Prostate Disease: Causes, Symptoms, and Treatment

The prostate—medically known as the prostate gland—is a chestnut-sized organ located below the bladder and surrounds the initial portion of the urethra. It consists of glandular, muscular, and connective tissue and weighs approximately 20–25 grams in adults.

Its main function is to produce a milky-white secretion that is a component of seminal fluid and aids in sperm motility. During ejaculation, the gland’s muscles facilitate the rhythmic expulsion of semen.

Since the urethra runs through the center of this organ, even minor changes in the glandular tissue can impair urine flow. As men age, the prostate often enlarges—a normal process that can, however, cause symptoms.

Diseases of this organ are common, especially after age 50. A distinction is made between benign and malignant conditions. The most important ones include:

Benign Prostatic Hyperplasia (BPH)
As men age, glandular tissue proliferates, narrowing the urethra. This can cause urinary symptoms but is generally not life-threatening.

Prostatitis (inflammation of the prostate)
Usually caused by bacterial infections, though sometimes no bacteria are detected. Typical symptoms include pain in the perineal/anal area, a burning sensation during urination, or fever; if left untreated, the condition can become chronic.

The prostate is located directly below the bladder and surrounds the urethra © Henrie | AdobeStock

Prostate cancer (prostate carcinoma)
The most common malignant tumor in men, usually slow-growing and highly treatable if diagnosed early. Since early stages are often asymptomatic, early detection is crucial.

Symptoms depend heavily on the specific cause. Urinary problems are common, as the prostate gland surrounds the beginning of the urethra and thus affects the flow of urine. Older men in particular may notice changes in their urinary habits or a feeling of pressure in the pelvic area over time.

Typical symptoms of benign prostatic hyperplasia (BPH)

Benign hyperplasia often leads to a narrowing of the urethra. This results in typical urinary symptoms such as:

• frequent urge to urinate, especially at night
• a weak or interrupted urine stream
• Difficulty starting urination
• Dribbling after urination or the feeling of incomplete bladder emptying

Symptoms associated with inflammation of the prostate (prostatitis)

Acute or chronic inflammation of the prostate can cause significant pain. Typical symptoms include:

• A burning sensation during urination
• Pain in the perineal or anal area
• Fever or a general feeling of illness
• Pain during ejaculation

Warning signs of malignant changes

Prostate cancer is usually asymptomatic in its early stages. Symptoms typically appear only as the cancer progresses, such as:

• Blood in the urine or semen
• Pain in the back or hip
• Weight loss, night sweats, and general weakness

Even though these signs may be nonspecific, they should be evaluated by a doctor. An early diagnosis significantly improves the chances of recovery.

Prostate conditions result from a combination of physical, hormonal, and genetic factors. Men over the age of 50 are particularly affected, as prostate growth changes with age. The prostate enlarges in almost all men over the course of their lives—this natural process is estimated to affect up to 90 percent of men over the age of 80.

Age-Related Changes

The prostate is located below the bladder and runs through the center of the urethra, so even small changes can affect urination. Prostate enlargement occurs when the glandular tissue is stimulated by hormones.
Specialists refer to this enlargement of the prostate as benign prostatic hyperplasia (BPH). It is usually caused by the long-term effects of male sex hormones, such as testosterone, which stimulate the growth of the glandular tissue. As the prostate grows larger, urine flow can be impaired, leading to typical symptoms of benign prostatic hyperplasia—such as a frequent urge to urinate, a weak urine stream, or nighttime urination.

In some cases, symptoms caused by an enlarged prostate improve significantly following appropriate treatment for the condition. Medications or minor procedures such as transurethral incision of the prostate (TUIP) can reduce pressure on the urethra. In rare cases, the prostate may even shrink slightly or, at the very least, stop growing further.

Lifestyle-Related Risk Factors

In addition to age, lifestyle plays a role in whether the prostate is affected. The most important risk factors include:

• Lack of exercise and being overweight
• heavy alcohol consumption and smoking
• a high-fat diet rich in animal fats
• High blood pressure, diabetes mellitus, and chronic urinary tract infections
• an unhealthy lifestyle characterized by low fluid intake and stress

An unbalanced diet or a constant lack of physical activity promotes prostate growth and increases the risk of bothersome symptoms. Studies show that many men who drink alcohol or smoke regularly are more likely to be affected by an enlarged prostate.
Even younger men may suffer from prostate disease in isolated cases, such as chronic inflammation or a congenital anatomical abnormality.

