Every man has a prostate gland, but few men think about it, until it gives them trouble. First, the embarrassing problems: a weak flow of urine, getting up many times during the night, difficulty in beginning to urinate. Things that become scary later: the high PSA level, the abnormal digital rectal exam, the recommendation for biopsy. And sometimes problems that are detected before there are any symptoms at all – a silent tumour found on a routine screen that, if caught early, is completely curable.
Prostate disease is not a single disease. There is a spectrum – from the entirely benign, age-related enlargement of BPH that affects the majority of men over 50, through prostatitis that causes chronic pelvic pain and misery, to prostate cancer that, when caught early, has cure rates of over 95 per cent, but when caught late, becomes the second leading cause of cancer death in men. It’s all about the right specialist, at the right time, with the right evaluation that determines outcomes across this entire spectrum.
Location & Size of the Prostate Gland in the Male Body
The prostate gland is located in the pelvis , below the urinary bladder and in front of the rectum . The prostate surrounds the urethra (the tube through which urine flows from the bladder and out of the body) completely at the point where the urethra leaves the bladder. This anatomical relationship explains why all but the rarest prostate conditions – benign enlargement, cancer or infection – produce urinary symptoms: the prostate’s enlargement or inflammation narrows the very passage through which urine must flow.
In a healthy young man , the prostate is approximately the size and shape of a walnut , weighing about 20 grammes . It has two symmetrical lobes, a fibrous outer capsule and a complex internal structure of glandular tissue, smooth muscle and fibrous stroma. The prostate is situated deep in the pelvis and is surrounded by important structures such as the rectum, bladder, neurovascular bundles responsible for erectile function and the external urinary sphincter. This explains why prostate diseases and their surgical treatment have an impact on sexual function and urinary continence.
Role of Prostate in Semen Production & Sexual Function
The main biological function of the prostate is reproductive. The cells of the prostate gland also secrete a milky, slightly alkaline secretion called prostatic fluid . This constitutes about 25 to 30 percent of the total semen volume . Prostatic fluid contains enzymes (including PSA – prostate-specific antigen), zinc, citric acid and other compounds that nourish and protect sperm, help to liquefy semen after ejaculation (allowing sperm to swim freely) and neutralise the acidic vaginal environment to improve sperm survival during fertilisation.
During ejaculation, the smooth muscle of the prostate (and of the seminal vesicles) contracts, forcing semen into the urethra. The internal architecture of the prostate and the concerted contraction of its musculature are important for normal ejaculatory function. This explains why certain prostate procedures, especially TURP and laser enucleation, may result in retrograde ejaculation (semen entering the bladder during orgasm) as an anticipated side effect, whereas newer procedures like UroLift and iTind are intentionally designed to maintain ejaculatory function.
How the Prostate Gland Changes With Age
The prostate grows throughout a man’s life, mainly because of the male hormone dihydrotestosterone (DHT), a powerful metabolite of testosterone made by the prostate’s own cells. This growth is normal and universal but in many men becomes clinically significant as they age, as the enlarged gland presses more and more on the surrounding urethra. The following table summarises the changes in the prostate over the decades:
Age | Prostate Size | Common Changes | What to Watch |
20s–30s | Walnut-sized (~20g) | Normal , no growth; full sexual function | No screening needed; report symptoms if any |
40s | May begin to grow | Early BPH possible; hormonal shifts begin | Annual PSA if family history; report urinary changes |
50s | ~30–40g typical | BPH increasingly common; PSA screening recommended | Annual PSA for all men from age 50 |
60s–70s | 40–80g or larger | Significant BPH in majority; cancer risk rises | Regular PSA, DRE; prompt investigation of changes |
80+ | Variable | Most have BPH; many have low-grade cancer | Manage symptoms; quality of life focus |
Why Prostate Health Is Important for Every Man Above 40
Prostate disease is not just an old man’s disease anymore. For men, BPH symptoms may start in their 40s. “Prostate cancer, the most common cancer in men over 65, also occurs in younger men, especially men with a family history. Early-stage prostate cancer in a man in his 40s or 50s is 100% curable, while metastatic prostate cancer is not,” he said. The window for curative intervention in prostate cancer is the asymptomatic, PSA-detectable stage , only available through screening. Waiting for symptoms to appear before evaluating the prostate could mean waiting until the disease is no longer curable. This is the biggest reason for regular PSA screening in every man from the age of 50, or from 40 to 45 in high-risk groups.
