Trouble Down Below: Signs of Prostate Problems

A healthy prostate is about the size of a walnut and weighs about 1 ounce (30 grams). But don’t be fooled by its small stature: This gland in the male reproductive system can become a large health concern.

Unfortunately, prostate health often isn’t a preferred conversation topic for many men and people assigned male at birth (AMAB). (It’s a sensitive matter about a sensitive area, after all.)

“It’s not something they generally want to talk about or bring up,” says urologist Brad Gill, MD. But it NEEDS to be brought up, he emphasizes — and here’s why.

Potential prostate problems

Some prostate conditions can affect your quality of life and lead to some embarrassing situations. Other possibilities — and we’re talking cancer here — may become life-threatening concerns.

Let’s look at the two most common issues.

Enlarged prostate

An enlarged prostate, or benign prostatic hyperplasia (BPH), is the most common prostate problem in men and people AMAB. It’s a natural part of our aging process. About half of all people with a prostate will have signs of BPH by age 60.

“Certain body parts continue to grow as you age,” explains Dr. Gill. “Your ears and nose are examples that you can see as they get bigger over time. Well, the same thing is happening inside you with your prostate.”

How much can your prostate grow? More than you might think, as that walnut-sized gland can grow to the size of a lemon by age 60. Sometimes, it can even get to the size of a grapefruit!

Given its location, an enlarged prostate can become an issue — especially when you pee. (But size is only one factor, as some prostates can be shaped in ways that make them more likely to block or slow urine flow even if they only get a little bit bigger.)

That’s because your prostate is located just below your bladder, your body’s holding tank for urine. There’s a passage, or channel, within the prostate that allows urine to drain out of your bladder and eventually through the tube (urethra) out of your penis.

As your prostate grows, the channel within it becomes blocked by tissue and reduces urine flow.

Untreated BPH can wear out your bladder, leading to the inability to pee (urinary retention), or increase the risk of urinary tract infections (UTI), bladder stones and kidney damage.

Prostate cancer

About 1 in 8 people with a prostate develop prostate cancer at some point during their life. In some cases, the disease can be deadly. Approximately 400,000 people around the world died of prostate cancer in 2022.

Now the good news: Prostate cancer usually grows very slowly, allowing most people with the disease to get diagnosed and treated before it spreads.

But finding prostate cancer means taking steps to look for it. “The important thing is not to ignore the risk,” emphasizes Dr. Gill. “You want to be proactive and get a prostate cancer screening.”

The risk of prostate cancer increases with age. The American Cancer Society recommends talking to a healthcare provider about a prostate cancer screening at:

• Age 40 if you’re at a very high risk for the disease (meaning you have more than one first-degree relative — a father or brother — who had prostate cancer before turning 65.)
• Age 45 if you’re at high risk for prostate cancer. (This group includes African American men, as well as those with one first-degree relative diagnosed with prostate cancer before turning 65.)
• Age 50 for men who are at average risk of prostate cancer.

Testing is typically done one of two ways. The prostate-specific antigen (PSA) test is the “hallmark” of prostate cancer testing, says Dr. Gill. It measures the amount of the PSA protein in your body. Higher levels may be a sign of prostate cancer.

A digital rectal exam (DRE) may also be used as a screening test. During an in-office DRE, your healthcare provider inserts a gloved, lubricated finger into your rectum to feel your prostate for abnormalities that could indicate prostate cancer.

Dr. Gill encourages people to talk about the importance of prostate cancer screenings with family and friends. Research shows that many men hesitate to take the preventive healthcare step or even discuss the topic.

“Starting the conversation or encouraging someone you care about to get screened is a great way to help normalize things and promote men’s health,” he says.

Warning signs of prostate problems

The prostate conditions mentioned share many of the same symptoms. If you experience the following, it’s best to make an appointment with a healthcare provider to find the reason.

Difficulty urinating

Peeing isn’t something you probably spend much time thinking about. When you need to, you go, right? It just flows out in a steady stream.

But over time, you may notice that your “stream” becomes more of a trickle. That reduction in flow is often a sign of an enlarged prostate that’s blocking the flow of urine. (Think of it like pinching a hose.)

“It’s usually a slow change that happens over years,” explains Dr. Gill. “Eventually, you wake up one day and realize, ‘Wow, I’m really not peeing very well.’”

Other signs of potential prostate problems include:

• Dribbling or leakage of urine
• A frequent urge to pee (as you don’t fully empty out)
• Needing to get up at night to go to the bathroom
• A stream that starts and stops or is tough to get going

An abrupt change in urination from one day to the next (such as suddenly being unable to pee) may be a sign of a more serious medical issue. A backup caused by urinary retention can lead to pain and discomfort while putting stress on your kidneys.

Blood in urine

As you might imagine, bloody urine is never typical. “It’s always something that warrants getting checked out,” stresses Dr. Gill. “One thing that can cause blood in the urine is cancer — and that is something you don’t want to ignore.”

Conditions that could lead to blood in urine and/or semen include:

• Bladder cancer
• Kidney cancer
• Prostate cancer

“That’s why we suggest seeing your healthcare provider and getting checked to see what’s going on,” he adds.