Genetic and hormonal factors

If a first-degree relative has been diagnosed with prostate cancer, a man’s personal risk of developing prostate cancer doubles. A hormonal imbalance between testosterone and estrogen can further accelerate the growth of the gland.
In addition, a compromised immune system weakens the body’s natural defenses, which makes it easier for bacteria to invade and can contribute to prostate inflammation.

Medical experts believe that the exact causes of prostate enlargement are not yet fully understood—it is likely that hormonal, genetic, and metabolic factors all play a role. Those affected often exhibit similar symptoms, which can be noticeable not only during urination but also during bowel movements.

Examination of the prostate is a central component of urological diagnostics. The goal is to detect changes—such as an enlarged prostate, inflammation, or tumors—at an early stage. Various methods are available for this purpose, which complement one another.

Digital Rectal Examination (DRE)

The digital rectal exam is a simple and well-established first step in diagnosis. During the exam, the doctor carefully feels the prostate with a finger through the rectum. This allows the doctor to assess the gland’s size, consistency, and any possible hardening.
An enlarged prostate usually feels soft and uniform, while lumpy or hard areas may indicate prostate cancer.
The exam takes only a few seconds and is generally painless, yet it is extremely valuable for early detection.

PSA Test for the Early Detection of Prostate Cancer

The PSA (prostate-specific antigen) test measures the concentration of a protein in the blood that is produced exclusively in the prostate. An elevated PSA level may indicate various prostate conditions, such as:

• benign prostatic hyperplasia (BPH)
• inflammation of the prostate (prostatitis)
• early- or advanced-stage prostate cancer

Since PSA levels are influenced by many factors, the result should always be evaluated in conjunction with other findings. Abnormal results usually lead to further testing, such as a prostate ultrasound or a biopsy, to confirm the diagnosis.

Importance for Screening

For men aged 45 and older, the German Society of Urology recommends an annual urological examination, which includes a digital rectal exam and, if necessary, a PSA test. These early detection measures often allow prostate diseases to be identified at an early stage when they are easily treatable.

If a prostate condition is suspected, a digital rectal exam and PSA test alone are often not sufficient to make a definitive diagnosis. Imaging procedures and, if necessary, a biopsy are used as supplementary tests. They help to precisely determine the extent of prostate enlargement or prostate cancer.

Ultrasound Examination (Transrectal Ultrasound, TRUS)

Transrectal ultrasound is one of the most important methods for visualizing the prostate.
During the procedure, a small probe is inserted through the rectum, allowing the doctor to assess the prostate through the urethra and adjacent structures of the bladder.
The image reveals whether the prostate is enlarged, whether there are signs of inflammation, or whether there are nodular areas that may indicate prostate cancer.
The volume of the prostate is also measured to determine whether benign prostatic hyperplasia (BPH) is present.

MRI and Other Imaging Techniques

If the ultrasound findings are abnormal or unclear, a magnetic resonance imaging (MRI) scan may be performed. This procedure provides high-resolution images of the prostate tissue and shows whether the tumor has spread beyond the capsule or affected neighboring organs.
This makes it easier to assess whether the prostate cancer is growing or is confined to the prostate.
MRI also provides valuable information for planning a possible surgery or radiation therapy.

Prostate Biopsy

If an ultrasound, MRI, or PSA level raises suspicion of cancer, a biopsy is performed. During this procedure, the urologist uses a fine hollow needle to remove several tissue samples from the prostate, usually under ultrasound guidance.
The collected tissue is then examined histologically to determine whether malignant cells are present.
A diagnosis of prostate cancer is considered confirmed only when this examination confirms the presence of cancer cells in the prostate tissue.

Significance of the Test Results

The combination of PSA level, ultrasound, and biopsy allows for an accurate assessment of whether the condition is benign prostate enlargement or prostate cancer.
Although many men over the age of 50 show changes in the prostate, only a fraction of these are actually malignant.
If detected early, the risk of developing prostate cancer can be significantly reduced through targeted therapy.