Benign Prostatic Hyperplasia (BPH) – Enlarged Prostate
BPH is the benign age-related enlargement of the prostate gland that affects most men over the age of 50. It causes progressive urinary obstruction – weak stream, frequent night-time urination, incomplete bladder emptying – but is nothing like cancer. Treatment options include drugs, advanced no-cut procedures (UroLift, iTind) and laser surgery.
After skin cancer, prostate cancer is the second most common cancer in men. In its early stages it causes no symptoms, and this is why PSA screening is important. When caught early and confined to the prostate, the cure rate is more than 95 percent with surgery or radiation. Dr. Vikas Singh offers complete treatment options and MRI-fusion biopsy for a precise diagnosis.
Prostatitis is inflammation of the prostate gland. It may be caused by a bacterial infection (acute or chronic bacterial prostatitis) or can occur without an obvious infection (chronic pelvic pain syndrome). It causes pelvic pain, dysuria, painful ejaculation and urinary symptoms. It occurs in men of all ages and is generally very responsive to specific treatment if properly diagnosed.
Signs that may indicate prostate disease are: Many men take these signs as ‘just getting older’ – but every one of them deserves a chat with a specialist, as early assessment means easier treatment and better results.
Weak or Slow Urine Stream
Anyone experiencing any of the above warning signs should seek medical care. The following situations require prompt or urgent specialist prostate assessment:
Unable to Pass Urine or Complete Urinary Retention
Acute urinary retention, the sudden, complete inability to pass any urine, is a medical emergency. The bladder gets painfully full and has to be drained by catheterisation without delay. The most common causes of acute retention are severe BPH or a UTI, causing prostate swelling in men. Any man who is unable to pass urine should be assessed urgently by a urologist. Don’t wait to see if it settles by itself.
Blood in Urine or Semen Without Any Obvious Cause
Any episode of blood seen in the urine (haematuria) or pink/brown discolouration of the semen (haematospermia) must be investigated by a urologist. Haematospermia is most often due to prostatitis or vascular changes associated with BPH, and is rarely a sign of malignancy. Painless visible haematuria in a man merits urgent investigation to exclude bladder and kidney cancer as well as prostate disease. Even if it is not repeated, one episode is enough to justify assessment.
PSA Level Found High on Routine Blood Test
An increased PSA result, even where the referring doctor says “it may just be benign”, needs specialist urological review . Elevated PSA can be caused by BPH, prostatitis or prostate cancer and differentiation of these entities requires examination, repeat testing and often mpMRI and biopsy. The most important thing is that if prostate cancer is diagnosed early, before symptoms develop, the PSA is high and it can almost always be cured. An elevated PSA without appropriate evaluation is a lost opportunity for early and potentially life-saving intervention.
Recurrent Urinary Tract Infections in Men
UTIs are rare in men under 50 years of age and always require investigation for a structural cause. Recurrent UTI in men may be a manifestation of an underlying prostate problem, BPH resulting in chronic residual urine acting as a reservoir for bacteria, prostatitis resulting in a focus of chronic infection or less commonly prostate cancer. A man with 2 or more UTIs should have a full urologic workup including urinalysis, urine culture, kidney/bladder ultrasound, and prostate evaluation.
Painful Ejaculation or Pelvic Pain Lasting More Than 3 Months
Chronic pelvic pain syndrome (CPPS), also referred to as Category III prostatitis, is characterised by pelvic pain, perineal pain, or painful ejaculation lasting longer than three months. It is one of the most debilitating and under-recognised urological conditions profoundly impacting quality of life and sexual wellbeing. A specialist’s evaluation is necessary to rule out a bacterial prostatitis, to eliminate other causes in the pelvis, and to initiate a targeted multimodal therapy addressing the neurological, muscular, and inflammatory aspects of the condition.
