A Complete Guide to Your Prostate

Medically reviewed by Kashif J. Piracha, MDMedically reviewed by Kashif J. Piracha, MD

The prostate is a small walnut-sized gland in the male reproductive system. It sits between the penis and the bladder in front of the rectum, the tube that holds stool (poop) until you are ready to go to the bathroom. The term prostate comes from the Greek word prohistani, meaning "to stand in front of," highlighting the prostate's position in front of the rectum.

The prostate's primary function is to produce fluid that nourishes and protects sperm. It also helps push semen out during ejaculation and regulate urine (pee) flow.

Common conditions affecting the prostate include prostatitis (inflammation), an enlarged prostate, and prostate cancer. Symptoms of prostate conditions often involve difficulty urinating, frequent urination, painful urination, and painful ejaculation.

Anatomy of the Prostate

The prostate is a soft gland with an inverted cone shape. In your 20s, it’s about the size of a walnut but tends to grow with age.

Location

The prostate sits just below the bladder and about two inches in front of the rectum. A portion of the prostate surrounds the urethra, the tube that carries pee and semen out of the penis. Next to the prostate are nerves essential for erectile function. Behind the prostate are the seminal vesicles, small glands that produce sperm and fluid.

Because of its closeness to the urethra and because it shares blood supply with the bladder, prostate problems can affect urination (peeing). Since the prostate is near the rectum, healthcare providers can check it with a digital rectal exam (DRE), where they feel the prostate through the rectum.

Structure

The prostate consists of the following tissues, each with a specific function:

• Glandular: Makes fluid

• Connective: Provides support

• Fibrous: Surrounds and protects

• Muscle: Assists with semen and urine flow

There are five lobes of the prostate, classified by their position.

• Anterior lobe: Front

• Posterior lobe: Back

• Lateral lobes: Two sides

• Median lobe: Middle

In addition, the prostate involves the following zones.

• Peripheral: The back section that makes up 70% of the prostate

• Central: The middle section that comprises 25% of the prostate.

• Transition: Section that surrounds the urethra and makes up 5-10% of the prostate

Prostate zones are crucial because each presents unique symptoms and issues. The peripheral zone, where prostate cancer often begins, may not cause symptoms until advanced stages due to its distance from the urethra. Disorders in the central zone, which houses ejaculatory ducts, commonly lead to ejaculation problems or pelvic pain. Issues in the transition zone typically manifest as urinary problems.

Anatomical Variations

Anatomical variations can occur as the prostate develops before birth. For example, some people might be born with an extra lobe, while others might have hypoplasia, meaning a section is small.  Ectopia happens when the prostate is in the wrong place, and vascular malformations are problems with blood vessels.

What Does the Prostate Do?

The prostate’s main job is to produce seminal fluid and help control semen and urine flow from the penis.

Seminal Fluid Production

When people with male reproductive organs climax during sex, they release semen from their penis (ejaculation). Semen is a mixture of seminal fluid and sperm.

The prostate gland produces about 20-30% of semen. The seminal vesicles supply most of the remaining fluid, with a small contribution from the testicles (two egg-shaped organs in the scrotum, below the penis, that produce sperm and the male sex hormone testosterone).

Reproductive Function

Seminal fluid provides sperm with energy and helps them move efficiently. It also balances the acidic environment in the female reproductive tract to protect sperm from harm. Prostate-specific antigen (PSA) in seminal fluid helps semen flow smoothly through the urethra during ejaculation. These roles help sperm reach the egg and can lead to pregnancy.

Ejaculation and Urinary Function

When you urinate, the prostate relaxes to allow urine to pass. During sexual climax, it squeezes to push semen into the tube. This squeezing action during ejaculation also closes off the passage between the bladder and urethra, preventing urine from mixing with semen.

Associated Conditions

Prostatitis, prostate enlargement, and prostate cancer are commonly associated conditions that cause symptoms like urinary difficulties, erectile dysfunction (ED), and painful ejaculation. Prostatitis is the most common condition in people with male reproductive organs under age 50, while a large prostate is the most common in those over age 50.

Prostatitis

Prostatitis occurs when the prostate is swollen, causing irritation. Acute prostatitis starts suddenly and is often severe. Chronic prostatitis develops slowly and can come and go. Bacterial infections may be an underlying cause, but the reason is not always apparent. For example, sitting for too long, stress, nerve damage, or tense pelvic muscles might contribute.