Benign prostatic hyperplasia (BPH) is the most common cause of urinary symptoms in older men. About half of all men over the age of 60 are affected by an enlarged prostate. Treatment depends on the severity of symptoms, the size of the gland, and any underlying medical conditions.

Conservative and Medication-Based Therapy

For mild symptoms, a “wait-and-see” approach combined with regular checkups is often sufficient. In addition, herbal supplements containing pumpkin seed, saw palmetto, or stinging nettle extracts can help alleviate symptoms.
If symptoms worsen, alpha-blockers and 5-alpha-reductase inhibitors are used.
Alpha-blockers relax the muscles of the prostate and urethra, thereby improving urine flow.
5-alpha-reductase inhibitors lower the level of the hormone dihydrotestosterone—as a result, the prostate gradually decreases in volume and shrinks slightly over time, which noticeably improves quality of life.

Surgical Procedures

If medication is not sufficiently effective or urinary retention occurs, urologists recommend surgery.
The standard procedure is transurethral resection of the prostate (TURP). In this procedure, the excess glandular tissue is removed via the urethra using an electric loop, allowing urine to flow freely again.
Alternatively, treatment can be performed using laser surgery. In this procedure, the tissue is vaporized or precisely ablated. Both methods are considered minimally invasive and result in significant symptom relief for most patients.

In cases of severely enlarged glands or specific anatomical conditions, open surgery may also be necessary, during which the urologist removes the prostate. This method is now rarely used, but it remains a safe procedure for severe BPH.

Postoperative Care and Recovery

After surgery, urinary symptoms usually improve within a few days. In the first few weeks, patients may experience a mild burning sensation or a frequent urge to urinate until the bladder adjusts to the new situation.
In the long term, bladder emptying improves significantly, and most patients report a noticeable improvement in their quality of life.
If the condition is detected and treated early, the prostate can be kept at a stable size permanently.

Inflammation of the prostate (prostatitis) can be acute or chronic. It is often caused by a bacterial infection that enters the gland through the urethra. In other cases, no bacterial cause can be identified—in such cases, doctors refer to it as nonbacterial prostatitis or chronic pelvic pain syndrome.

Acute Bacterial Prostatitis

Acute bacterial prostatitis is usually caused by intestinal bacteria such as Escherichia coli. Typical symptoms include fever, pain during urination, a strong sensation of pressure in the perineum, and urinary dysfunction.
Treatment involves antibiotics, which must be taken for at least two to three weeks to completely eliminate the bacteria. In addition, pain relievers and anti-inflammatory medications can help alleviate symptoms.
During the acute phase, physical exertion should be avoided, and patients should ensure adequate fluid intake to flush the bladder and wash out bacteria.

Chronic Prostatitis and Nonbacterial Pain Syndrome

If symptoms persist for more than three months, the condition is considered a chronic form of the disease. In these cases, the primary symptoms are usually urinary difficulties, pain in the pelvic area, and a reduced quality of life.
Since the exact causes of this chronic prostate inflammation are not yet fully understood, treatment is symptom-oriented.
It includes:

• anti-inflammatory medications
• muscle relaxants to facilitate urine flow
• pelvic floor physical therapy
• Heat therapy to improve blood circulation
• if necessary, herbal preparations with anti-inflammatory effects

Psychological stress can also exacerbate the symptoms. Relaxation techniques and targeted exercise help many patients manage their symptoms over the long term.

Course and Prognosis

In most cases, acute bacterial prostatitis heals completely with consistent treatment. However, if treatment is delayed or inadequate, it can progress to a chronic form.
An early urological examination is therefore crucial to prevent complications such as prostate abscesses or permanent urinary dysfunction.

Prostate cancer is the most common cancer in men. It develops from the glandular cells of the prostate and usually grows slowly. The tumor is often detected during a screening exam before symptoms appear. Treatment depends on the stage of the disease, the patient’s age, and his overall health.