Every Man Above 50 Should Get Prostate Screening Done
The recommendation is that all men should get screened for PSA from the age of 50. Not because prostate cancer is unavoidable but because prostate cancer in its early stages is curable and in its late stages is not. The first PSA at age 50 is done as a baseline and costs very little and takes 5 minutes to do. This provides a personal reference value to compare with future PSA measurements. Men with a baseline PSA <1ng/ml at age 50 have a very low short-term risk of cancer. Men with a higher baseline PSA or a rapidly rising PSA over time need to be monitored more frequently. The PSA screen doesn’t just detect cancer it characterises the risk for each man and guides how closely he needs to be followed.
High-Risk Men Above 40 With Family History of Prostate Cancer
Men with a first-degree relative (father or brother) with prostate cancer have about twice the population risk of being diagnosed with the disease. Men with two or more first-degree relatives with prostate cancer are at three to five times the risk of the general population. For this high-risk group, PSA screening should start at age 40 instead of 50, since inherited prostate cancer tends to occur at younger ages and can be more aggressive. Men of some ethnicities (especially those with African ancestry) and male carriers of the BRCA1 or BRCA2 gene mutations are also at increased risk and should begin screening at age 40 to 45.
The appropriate treatment of prostate is based on the correct diagnosis. Dr Vikas Singh employs a systematic, evidence-based approach assessing each patient, combining clinical examination with the most appropriate investigations for the presentation.
PSA Blood Test | Prostate-specific antigen level in blood | Prostate cancer screening; BPH monitoring; prostatitis |
Digital Rectal Exam (DRE) | Prostate size, texture & nodularity on palpation | Cancer (hard/irregular nodules); BPH (smooth enlargement) |
Uroflowmetry | Maximum urine flow rate (Qmax) & voiding pattern | BPH severity: bladder outlet obstruction quantification |
Post-Void Residual (PVR) | Volume of urine remaining in the bladder after voiding | BPH; bladder dysfunction assessment |
TRUS of Prostate | Prostate volume, echogenicity & guide for biopsy | Prostate volume measurement; biopsy targeting |
mpMRI Prostate | Detailed tissue characterisation; PI-RADS scoring | Prostate cancer detection, local staging, and biopsy planning |
MRI-Fusion Biopsy | Histological tissue samples from MRI-targeted areas | Definitive cancer diagnosis; Gleason grading |
Urine Culture | Bacterial growth from a urine sample | Prostatitis; recurrent UTI in men |
Urodynamic Studies | Bladder pressure, detrusor function & outlet resistance | Complex voiding dysfunction; neurogenic bladder |
PSA Blood Test (Prostate Specific Antigen)
Prostate-specific antigen, or PSA, is a protein produced only by prostate gland cells. PSA above the normal range for your age is an indication for further investigation , but does not confirm cancer ( BPH , prostatitis and vigorous cycling can all increase PSA levels ). The absolute level of PSA, the rate of change over time (PSA velocity and doubling time), the free/total PSA ratio, and the patient’s age and prostate size all impact the action taken on a PSA result. Dr Vikas Singh takes a holistic look at PSA results and not just as a number, thus preventing both over-investigation for benign elevations and under-investigation for significant disease.
Digital Rectal Examination (DRE)
DRE This is a quick , gentle exam where the doctor feels the prostate through the rectum . It takes under a minute and provides information not available from any blood test . It gives information on the prostate ‘s size , symmetry , consistency and the presence of any hard , irregular nodules suggestive of cancer . A normal prostate has a smooth, symmetrical texture. Biopsy is indicated for hard or nodular prostate irrespective of PSA level. DRE and PSA are used together. They find more cancers than either alone.
Uroflowmetry & Post-Void Residual Urine Test
Uroflowmetry is an objective measurement of the maximum urine flow rate (Qmax) and voiding pattern, quantifying the degree of bladder outlet obstruction due to BPH. A normal Qmax is above 15 ml/s; less than 10 ml/s suggests significant obstruction. Post-void residual ( PVR ) measurement , a simple bladder ultrasound after voiding , measures the amount of urine remaining in the bladder , which indicates how well the bladder is emptying against the resistance of the prostate . Taken together, these non-invasive tests provide objective functional data that help guide treatment decisions for BPH.
