In cases of severe urinary obstruction, the kidneys may also be damaged. In rare cases, a severely enlarged prostate can lead to acute urinary retention. Those affected are unable to pass urine despite having a full bladder and usually experience severe pain. This is a medical emergency that requires immediate treatment.

Prostatitis (inflammation of the prostate)

Inflammation of the prostate can be acute or chronic. It can be very painful and cause significant symptoms. Acute bacterial prostatitis is caused by bacteria, which usually enter the prostate via the urinary tract. Typical symptoms include pain when passing urine, fever and chills. It requires prompt medical treatment. Antibiotics are used to treat the condition.

If the prostatitis persists for more than three months and bacteria are repeatedly detected in the urine, prostate secretions or ejaculate, this is referred to as chronic prostatitis. The symptoms are often less sudden and pronounced than in the acute form, but may recur. Pain may be experienced when passing urine, in the perineal area or during ejaculation.

In the vast majority of cases, however, prostatitis is not caused by bacteria, and the exact triggers for the inflammatory processes are unknown. Medical professionals refer to this as non-bacterial chronic prostatitis.

Prostate cancer

Prostate cancer is the most common form of cancer in men in western industrialised countries. In its early stages, it usually causes no symptoms; it is only when the tumour grows and presses on the urethra that difficulties with urination occur. This may be accompanied by symptoms such as fever, night sweats, fatigue or weight loss. It is important to seek a diagnosis from a specialist, as they can use specific tests to determine whether it is actually a tumour; in many cases, the symptoms are caused by ‘nothing more than’ a benign enlarged prostate. You can read more about prostate cancer here.

What role does the PSA level play in prostate health?

PSA stands for prostate-specific antigen and is a protein produced mainly in the prostate. It liquefies the seminal fluid, thereby ensuring sperm motility. A blood test can be used to determine the PSA concentration.

PSA is primarily used as a tumour marker for prostate tumours. It can help to detect prostate cancer and also plays a role in the course of the disease, as it can be used to assess the progression of the disease, the prognosis and the success of treatment.

The frequently cited threshold of 4 ng/ml, equivalent to 4 µg/l, is not a definitive boundary between health and disease. Prostate cancer may be present even at lower levels. Conversely, conditions such as a benign enlarged prostate or inflammation can raise the level. The assessment therefore takes into account, amongst other factors, the patient’s age, the size of the prostate and previous PSA levels.

However, a PSA test on its own only indicates changes in the prostate and is not considered a definitive sign of prostate cancer. Nevertheless, the test – which is free as part of a screening programme – may be useful in individual cases.

Why is prostate screening so important?

Early detection of prostate cancer aims to identify the disease before symptoms appear. Prostate cancer is the most common form of cancer among men in Austria and is usually asymptomatic in its early stages. Difficulty urinating or pain may only occur once the disease has progressed.

However, if it is detected in good time, the chances of a cure are very good, and less invasive treatment methods can be used. Furthermore, doctors can more clearly pinpoint typical symptoms through screening, and often problems with urination are ‘merely’ caused by prostatitis or a benign enlarged prostate.

How can you keep your prostate healthy?

To keep the prostate healthy in the long term and reduce the risk of inflammation, benign enlargement or cancer, your overall lifestyle plays a crucial role. As is so often the case, it comes down to a healthy diet, sufficient exercise and weight management.

What diet is good for the prostate?

A varied, predominantly plant-based diet supports health and wellbeing. Evidence of potential benefits for the prostate comes from observations in Asian countries, where benign prostate enlargement is reported less frequently. The traditional, high-fibre diet may contribute to this. However, a causal link has not been sufficiently proven. No specific ‘prostate diet’ can be derived from this.

The following tips can help you maintain a balanced diet:

• Fats: Opt for plant-based oils containing unsaturated fatty acids, such as rapeseed, walnut, olive or linseed oil.
• Fibre: Eat wholegrain products and pulses such as beans, lentils or chickpeas regularly.
• Fruit and vegetables: Make sure there is variety on your plate. Different varieties provide different vitamins, minerals and phytochemicals.
• Phytoestrogens: These are hormone-like substances found in plant-based foods that can help counteract prostate growth. They are found primarily in pulses, soya and soya products, cereal products (oat flakes, linseeds, etc.) and certain drinks such as tea
• Phytochemicals: Phytochemicals influence various metabolic processes and help to reduce inflammation. They are found in many types of fruit (pomegranates, melons, etc.) and vegetables such as tomatoes, cauliflower, broccoli, Chinese cabbage, potatoes, pulses, nuts and wholemeal products. In particular, the phytochemical lycopene, which is found in abundance in tomatoes, may offer protection for prostate cells. Other good sources of lycopene include watermelons, peppers, rose hips, apricots and chillies.
• Drinks: Drink around 1.5 to 2 litres spread throughout the day, preferably water or unsweetened tea. Your fluid requirements may increase in hot weather or during physical activity.
• Red meat and processed meats: Eat little red meat and as little processed meat as possible, such as sausages or bacon. Opt for pulses or fish more often as an alternative.

