Prostate health worries: tests, waiting and talking about it

Benign prostatic hyperplasia (BPH) means the prostate has grown larger, and it is not cancer. It is the most common prostate problem in men over 50, and it rarely causes symptoms before 40.

What men may notice

• A weak stream, or one that stops and starts
• Dribbling at the end
• Getting up at night to pee
• Needing to go often or suddenly
• Trouble starting or fully emptying the bladder

Symptoms don’t always match the size of the prostate. Other conditions can cause the same signs, so any change in peeing is worth getting checked.

Prostatitis is inflammation of the prostate. It is the top urinary tract problem for men under 50. The most common type, chronic prostatitis / chronic pelvic pain syndrome, can happen at any age and is still not well understood.

Stress may play a part in this long-lasting pelvic pain, and for some men, lowering stress may help reduce flare-ups. That makes looking after your mind part of looking after your body here.

About 1 in 8 U.S. men will be diagnosed with prostate cancer, most of them over 65. Most prostate cancers grow slowly and don’t cause health problems.

Early prostate cancer often causes no symptoms at all. That is why some men choose testing, and why urinary changes alone usually point to something else.

• Age: the chance rises as men get older
• Being Black or African American: more likely to get it, at a younger age, and to die from it
• Family history: a father, son or brother with prostate cancer, or family members with breast, ovarian or pancreatic cancer
• Inherited gene changes, such as in BRCA1 or BRCA2

Clinicians who look after prostates talk about these things every day. To them, a weak stream or a question about sex is ordinary information, not something shameful.

Many prostate changes are caused by an enlarged prostate or inflammation, not cancer. Even a raised PSA test often has another cause.

Some men fear that tests or treatment will change their sex life. These are fair questions to ask a clinician directly, before any decision is made. Feeling worried about this doesn’t make you vain or weak.

Avoiding the doctor gives short-term relief, but the worry usually stays in the background. Getting checked often brings more peace than waiting. See the guide “Why men avoid the doctor, and how to go anyway” for ways past this.

• An enlarged prostate (BPH)
• Getting older, since PSA rises with age
• Infection or inflammation of the prostate
• Recent ejaculation or vigorous exercise like cycling (usually short-lived)
• A recent prostate procedure or biopsy

Some clinicians suggest avoiding ejaculation and vigorous exercise for about 2 days before the test. Ask what your clinic recommends.

There is no single cut-off that separates a normal from an abnormal result. A level above 4.0 is often treated as raised, but some doctors use different levels for younger and older men.

About 6–7% of men tested get a false-positive result in a round of screening. Of men who go on to a biopsy because of a raised PSA, only about 1 in 4 are found to have cancer.

Some prostate cancers grow so slowly they would never cause symptoms or shorten life. Finding and treating them can bring side effects with urine, bowels or sex. This is called overdiagnosis, and it is one reason the PSA decision is a personal one.

• Bring a list of your 2 or 3 most important questions and ask them first
• Note any changes in peeing, pain or sex, and when they started
• Bring your family health history
• Bring someone with you if you’d like support or a second set of ears

A digital rectal exam means the clinician feels the prostate with a gloved finger. It is not used for routine screening, but it may be used when there are symptoms or a raised PSA. It usually takes less than a minute.

It’s okay to

• Ask what will happen before it starts
• Ask them to tell you as they go
• Say if you need a moment, or want to stop
• Ask for a chaperone if that would help you feel safer

Nerves can make it hard to take in information. Asking a clinician to repeat something is normal, and it helps you get things right.

Waiting leaves the mind to fill the gaps, and it often fills them with the worst case. Worry, poor sleep and a short temper during this time are normal reactions, not a sign you’re handling it badly.

• Ask when and how you’ll get results, so you’re not checking constantly
• Give worry a set time each day, then do something else
• Keep up routines: work, exercise, meals, sleep
• Limit late-night searching about symptoms
• Tell one person you trust what’s going on

If you haven’t got your results when expected, contact the clinic. Following up is part of taking charge of your care, not being a nuisance.

Words you could use

• “I’ve got a test coming up and I’m more worried than I’ve let on.”
• “I don’t need you to fix it. I just don’t want to keep it from you.”
• “Would you come to the appointment with me?”

Prostate problems are common, so other men in your life may have had tests or symptoms too. A simple “Have you ever had your prostate checked?” can open a useful conversation.

Having a father or brother with prostate cancer raises a man’s own risk. If you are diagnosed, letting male relatives know helps them have better-informed talks with their own clinicians.

• Instead of “I’m being soft”, try “I’m looking after myself”
• Instead of “It’s definitely cancer”, try “I don’t know yet, and I’m finding out”
• Instead of “Nobody needs to know”, try “One person can help me carry this”

Because many prostate cancers grow slowly, some men and their care teams choose to watch them closely before deciding on treatment. Ask your care team how much time you have to make decisions.

• How fast is this likely to grow?
• What are all my options, including watching closely?
• How might each option affect peeing, bowels and sex?
• Who can I talk to about how I’m feeling?
• Is there a support group nearby or online?

There’s no right way to react. Talking with a counsellor, a support group or other men who’ve been through it can help. The Cancer & mental health guide has more on coping with a diagnosis.

Call 1-800-4-CANCER (1-800-422-6237), Monday to Friday, 9 a.m. to 9 p.m. Eastern, or chat online at cancer.gov/contact. You can ask about PSA tests, results and finding support.

Community health centers offer care where what you pay depends on your income. Find one at findahealthcenter.hrsa.gov.

Call or text 988, or chat at 988lifeline.org, any time, in the U.S. It’s free and confidential.

Your local doctor or national health service is the best first step for prostate concerns. For emotional support, Find A Helpline (findahelpline.com) lists free helplines in many countries.