Transrectal Ultrasound (TRUS) of Prostate
TRUS uses a small ultrasound probe inserted into the rectum to get a close-up view of the prostate, allowing accurate measurement of prostate volume (important in choosing BPH treatment), detection of echogenic abnormalities and, most importantly, directing the placement of prostate biopsy needles. TRUS-guided prostate biopsy systematically samples twelve or more cores from the prostate to detect cancer in a man with elevated PSA and/or abnormal DRE . In modern practice TRUS is increasingly used in combination with MRI fusion for targeted biopsy (see below).
Multiparametric MRI (mpMRI) of Prostate
Multiparametric MRI represents the gold standard imaging investigation for prostate cancer detection and local staging. It gives a high resolution visualisation of the prostate, characterising suspicious areas using the PI-RADS scoring system (1 to 5). Increased PSA in men is a common indication for biopsy, and mpMRI can identify suspicious lesions for targeted biopsy, avoid unnecessary biopsy in many men with PI-RADS 1-2 scores, and provide staging information (e.g. if cancer has breached the prostate capsule or invaded the seminal vesicles) to inform treatment decisions. “It’s routine to get an mpMRI before a biopsy,” says Dr. Vikas Singh.
MRI-Fusion Guided Prostate Biopsy
The most accurate way of detecting clinically significant prostate cancer is MRI-fusion targeted biopsy. During biopsy, MRI images are digitally fused with the real-time TRUS images, allowing the biopsy needle to be accurately guided to the specific suspicious areas found on the MRI. This targeted approach finds many more clinically important cancers and fewer unimportant low-grade cancers than standard systematic biopsy alone. It decreases the number of biopsy cores and allows a better characterisation of the location and extent of the cancer. Dr. Vikas Singh has one of the most advanced prostate diagnostic capabilities available in Central India, MRI-fusion targeted biopsy.
Urine Culture & Urodynamic Studies
Urine culture can be useful in identifying the causative organism and directing antibiotic choice in men with prostatitis or recurrent UTIs. A four-glass (or two-glass) test collects timed sequential samples of urine and prostatic fluid before and after prostate massage. It can localise bacterial infection specifically to the prostate and distinguish bacterial prostatitis from other urinary infections. Urodynamic studies measure bladder pressure, detrusor function and urethral resistance during filling and voiding. They are reserved for men with complex voiding dysfunction in whom the relative contributions of bladder overactivity, underactivity and outflow obstruction need to be objectively characterised before treatment.
Not all prostate conditions can be prevented, but there is strong evidence that certain lifestyle choices can affect prostate health, reducing the risk of developing prostate disease and slowing the progression of existing conditions. Here’s what the evidence proves:
Diet & Foods That Support Prostate Health
Epidemiological studies have associated lower risk of prostate cancer with consumption of vegetables, especially cruciferous vegetables (broccoli, cauliflower, Brussels sprouts, cabbage). Cruciferous vegetables contain sulforaphane and other bio-active compounds which act anti-proliferatively on prostate cells. Tomatoes and tomato products are also high in lycopene, a carotenoid antioxidant with specific evidence for reducing the risk of prostate cancer, particularly when eaten cooked (which increases the bioavailability of lycopene). Green tea has catechins that may inhibit growth of prostate cancer cells in laboratory models. By contrast, some studies have linked a diet high in processed red meat, animal fat and dairy products to a small increased risk of prostate cancer. The diet with the strongest evidence for overall prostate and cardiovascular health is a generally healthy Mediterranean-style diet , rich in vegetables, fruits, whole grains, fish and olive oil .
Role of Exercise & Weight Management in Prostate Health
The protective effect of physical activity on prostate health is well known. Exercise lowers circulating insulin, insulin-like growth factor (IGF-1) and inflammatory cytokines that promote proliferation of prostate cells. Regular exercise reduces the likelihood of men developing BPH and lowers the severity scores of LUTS (lower urinary tract symptom) and the incidence of prostate cancer compared to men who are sedentary. The effect is greatest for vigorous exercise, brisk walking, running, cycling and swimming for at least 150 minutes a week at moderate intensity. Obesity is independently associated with more severe BPH symptoms, higher PSA levels and increased prostate cancer aggressiveness. Weight loss in overweight men with BPH has been shown to significantly improve urinary symptom scores.