Is drinking plenty of fluids good for the prostate?

Adequate fluid intake of 1.5 to 2 litres of water or unsweetened tea is generally important and can also help to ‘flush out’ the urinary tract. Drinking more than this amount can be counterproductive if you already have problems with urination. If you experience a frequent urge to urinate at night, it may help to spread your fluid intake throughout the day and drink less before going to bed.

What else can you do to support prostate health?

The second pillar of self-care for prostate health is exercise, and numerous recent studies show that sport and regular exercise can have a protective effect on the prostate. Particularly in the case of benign prostatic hyperplasia (BPH), which is often accompanied by lower urinary tract symptoms, many studies suggest that regular physical activity is associated with a lower incidence and reduced progression of BPH.

There is also evidence of a possible protective effect in the case of prostate cancer: some studies link regular physical activity to a lower risk of developing the disease. However, the results are inconsistent. The extent to which exercise actually influences the risk, and whether starting early offers additional benefits, has not yet been sufficiently clarified. In cases of existing prostate cancer, regular exercise can improve physical performance and quality of life. Smaller studies also show that supervised exercise programmes can have a beneficial effect on PSA levels. Whether exercise thereby also slows the progression of the cancer has not yet been sufficiently proven.

Endurance and strength training also support cardiovascular health. Studies show that they can also improve erectile function following prostate cancer treatment. As far as sports are concerned, experts recommend a combination of moderate-intensity endurance exercise, strength training and pelvic floor exercises, ideally totalling 150 minutes per week at a moderate pace.

If you have acute prostatitis, particularly if accompanied by a fever, you should avoid exercise and take it easy physically. Acute bacterial prostatitis requires prompt medical treatment with antibiotics.

Do herbal remedies help with an enlarged prostate?

Herbal remedies are used to relieve symptoms associated with urination. However, the extent to which they are effective varies depending on the specific preparation, and the evidence is not consistently well-established. There is insufficient evidence to show that they reliably shrink the prostate or slow down tissue growth. Before taking any such remedies, the symptoms should be assessed by a doctor.
The evidence regarding saw palmetto is also inconclusive: a large review of studies found little or no benefit overall compared with a placebo.

The European urological guideline, on the other hand, considers a specific saw palmetto extract, obtained using hexane, as a possible option with limited efficacy. The results cannot be generalised to all saw palmetto products. Many preparations are well tolerated. Nevertheless, side effects and interactions may occur. You should discuss with your doctor or at the pharmacy whether combining it with other medicines is advisable.

What role do vitamins and trace elements play in prostate health?

Vitamins and trace elements play a role in prostate health as part of a healthy, balanced diet. However, scientific studies on the specific intake of high doses do not show any significant benefit for the prevention of prostate diseases, and there are general warnings against overdose. Amongst others, vitamin D and vitamin E have been studied. No reliable protection against prostate cancer has been demonstrated for vitamin D supplements. In a large study, high-dose vitamin E actually increased the risk of prostate cancer. Similarly, no recommendation can be made regarding vitamins B1 and B2 for the specific prevention of prostate cancer.

Lycopene is a phytochemical found in tomatoes, amongst other foods. Observational studies suggest that regular consumption of tomato products may be associated with a lower risk of prostate cancer, particularly advanced forms. Zinc and selenium should also not be taken specifically for the prevention of prostate cancer. There is no evidence of a preventive benefit from additional supplements, and excessive intake can be harmful.
A balanced, predominantly plant-based diet is therefore recommended. Dietary supplements may be appropriate in cases of a diagnosed deficiency or other medical indication. Their use and dosage should be agreed with a doctor.

When should you see a doctor about prostate problems?

Prostate problems usually manifest as difficulties with urination or pain. Both are good reasons to see a doctor.
You should definitely do so if you experience the following warning signs:

• if there is blood in your urine or semen
• if you are suffering from sudden urinary retention or severe pain in the lower abdomen
• if you experience pain (particularly a burning sensation) when passing urine, possibly accompanied by a fever
• if you suffer from a weak urine stream, the urge to urinate at night or the feeling that your bladder is not completely empty

In Austria, an annual urological check-up is recommended for men aged 45 and over.