Treatment in the Early Stages

If the prostate cancer is confined to the prostate and has not metastasized, the chances of a cure are very good. In these cases, the urologist or oncologist can choose between different treatment options:

• Active Surveillance: For a slow-growing tumor, the doctor regularly monitors the PSA level and performs periodic biopsies. This strategy is particularly suitable for older patients without symptoms.
• Surgery (radical prostatectomy): In this procedure, the prostate is completely removed, often using minimally invasive or robot-assisted techniques (e.g., the Da Vinci system). In many cases, this can cure the cancer. After the procedure, the prostate naturally shrinks, and urine flow is restored through the urethra.
• Radiation therapy: Alternatively, radiation therapy can be used to specifically destroy cancer cells. The results are comparable to those of surgery, especially in the early stages.

Treatment for Advanced or Metastatic Prostate Cancer

If prostate cancer grows and spreads beyond the prostate to neighboring organs or lymph nodes, further measures are necessary.
The following treatments are then commonly used:

• Hormone therapy: The goal is to inhibit the production of male sex hormones, as these promote tumor growth.
• Chemotherapy: Used when the cancer no longer responds to hormone therapy.
• Radiation therapy or combination treatments: to control tumor growth and alleviate symptoms.

While these procedures cannot cure the disease, they can significantly slow its progression and improve quality of life. Specialized centers are also increasingly using precision radiation therapy, which spares healthy tissue.

Follow-up Care and Prognosis

After successful surgery or radiation therapy, regular follow-up exams are important. The PSA level serves as a marker to detect a possible recurrence at an early stage.
Thanks to modern therapies, over 90% of men with prostate cancer are still alive five years after diagnosis. Early detection remains crucial—because in the early stages, the disease is almost always curable.

The course of prostate diseases depends heavily on the type of disease and the timing of the diagnosis. Benign conditions, such as benign prostatic hyperplasia (BPH), usually progress slowly and are very treatable. Malignant tumors, such as prostate cancer, on the other hand, can grow at varying rates and require close monitoring by a urologist.

Benign Prostatic Hyperplasia (BPH)

With an enlarged prostate, symptoms often increase gradually over the course of several years. Without treatment, complications may arise, such as:

• incomplete bladder emptying
• formation of bladder stones or residual urine
• recurrent urinary tract infections
• Urinary retention, i.e., a complete blockage of urine flow

If the condition is detected and treated early, quality of life can usually be fully restored. After successful treatment, bladder and kidney function are preserved.

Prostate Inflammation (Prostatitis)

Acute prostatitis usually resolves within a few weeks with targeted antibiotic therapy. Chronic forms, on the other hand, have a fluctuating course and require patience as well as long-term treatment.
The earlier the inflammation is detected, the lower the risk of permanent damage to the prostate tissue.

Prostate Cancer

The course of prostate cancer varies greatly from person to person. In most cases, the tumor grows slowly, so the chances of a cure are excellent in the early stages.
If the cancer has already spread beyond the prostate, it can metastasize to lymph nodes or bones.
Even at this stage, treatment can slow the progression of the disease and effectively alleviate symptoms. Modern forms of therapy now enable a significantly extended life expectancy while maintaining a good quality of life.

Overall, the prognosis for prostate diseases is favorable, provided they are detected early and treated consistently.
While benign changes rarely cause complications, even prostate cancer in its early stages can be completely cured in most cases.
Regular screening exams are crucial, as they enable timely diagnosis and targeted treatment.

Regular urological examinations are crucial for detecting changes in the prostate gland in a timely manner. Professional societies recommend that men undergo an annual prostate examination starting at age 45, or earlier if there is a family history of the disease. The examination typically includes a digital rectal exam, a PSA test, and, if necessary, an ultrasound.

The Goal of Screening

The goal of these measures is to detect benign and malignant changes early, even before symptoms develop. The earlier a tumor or enlargement is detected, the greater the chances of a complete cure and a lasting improvement in quality of life. Many men over the age of 50 benefit from this early diagnosis, as it can prevent complications such as urinary retention or inflammation.

