More half-truths have built up around the prostate than around almost any other organ. Some make men put off a check-up for years, others push them into needless worry or towards supplements with no proven effect. At his practice in Plovdiv, Dr Slavi Penev hears the same questions every day, so below are the most common myths, set against what medicine actually knows.
The prostate is a gland the size of a chestnut that sits below the bladder. It produces part of the seminal fluid and changes naturally with age – which is where most of the misunderstandings start.
Myths about the enlarged prostate
Myth 1: An enlarged prostate is the beginning of cancer
Fact: benign prostatic hyperplasia (BPH) and cancer are two different diseases. Enlargement mainly affects the inner part of the gland and presses on the urethra, whereas cancer most often starts in its outer (peripheral) zone. One does not turn into the other, but they can exist at the same time – which is why the urologist assesses the gland as a whole and not just its size. Find out more on the page about benign prostatic hyperplasia.
Myth 2: The prostate is only a concern for older men
Fact: enlargement really is typical of the years after 50, but prostatitis – inflammation of the gland – is the most common urological diagnosis in men under 50. Pelvic pain and burning in a thirty-year-old man are also a reason for a check-up. And with a family history, the conversation about prostate cancer starts earlier, not later.
Myth 3: If the prostate is enlarged, surgery is inevitable
Fact: size alone is not a reason for surgery. What matters are the symptoms, the residual urine (urine left in the bladder after urinating) and complications. Many men feel well for years with changes to their habits and medication. Surgery is discussed when medicines do not help or when urinary retention, repeated infections, bladder stones or kidney involvement appear.
Myths about the examination and PSA
Myth 4: The examination is humiliating and painful
Fact: the rectal examination takes about ten seconds and is more unpleasant than painful. It gives irreplaceable information about the texture and surface of the gland. The examination is completed with an ultrasound scan, which shows the size of the prostate and the residual urine. How a prostate check with Dr Penev works is described step by step.
Myth 5: A high PSA means cancer
Fact: PSA is a protein made by the prostate, not by cancer. Its level rises with benign enlargement, inflammation, infection, after ejaculation, cycling and even after the rectal examination itself. So one raised value is not a diagnosis – the test is repeated at a calm time, compared with the volume of the gland and, if needed, followed by an MRI scan before a biopsy is even discussed. Details are in the article on the PSA test.
Myth 6: I have no symptoms, so my prostate is healthy
Fact: early prostate cancer usually causes no symptoms, because it grows in the outer part of the gland, away from the urethra; urinary symptoms most often come from benign enlargement. That is why the European Association of Urology (EAU) recommends that men over 50 (over 45 with a family history) have an informed conversation with a urologist about the benefits and risks of monitoring PSA. What a preventive check-up after 40 includes is described separately.
Myths about lifestyle
Myth 7: Sex and cycling harm the prostate
Fact: a regular sex life does not damage the gland; some studies even link frequent ejaculation with a lower risk, although the link has not been definitively proven. Cycling can temporarily raise PSA, and an unsuitable saddle can cause discomfort in the perineum (the area between the scrotum and the anus), but it causes neither enlargement nor cancer. The practical advice is something else: do not have a PSA test within two days of a long training session or ejaculation.
Myth 8: Herbs and supplements cure the prostate
Fact: plant extracts slightly ease the symptoms in some men, but their effect is modest and does not change the course of the disease. The danger is that for months they mask symptoms that deserve a diagnosis. A supplement cannot tell benign enlargement from chronic prostatitis or from cancer – only an examination can.
Myths about treatment
Myth 9: Surgery puts an end to your sex life
Fact: operations for benign enlargement (transurethral resection of the prostate – TURP, laser methods) usually preserve erections. A common consequence is retrograde ejaculation – the semen goes into the bladder instead of out; it is harmless, but it is good to know about it in advance. With surgery for cancer the risk to erections is higher, but nerve-sparing techniques, including laparoscopic and robotic ones, and early rehabilitation allow many men to keep a fulfilling intimate life. Dr Penev discusses what to expect in your case before every operation.
When to see a urologist
Book an appointment within days if your stream has weakened, you get up more than once at night, you feel your bladder does not empty completely or you have pelvic pain and burning. Blood in the urine, even once and without pain, needs an examination without delay, not waiting for it “to pass”. Seek help immediately – at an emergency department or by calling 112 (the European emergency number) – if you cannot urinate at all and your bladder is full and painful, or if a high temperature and shivering are added to your symptoms, which may mean acute prostatitis.
The truth about the prostate is more reassuring than the myths: most conditions are easy to detect and respond well to treatment when help is sought in time. If you have a question that worries you, book an appointment with Dr Penev in Plovdiv or Karlovo – an initial consultation is €50 and a follow-up consultation €30.
Frequently asked questions
At what age should I have my first prostate check?
If you have no symptoms and no close relatives with prostate cancer – at around 50, although a first conversation with a urologist can just as well be earlier. If your father or brother has had the disease, the conversation starts at around 45, and with a proven inherited predisposition – at around 40. If you have symptoms, age does not matter.
How often should the prostate be checked?
With a normal finding and a low PSA level, the next check can often be in two or more years; with borderline values, an enlarged prostate or a family history, every one to two years. The urologist sets the interval individually according to your age, PSA level and family history.
What should I do if my PSA is slightly raised?
Do not jump to conclusions. Usually the test is repeated after a few weeks, once an infection has been ruled out, and with no ejaculation or cycling in the previous two days. The urologist decides whether further tests are needed.
Is prostatitis sexually transmitted?
In the great majority of cases chronic prostatitis is not caused by an infection and is not passed on to your partner. If a bacterial cause is proven, the doctor decides whether your partner also needs to be tested.
Is getting up at night to use the toilet linked to the prostate?
In men over 50 an enlarged prostate is one of the most common causes, but not the only one – heart and kidney disease, diabetes and drinking habits also play a role. The cause is clarified with an examination.
The information on this website is for general education and does not replace an examination and consultation with a doctor. If you have urgent symptoms, seek medical help immediately or call 112.