6 Signs of Prostate Problems and What They Could Mean

Bodies naturally change as people age, but when are those changes, such as those in the prostate, warning signs of possible issues?

The prostate is a small gland in men located in the groin that is about the size of a ping-pong ball. As men age, it tends to grow larger, which can lead to a variety of health issues, says James Michael Orsini, Jr., M.D.,oncologist and hematologist at Mountainside Medical Center.

He weighs in on six warning signs of prostate issues.

Prostate Problem Warning Signs

Dr. Orsini encourages men to see their doctor if they experience any of the following symptoms:

1. Difficulty emptying the bladder
2. Increased frequency in urination
3. Burning or fullness sensation
4. Problems with ejaculation
5. Blood in urine
6. Change in urine stream (for example, a weak stream or a stream that starts and stops)

Common Prostate Problems

These warning signs of prostate issues don’t necessarily mean that you have prostate cancer. Several other possible prostate problems might be responsible, Dr. Orsini says.

Benign prostatic hyperplasia (BPH): BPH, a non-cancerous enlargement of the prostate, and is very common in older men. About 50 percent of men ages 51–60 have BPH; that number jumps to 70 percent among men ages 60–69 and 80 percent among men over 70 years of age. Treatments for BPH can include medications to shrink the prostate or relax the muscles, surgery to reduce the size of the prostate and ablative techniques. More recently minimally invasive water vapor techniques have proven successful.

Prostatitis: Prostatitis is a condition where the prostate is swollen and tender. It can be caused by a bacterial infection and is common in males younger than 50, but it can occur at any age. While prostatitis isn’t always curable, it is treatable with antibiotics.

What to Know About Prostate Cancer

Prostate cancer is the most common cancer in American men. Those at greatest risk are men 50 or older and have a family history. The prevalence of prostate cancer is higher in African American men as well as Hispanic and Native American men.

“Know your family history and consider genetic testing,” Dr. Orsini says. “These factors will help you and your doctor know when you should start screenings. The more risk factors you have, the sooner you should start regular screenings. If you are experiencing any symptoms, go see your doctor immediately, because we always want to catch these things early.”

Treatment for Prostate Cancer

Early detection of low-risk tumors in men can allow them to opt for active surveillance, a strategy for non-aggressive forms of cancer where people are closely monitored and not started on any treatments including upfront surgery or radiation.

“Because low-risk prostate cancer isn’t likely to decrease life expectancy, monitoring is a good option for certain patients.

For those with more aggressive forms of prostate cancer, several options are available. “There has been a tremendous amount of new research into treatment within the last five years,” says Dr. Orsini.

Treatment options include:

Radiation treatments

• IMRT
• SBRT
• ERBT
• Brachytherapy
• Proton therapy

Surgery

• Robotic Surgery is becoming standard of care

Chemotherapy

• Taxotere
• Cabazitaxol
• Carboplatin

Hormonal oncolytics

• Androgen receptor blockers
• Bicalutamide (1st generation)
• Enzalutamide (2nd generation) 
• Apalutamide
• Darolutamide
• Androgen biosynthesis inhibitors
• Abiraterone acetate

Hormone therapy

• Androgen deprivation therapy

Immunotherapy

• IOs (Keytruda, Nivoilumab, etc.), only affective today in about 10 percent of patients
• Provenge, which uses patients’ own blood that is modified and given back to the patient in three doses

Bone targeting therapies

• Radium 223
• Xofigo 
• Lutetium (177Lu) vipivotide tetraxetan
• Pluvicto (Mountainside is the first in the state to offer this treatment)

Other non-chemotherapeutic agents are offered for bone and cardiac health, and working in-conjunction with urology, cardiology and primary care is of utmost importance.

The current five-year survival rate for those diagnosed with early stage prostate cancer is more than 99 percent, but early detection is key, Dr. Orsini says.

Targeting Prostate Cancer

Mountainside Medical Center uses innovative tools to detect and treat prostate cancer. In July 2022, Mountainside became one of the first hospitals in New Jersey to offer prostate-specific membrane antigen (PSMA) PET imaging, which allows doctors to localize prostate cancer cells.

This technology became even more useful in November 2022 when Mountainside was approved to use Pluvicto, a targeted radioligand therapy treatment for PSMA+ mCRPC (metastatic prostate-specific membrane antigen-positive, castration-resistant prostate cancer). This therapy delivers radiation to specifically targeted cancer cells, with minimal effect on healthy cells.

“In conjunction, these tools significantly improve survival for patients who have already been treated with other anticancer treatments,” Dr. Orsini says.

Next Steps & Resources:

• Meet our source: James Michael Orsini, Jr.,
• Learn more about the cancer program at Mountainside Medical Center