Alcohol, Caffeine & Their Impact on Prostate Symptoms
Both alcohol and caffeine have direct effects on urinary function that are particularly relevant to men with BPH or prostatitis. Coffee, tea, cola and energy drinks have caffeine, which is a diuretic (increases urine output) and a bladder irritant (causes urgency and frequency). Among the most practical and immediately effective symptom management strategies in men with established BPH or overactive bladder symptoms is limiting caffeine intake, especially after midday and in the evening, which reduces nocturia (night-time waking to urinate) in many patients within days. Alcohol is also a bladder irritant and a diuretic, and excessive alcohol intake is associated with more severe LUTS and prostatitis symptoms. A moderate reduction in alcohol intake often leads to a noticeable improvement in urinary symptoms and other health benefits.
Supplements for Prostate Health – What Works & What Does Not
The market for prostate health supplements is a big one, and it can be confusing. This is a straightforward evaluation of the evidence for the most popular supplements. The most commonly marketed supplement for BPH, saw palmetto (Serenoa repens), has been studied extensively, and the evidence is at best mixed. Large, well-designed trials have failed to show benefit over placebo for BPH symptoms. Beta-sitosterol (a plant sterol in many prostate supplements) has modest but real evidence of improved urinary flow in BPH. Selenium and vitamin E supplementation, thought to reduce prostate cancer risk, were shown in the large SELECT trial to have no protective effect and in some analyses, potentially increased risk. Lycopene from food sources (tomatoes) has better evidence than lycopene supplements. The honest advice is to choose dietary sources over supplements, and to speak to your doctor about any supplements before taking them, as some interact with medications or can falsely affect PSA levels.
Stress & Its Connection to Prostatitis & Pelvic Pain
Chronic pelvic pain syndrome (CPPS / Type III prostatitis) has a well established psychological and neurological component which differentiates it from simple inflammatory disease of the prostate. Chronic psychological stress activates the sympathetic nervous system and causes sustained pelvic floor muscle tension, which is a key driver of pelvic pain, urinary urgency, and painful ejaculation in CPPS. Many men with CPPS report that their flares of symptoms are directly triggered by times of great psychological stress or anxiety. This is not to say that the pain is “all in the mind”, the neurological and muscular changes are real and measurable, but it does mean that successful management of CPPS requires the psychological and lifestyle contributors to be addressed in addition to any inflammatory or infectious components. Evidence-based adjuncts to medical treatment of CPPS include stress management, mindfulness, cognitive behavioural therapy and pelvic floor physiotherapy.
Prostate conditions are not just medical conditions. They are conditions that touch on the most personal and fundamental aspects of a man’s life. Which is why every man with prostate concerns deserves to have a specialist who offers clinical depth and genuine empathy. Why Patients from All Over Central India Prefer Dr. Vikas Singh:
No, benign prostatic hyperplasia (BPH) and prostate cancer are entirely different conditions. BPH is a non-cancerous ageing related enlargement of the prostate that causes urinary problems but DOES NOT turn into cancer and does NOT increase the risk of cancer. Prostate cancer is a malignant disease arising from cells of the prostate epithelium that can spread beyond the prostate if not treated. Both of these conditions can present with similar urinary symptoms which is why PSA testing and examination is important in the evaluation of any prostate symptom. The two conditions may also coexist in the same man, again stressing the need for proper evaluation rather than assuming symptoms are solely due to benign enlargement.
“PSA screening from 50 years of age is recommended for all men in the general population. Men with a first-degree family history of prostate cancer (father or brother), those of African ancestry, or those with BRCA mutations should begin PSA testing at age 40. First PSA establishes a personal baseline to which future measurements are compared to find meaningful changes over time. A baseline PSA of < 1 ng/ml at age 50 years indicates a very low risk in the short term; if PSA is higher at baseline or rising, more frequent surveillance and perhaps further investigation are required.
Yes, most prostate problems are treated without open surgery. Alpha-blockers, 5-alpha reductase inhibitors or combination medication are the common first-line treatment for BPH with very good results for many patients. “When medicines don’t work, minimally invasive procedures like UroLift and iTind can be very effective treatment options requiring no incision and stitches and are performed as day-care procedures. Even the laser procedures (TURP, HoLEP) are done entirely through the urethra with no external cuts. Treatments for prostatitis include antibiotics, alpha-blockers and anti-inflammatories. Most prostate cancer surgery is done using small keyhole incisions . Open surgery or laparoscopic surgery is only needed for prostate cancer in some stages .