Common prostatitis symptoms include:

• A weak urine stream

• Difficulty starting to pee

• Fever

• Frequent urination

• Painful ejaculation

• Painful urination

• Pain in the pelvis, groin, testicles, or rectum (last part of the colon, right above the anus)

• Urinary urgency

Prostate Enlargement and Benign Prostatic Hyperplasia (BPH)

Prostate enlargement includes benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate gland. The primary symptoms are:

• Urinary frequency (eight or more times a day)

• Nocturia (frequently waking up at night to pee)

• Weak urine stream

You might also notice:

• Difficulty starting or stopping urination

• Dribbling urine
  

• Incontinence (inability to hold urine)

• Pain with urination or ejaculation

• Urine retention (bladder not emptying)

• Unusual urine color or smell

• Urinary urgency

• Inability to urinate at all (a medical emergency)

The size of the prostate does not always correlate with symptom severity. Some men with large prostates have minimal symptoms, while others with smaller prostates experience more severe issues. Risk factors include age (40+), family history, obesity, diabetes, and a sedentary lifestyle.

You may not notice any issues until you suddenly find yourself unable to urinate, which is a medical emergency. The inability to urinate may happen after you take cold or allergy medicines that can prevent the bladder from relaxing and releasing urine.

Prostate Cancer

Prostate cancer is most common over the age of 50. Some people do not experience symptoms, so regular screening with prostate-specific antigen (PSA) tests and digital rectal exams (DRE) are important for early detection. For a DRE, a provider inserts a lubricated, gloved finger into the rectum to check for enlargement, lumps, or tenderness. When symptoms occur, they may include:

• Blood in urine or semen

• Difficulty urinating

• Frequently waking up at night to pee

• Pelvic or lower back pain

• Weak urine flow

Diagnostic Testing

When prostate issues arise, healthcare providers begin with a medical history and examination to understand symptoms and risk factors. The exam may include a DRE. Your provider may also use the following tests to evaluate prostate size, structure, and function:

• Biopsy: A biopsy involves your provider using a small needle to get a tiny sample of prostate tissue to examine under a microscope.

• Cystoscopy: A healthcare provider looks inside the urethra and bladder using a thin, lighted tube.

• Imaging tests: Ultrasound or computerized tomography (CT) scans provide detailed images.

• Postvoid residual volume test: An ultrasound or a urinary catheter (tube) measures the amount of urine in the bladder after peeing.

• Uroflowmetry (urine flow test): This test measures how well the bladder and urethra store and release urine.

Blood and urine tests might include:

• Urinalysis: You'll urinate in a cup, and your sample will be evaluated for signs of infection.

• Prostate-specific antigen (PSA): This blood test provides information about prostate enlargement, inflammation, or cancer.

• Serum creatinine: Creatine blood tests check kidney function and are important for investigating benign prostatic hyperplasia (BPH).

• MyProstateScore 2.0 (MPS2) test: This urine exam tests for genes linked to aggressive prostate cancers.
  

Tips for Keeping Your Prostate Healthy

Getting regular check-ups and screenings, avoiding smoking, staying physically active, and maintaining a healthy weight are some of the most effective ways to keep your prostate healthy. These actions help reduce the risk of prostate cancer, BPH, obesity, type 2 diabetes, and heart disease, which can increase the risk and severity of prostate conditions. Here are some general recommendations.

Get Regular Check-Ups and Screenings

Visit your healthcare provider regularly and report any changes in your urinary patterns. Consider prostate screening around age 50—or age 40 if you have a family history or are at high risk.

Stay Active

Staying active does not necessarily mean intense exercise. Walking briskly for 30 minutes a day most days is helpful. Whether at the office, in the car, or on a bicycle, it’s also important to avoid prolonged sitting, as it puts pressure on your prostate.

Eat an Anti-Inflammatory Diet

An anti-inflammatory diet like the Mediterranean diet or a plant-based diet may also help reduce the risk of prostate problems. An anti-inflammatory diet includes foods such as. 

• Fruits

• Vegetables like broccoli and Brussels sprouts

• Lycopene-rich foods like cooked tomatoes, watermelon, grapefruit, rose hips, and guava

• Whole grains

• Healthy fats like extra virgin olive oil, avocados, nuts, and seeds

• Fish (e.g., salmon, tuna, mackerel)

• Lean proteins like chicken and turkey

• Beans and legumes (e.g., lentils, peas, chickpeas)
  

An anti-inflammatory diet also involves limiting the following:

• Alcohol

• Caffeine

• Dairy

• Processed foods

• Red meat

• Saturated fats

• Added salt and sugars

Other Tips

Some people find that saw palmetto extract or prostate massage can help lessen prostatitis or BPH. While some evidence suggests each could be beneficial, research is conflicting. Always consult your healthcare provider before trying new supplements or herbs, as they can interfere with other medications or cause side effects.

A Quick Review

The prostate is a small gland about the size of a walnut. It’s part of the male reproductive system and sits between the penis and the bladder. The primary function of the prostate is to produce seminal fluid and regulate the flow of semen and urine.

Common prostate conditions include inflammation, enlargement, and cancer. Symptoms typically include urination problems, painful ejaculation, erectile dysfunction, or pelvic pain.

Prostate health involves maintaining a healthy weight, staying active, avoiding smoking, eating an anti-inflammatory diet, and getting regular check-ups and recommended screenings.

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