Prostate Health: What's Normal, What's Not, and When to Get Checked

Most men don't spend much time thinking about their prostate until something changes. Maybe they're getting up several times a night to use the bathroom, noticing their urine stream isn't as strong as it used to be, or having difficulty getting started. Often, these changes are dismissed as a normal part of aging.

While prostate changes do become more common as men get older, that doesn't mean every symptom should be ignored. And perhaps more importantly, having prostate symptoms doesn't automatically mean you have prostate cancer.

For Men's Health Month, I want to clear up some of the confusion surrounding prostate health, including what symptoms might mean, when to seek evaluation, and how to think about prostate cancer screening.

Understanding Your Prostate

The prostate is a small gland, roughly the size of a walnut, located just below the bladder. It produces some of the fluid that makes up semen and surrounds part of the urethra, the tube that carries urine out of the body. Because of its location, changes in the prostate can affect urination, which is often how men first notice something isn't quite right.

One of the most common conditions is benign prostatic hyperplasia (BPH), or an enlarged prostate. As men age, the prostate often grows, sometimes putting pressure on the urethra and making it more difficult to empty the bladder. This can lead to a weaker urine stream, frequent urination, or waking multiple times during the night.

BPH is not cancer, nor does it mean that cancer will eventually develop. It's a common, noncancerous condition, particularly among men over 50. And not everyone with an enlarged prostate needs treatment. If symptoms are mild, we may begin with simple adjustments such as limiting fluids before bedtime, reducing caffeine or alcohol, or reviewing medications that could be contributing to urinary problems.

When symptoms become more bothersome, medications or procedures may be appropriate. The goal isn't necessarily to treat the size of the prostate but to improve symptoms, protect bladder function, and preserve quality of life.

Another condition worth understanding is prostatitis, or inflammation of the prostate. Unlike the gradual urinary changes associated with BPH, prostatitis may cause pelvic discomfort, painful urination, or pain with ejaculation. Some cases are caused by bacterial infections, while others involve chronic pelvic pain without an identifiable infection. Treatment depends on the cause, which is why antibiotics aren't appropriate for every case.

These conditions can produce overlapping symptoms, and urinary problems can also originate in the bladder or elsewhere in the urinary tract. That's why it's worth having new or persistent symptoms evaluated rather than assuming they're simply part of getting older.

There are also symptoms that shouldn't wait for a routine appointment. Blood in the urine, fever with urinary or pelvic pain, or significant lower abdominal discomfort deserve prompt evaluation. If you're suddenly unable to urinate, seek emergency care.

What About Prostate Cancer?

Prostate cancer is understandably one of the biggest concerns men have when discussing prostate health. But something I think is important to understand is that prostate cancer often causes no symptoms in its early stages. And many of the urinary symptoms men associate with prostate cancer are more commonly caused by noncancerous conditions such as BPH.

That brings us to prostate-specific antigen, or PSA, testing.

PSA is a protein produced by the prostate that we can measure with a blood test. Higher levels may indicate prostate cancer, but they can also occur with an enlarged prostate, inflammation, or other conditions. In other words, an elevated PSA doesn't automatically mean cancer, and a normal result doesn't completely rule it out.

This is one reason prostate cancer screening isn't quite as straightforward as checking blood pressure or cholesterol.

Some prostate cancers grow slowly and may never cause problems during a man's lifetime. Others are more aggressive and benefit from early detection. Screening can help identify potentially serious cancers, but it can also lead to unnecessary biopsies, anxiety, and treatment of cancers that may never have caused harm. Treatments can have lasting effects on urinary and sexual function.

So how do we decide who should be screened?

The U.S. Preventive Services Task Force recommends that men ages 55–69 make an individual decision about PSA screening after discussing the potential benefits and harms with their physician. It recommends against routine screening in men 70 and older.

Other organizations, including the American Cancer Society, recommend beginning those conversations earlier. For men at average risk, the American Cancer Society recommends discussing screening at age 50. For Black men and men with a father or brother diagnosed with prostate cancer before age 65, that conversation should begin around age 45. Men with multiple close relatives diagnosed at younger ages may benefit from discussing screening as early as age 40.

These recommendations aren't identical, but they share an important principle: screening decisions should consider your individual risk, overall health, life expectancy, and personal preferences.

In my practice, I want patients to understand not only why we might order a PSA test but also what we would do with the result. An abnormal test doesn't automatically mean a biopsy is necessary, and a prostate cancer diagnosis doesn't always mean immediate treatment. In some cases, carefully monitoring a low-risk cancer is an appropriate option.

Taking Care of Your Prostate as You Age

When patients ask what they can do to keep their prostate healthy, I bring the conversation back to many of the same habits we discuss for overall health: regular physical activity, nutritious food, adequate sleep, maintaining a healthy weight, and avoiding tobacco.

These habits support long-term health, although none can guarantee that you'll avoid an enlarged prostate or prostate cancer. I also caution patients about supplements marketed specifically for prostate health. Many make impressive promises without strong evidence that they prevent disease or meaningfully improve symptoms.

What I encourage instead is paying attention to changes in your body and bringing them up during routine visits. If you're waking several times a night to urinate, having difficulty emptying your bladder, or noticing changes in your urinary habits, we should talk about it.

Sometimes the solution is as simple as adjusting fluid intake or reviewing medications. Other times, further evaluation is appropriate.

And even if you're not experiencing symptoms, it's worth discussing your prostate cancer risk as you get older, especially if you have a family history.

A Conversation Worth Having

One of the things I appreciate about practicing Direct Primary Care is having the time to discuss concerns that patients might otherwise dismiss or feel uncomfortable bringing up. Urinary symptoms and sexual health aren't always easy topics to discuss, but they're important parts of men's health.

I don't believe every man needs the same screening tests or treatments. What I do believe is that men deserve to understand their options and participate in decisions about their health.

An enlarged prostate isn't the same as prostate cancer, urinary symptoms shouldn't automatically be dismissed as aging, and PSA screening isn't a one-size-fits-all decision.

Whether you're noticing changes or simply wondering when you should begin prostate cancer screening, start with a conversation with your physician. Understanding your personal risks and options is one of the best ways to take an active role in your health.

At Direct Primary Care of West Michigan, we believe preventive care starts with a relationship. Learn more about our approach to personalized, relationship-based primary care at dpcwestmi.com.