Lifestyle and Prevention

In addition to early medical detection, prevention through a healthy lifestyle plays a key role. The following factors reduce the risk of prostate disease or enlargement:

• a balanced diet low in animal fats
• plenty of vegetables, a high-fiber diet, and adequate fluid intake
• regular exercise to avoid becoming overweight
• Avoiding smoking and excessive alcohol consumption
• Stress reduction and adequate sleep

These measures support blood flow to the glandular tissue and help counteract inflammation. They also help alleviate symptoms and promote overall health.

The Importance of Regular Checkups

Even after successful treatment, regular checkups with a urologist are recommended. This allows for the early detection of potential relapses or new changes. Modern screening programs combine clinical examinations, laboratory test results, and imaging techniques to reliably assess the risk of cancer.

A healthy lifestyle can play a significant role in preventing prostate-related symptoms and reducing the risk of both benign and malignant changes. Numerous studies show that men over 50 who eat a balanced diet and exercise regularly are less likely to suffer from an enlarged prostate or tumor growth.

Diet and Hydration

A balanced diet rich in fruits, vegetables, and plant-based oils supports the gland’s metabolic processes. Foods high in animal fats or highly processed carbohydrates, on the other hand, should be consumed only in moderation.
Drinking enough fluids—preferably water or unsweetened tea—keeps the urinary tract clear and reduces the risk of inflammation.
A healthy lifestyle over the long term can help stabilize the prostate, preventing the organ from continuing to grow or becoming excessively enlarged.

Exercise and Weight Management

Regular physical activity has a positive effect on hormone balance and blood flow to the pelvic organs. Even moderate exercise such as cycling, swimming, or brisk walking boosts metabolism and prevents obesity—one of the most significant risk factors for hormonal changes and prostate problems.
Maintaining a healthy body weight can help the prostate shrink or stop growing over the long term.

Stress Relief and Overall Health

Chronic stress leads to hormonal fluctuations that can promote inflammatory processes. Regular relaxation exercises, adequate sleep, and social activity contribute to a stable balance of the autonomic nervous system.
Anyone who notices symptoms, such as a frequent urge to urinate or difficulty urinating, should seek medical advice early on. This allows for the timely detection of conditions and targeted treatment of urinary symptoms.

Conclusion on Preventive Measures

Overall, a healthy lifestyle can improve quality of life and reduce the need for invasive procedures. A combination of a balanced diet, exercise, stress reduction, and regular medical checkups is the most effective form of prevention against prostate diseases.

At what age should men begin having their prostate examined?

Professional associations recommend that men aged 45 and older undergo an annual urological screening. If there is a family history of prostate cancer—for example, if a first-degree relative has been diagnosed with prostate cancer—it may be advisable to have a prostate exam sooner. This usually involves a digital rectal exam of the prostate gland and, if necessary, a PSA test.

What are the typical symptoms of benign prostate enlargement?

Typical symptoms of benign prostatic hyperplasia (BPH) include a frequent urge to urinate, a weak urine stream, and the feeling that the bladder has not been completely emptied. These symptoms occur because the prostate is located below the bladder and surrounds the urethra. As it enlarges, it obstructs the flow of urine.

How is an enlarged prostate treated?

Treatment for an enlarged prostate depends on the severity of the symptoms. Herbal supplements or medications that relax the prostate muscles or slow its growth often help. If these measures are not sufficient, a transurethral incision of the prostate (TUIP) or minimally invasive laser surgery can improve urine flow. In severe cases, excess tissue is surgically removed.

Can the prostate shrink again?

Yes—through targeted therapy or hormone regulation, the glandular tissue can partially regress, causing the prostate to shrink or stop growing. A healthy lifestyle with a balanced diet, regular exercise, and avoiding alcohol and smoking can also help keep the prostate’s size stable.

What role does the PSA test play in early detection?

The PSA test measures a protein that is produced only in the prostate. An elevated level may indicate inflammation, enlargement, or even prostate cancer. It is not a substitute for a medical examination, but it provides valuable information and enables early diagnosis, especially in men over 50.

Can prostate disease be prevented?

A healthy lifestyle helps prevent these conditions: a diet low in animal fats and high in vegetables, along with sufficient exercise and regular screenings, reduces the risk. This can prevent the prostate from enlarging or causing distressing symptoms when urinating.