José Preza Fernandes, a urology specialist at Hospital da Luz, answers frequently asked questions about prostate conditions , their prevention and diagnosis, and the warning signs to look out for. What is the prostate, what is its function, and why is it so important for men's health? The prostate is an exocrine gland of the male reproductive system, approximately the size of a walnut. It is located below the bladder and in front of the rectum, surrounding the first part of the urethra. In my clinical practice, I usually explain that the prostate main function is to produce and secrete prostatic fluid, an essential component of semen that nourishes, protects and transports sperm, helping to ensure their viability. The prostate is important for men's health not only because of its reproductive function, but also because of its anatomical relationship with the urinary tract. Any change in its size or structure can directly affect urination and quality of life. When we talk about prostate diseases, we tend to immediately think of cancer. What other conditions can affect the prostate, and how can we distinguish between them? Although cancer is the condition that causes patients the greatest concern, most prostate problems I see in clinical practice are not malignant. The two most common benign conditions are: Benign prostatic hyperplasia (BPH): a non-cancerous enlargement of the prostate that becomes very common with age and can cause obstructive and irritative urinary symptoms; Prostatitis: inflammation or infection of the prostate. Unlike BPH and cancer, which tend to develop progressively and may be silent in their early stages, prostatitis often causes acute pelvic pain, a burning sensation when urinating and fever, and frequently affects younger men. These conditions are distinguished through a thorough urological assessment, including the patient's medical history, a digital rectal examination, laboratory tests such as prostate specific antigen (PSA), and imaging tests. Prostate cancer is one of the most common cancers in men. What are the main risk factors, and who should be vigilant? The main well-established risk factors are: Age: the risk rises significantly after the age of 50; Family history: men with close relatives, such as a father or brother, who have been diagnosed with the disease; Ethnicity: men of African ancestry have a higher incidence. All men aged 50 and over should be particularly attentive to their prostate health, or from the age of 45 if they have a family history of prostate or breast cancer. Are age and family history determining factors? If a father or brother has had prostate cancer, at what age should a man seek medical advice? Yes, they are extremely important factors. If a man has a first-degree relative, such as a father or brother, with prostate cancer, his risk of developing the disease is considerably higher. In these higher-risk cases, I always recommend starting screening discussions and seeking advice from a urologist earlier, usually around the age of 45. This allows for early detection, at a stage when the likelihood of successful treatment is greatest. One of the most concerning aspects of prostate cancer is that it can develop without causing symptoms. What signs can appear, and why shouldn't we wait for them before seeking medical advice? It is essential to dispel a very common misconception: urinary symptoms do not necessarily mean prostate cancer. In most cases, symptoms such as a weak urine stream, a feeling that the bladder has not emptied completely, increased urinary frequency or the need to get up several times during the night to urinate are associated with benign conditions. These include, in particular, benign prostatic hyperplasia (BPH), the natural enlargement of the prostate associated with ageing, as well as inflammatory or infectious conditions. Prostate cancer, on the other hand, predominantly develops in the peripheral part of the prostate, away from the urethra. For this reason, in its early stages, when it is highly treatable and potentially curable, the disease is almost always asymptomatic and silent. If we wait for symptoms to appear before investigating the prostate, we may miss the opportunity for an early diagnosis. In short, I would like to leave men with two essential messages: If you have urinary symptoms: do not immediately assume you have cancer. Seek medical advice, because there are simple and highly effective treatments that can improve your quality of life; If you have no symptoms at all: do not assume that everything is fine. The absence of symptoms does not remove the need for regular monitoring and early detection from the recommended age onwards. There is still some anxiety around prostate examinations, particularly the digital rectal examination. What does a urological assessment involve today, and what tests may be necessary? Unfortunately, fear and the stigma associated with the digital rectal examination remain cultural barriers that can cost lives. In my consultations, I make a point of explaining that a modern urological assessment is quick, painless and carried out with full respect for the patient's privacy and dignity. It consists of a detailed discussion of the patient's medical history, complemented by a blood test to measure prostate-specific antigen (PSA) and a physical examination, including a digital rectal examination, which allows me to assess the size and consistency of the prostate and check for the presence of any nodules. When there is a suspicion of disease, I use additional tests such as multiparametric magnetic resonance imaging (MRI) and a targeted prostate biopsy. At what age should a man start paying attention to his prostate health? Is there a recommended age for PSA testing, or should the decision depend on individual risk? As a general rule, men without specific risk factors should start discussing their prostate health and consider PSA testing at around the age of 50. However, for men with risk factors, such as a family history or African ancestry, this assessment should begin at the age of 45. The decision to have a PSA test should always be individualized and discussed during a medical consultation, taking into account each man's overall risk. Does a high PSA level necessarily mean cancer? What happens when the results raise concerns but are not enough to establish a diagnosis? Not at all. A high PSA level does not automatically mean cancer. PSA is a sensitive but not very specific marker, which means that levels can also rise as a result of infections such as prostatitis, inflammation, benign prostatic hyperplasia, or even after intense physical exercise. When the result raises concerns but is inconclusive, the next step in my practice is usually to request an MRI scan. If there is still suspicion of a malignant lesion, a biopsy is performed to establish a definitive diagnosis. When prostate cancer is diagnosed, what are the main treatment options available today? Is surgery always necessary, or are there situations in which the disease can simply be monitored? Treatment options have evolved considerably and are tailored to the stage of the tumor, its aggressiveness, including the Gleason score, and the patient's overall health. Today, we have several approaches available. These range from active surveillance, which is appropriate for very localized, low-risk tumors and involves closely monitoring the patient without immediate treatment, thereby avoiding unnecessary side effects, to surgery (radical prostatectomy) and radiotherapy. Surgery is therefore not always necessary. Personalized medicine helps determine the most appropriate strategy for each patient. One of the concerns associated with treatment is its impact on sexual function and urinary continence. To what extent can these effects be prevented, treated or reversed? This is undoubtedly one of the main concerns patients bring to consultation. However, technological advances, including robotic surgery and nerve-sparing techniques, have significantly reduced these complications. In terms of urinary continence, the vast majority of men regain full control, often with the support of pelvic floor rehabilitation. As for sexual function, although there is still a risk of impairment, highly effective medical treatments and penile rehabilitation therapies are now available to help patients regain their quality of life. Is there any way to reduce the risk of developing prostate cancer? What role can diet, physical activity and lifestyle play, given that some risk factors cannot be changed? Although genetics, age and ethnicity cannot be changed, adopting a healthy lifestyle can play an important protective role. I always advise my patients to follow a balanced diet rich in vegetables, fruit and omega-3 fatty acids, such as the Mediterranean diet, while limiting excessive consumption of animal fats and processed red meat. Regular physical activity, maintaining a healthy weight and not smoking can also have a positive effect on inflammatory and hormonal processes in the body. Finally, what message would you like to give to men who continue to postpone seeing a doctor because of embarrassment, fear of a diagnosis, or the belief that they only need to seek help when they have symptoms? The message I try to convey to my patients every day is that fear and taboo should never take priority over prevention: When prostate cancer is diagnosed early, cure rates are above 90%. Postponing a medical consultation because of embarrassment or fear of the unknown may mean losing the opportunity to treat a silent disease in time; Looking after your prostate health is an act of responsibility towards yourself and those you love; Talk to your urologist, ask any questions you may have, and undergo the recommended screening and assessments; Prevention remains our best weapon and saves lives. Meet the urology clinical team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item. English translation generated with AI and reviewed by the editorial team.