PSA (Prostate-Specific Antigen) is a protein produced only by cells of the prostate gland, normal or cancerous. A PSA test is a blood test that measures how much PSA is in the blood. An elevated PSA does not automatically mean cancer , it can be raised by BPH ( where the enlarged gland simply produces more PSA ) , prostatitis , vigorous cycling and sexual activity in the 48 hours before the test . An elevated PSA is a signal for further investigation: repeat PSA, physical examination (DRE) and in most cases mpMRI and potentially biopsy. The interpretation of an elevated PSA and the decision to act on it are influenced by the absolute value of the PSA, the rate of change over time and other context.
The effects of prostate surgery on sexual function vary depending on the type of surgery. For BPH treatments: UroLift and iTind are specifically designed and proven to preserve ejaculation function. TURP and laser enucleation (HoLEP) generally cause retrograde ejaculation , where the semen goes into the bladder during orgasm instead of being expelled . This does not change the feeling of orgasm but does affect fertility . Erectile function is usually unaffected by surgery for BPH. Prostate cancer surgery (radical prostatectomy): risk of erectile dysfunction depends on patient age, pre-operative erectile function and whether nerve-sparing technique is performed, nerve-sparing surgery gives the best chance of preserving erections post-operatively. Dr. Vikas Singh discusses the implications for sexual function with each patient individually before any procedure.
The International Prostate Symptom Score (IPSS) is a validated questionnaire that has seven questions on urinary symptoms , frequency, nocturia, weak stream, hesitancy, intermittency, urgency and incomplete emptying , plus one question on quality of life. Each symptom is scored 0 to 5, giving a total score of 0 to 35: mild (0 to 7), moderate (8 to 19), or severe (20 to 35). The IPSS is a reproducible, objective measure of symptom burden that permits systematic monitoring and comparison of changes over time and response to treatment. Dr. Vikas Singh uses the IPSS as a baseline and follow up assessment tool for all patients with BPH and prostatitis.
If you are coming for a prostate consultation it would be helpful if you bring along any previous PSA test results (even from some years ago, as trend is as important as absolute level), any previous urological investigations (uroflowmetry, ultrasound, MRI, biopsy reports) and a list of current medications. It would also be helpful if you could bring a brief written note of your symptoms including when they started, how they have changed over time and which symptoms bother you most. If you have nocturia, it helps to make a note of how many times you get up each night on average. If possible, record your normal daily fluid intake. This information will help to ensure the consultation is focused and as productive as possible.
Your options will be based on the stage and grade (Gleason/Grade Group score) of the cancer, PSA level, age, general health, and your own preferences. Active surveillance is an appropriate management strategy for low-risk localised prostate cancer (Stage I, Grade Group 1), where treatment can be deferred until or if progression occurs, with close monitoring with regular PSA, mpMRI and repeat biopsy. For intermediate and high risk localised cancer, treatment usually involves radical prostatectomy (surgical removal of the prostate, laparoscopic or robotic) or radiation therapy with or without hormone therapy. Combinations of hormone therapy (androgen deprivation therapy), novel androgen receptor pathway inhibitors, radiation and chemotherapy are used to treat advanced localised and metastatic disease. All relevant treatment options are presented to all patients and recommendations are individualised taking into account the entire clinical picture.
Acute bacterial prostatitis presenting with fever, rigours, pelvic pain and severe urinary symptoms is a serious condition and requires prompt antibiotic therapy and sometimes hospitalisation. Without treatment it can develop into a prostatic abscess which needs to be drained surgically. Chronic bacterial prostatitis , with recurrent urinary tract symptoms and positive urine/prostatic fluid cultures , requires prolonged courses of appropriate antibiotics and often specialist assessment to confirm that the organism has been fully eradicated. Chronic pelvic pain syndrome (CPPS / Category III prostatitis) is not a life threatening condition but can be very debilitating. It results in chronic pelvic pain, urinary symptoms and sexual dysfunction which significantly impairs quality of life and requires specialist multimodal management.
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