Short answer: the prostate produces most of the fluid in semen and sits directly beneath the bladder, wrapped around the urethra. Enlargement, inflammation or disease therefore affects urination and ejaculation together. Most prostate problems in men over 50 are benign — but the symptoms overlap enough with the serious ones that guessing is a poor strategy.
What changes with age
Benign prostatic hyperplasia
The prostate enlarges gradually from around 40. This is normal and extremely common. Because it surrounds the urethra, enlargement causes a weaker stream, hesitancy, incomplete emptying, and getting up at night to urinate. It is not cancer and does not become cancer, but it can affect quality of life considerably and is treatable.
Prostatitis
Inflammation of the prostate, which can be infective or not. It causes pelvic or perineal pain, pain on ejaculation, and urinary symptoms. It is the most common prostate problem in men under 50 and is frequently missed or mistaken for something else.
Prostate cancer
Common — the most frequently diagnosed cancer in UK men — and frequently slow-growing. Early prostate cancer usually causes no symptoms at all, which is the single most important fact about it. Symptoms tend to appear only once it is advanced, so waiting to feel something is not a screening strategy.
How this affects sex
- Ejaculation — reduced volume, discomfort or pain on ejaculating, or blood in semen (which needs assessment)
- Erections — BPH and its treatments can contribute, and prostate surgery or radiotherapy commonly affects erectile function directly, via nearby nerves
- Medication effects — finasteride and dutasteride, used for BPH, can reduce libido and cause erectile difficulty; alpha-blockers can cause retrograde ejaculation
- Pain — prostatitis frequently presents as pain during or after ejaculation
If erections are the main issue, read erectile dysfunction alongside this.
What PSA does and does not tell you
PSA is a protein produced by the prostate, measurable in blood. Raised levels can indicate cancer, but also BPH, prostatitis, a urinary infection, recent ejaculation, vigorous exercise (notably cycling) or a recent examination.
So a raised PSA is not a diagnosis — it is a prompt for further assessment. Equally, a normal PSA does not entirely exclude cancer. It is a useful signal, not a verdict, and that nuance is why it is worth understanding before testing rather than after.
In the UK there is no national screening programme, but men over 50 can request a PSA test from their GP. Risk is higher, and starts earlier, for black men and for men with a father or brother who has had prostate cancer — for whom the conversation is worth having sooner.
PSA testing at home
A PSA blood test analysed by a UKAS-accredited UK laboratory, in discreet plain packaging. Avoid ejaculation, vigorous exercise and cycling for 48 hours beforehand, as each can raise the result.
See the PSA testyou have blood in urine or semen, difficulty urinating or a sudden change in your stream, pain on ejaculation, bone pain, or unexplained weight loss. Blood in semen and any new urinary difficulty are worth prompt assessment even though the common causes are benign.
What helps generally
The unglamorous list again, and for once the evidence is reasonably consistent: regular physical activity, maintaining a healthy weight, not smoking, moderate alcohol, and treating high blood pressure and diabetes. Cardiovascular health and sexual function share most of their risk factors, so the same actions improve both.
Common questions
Does an enlarged prostate cause erectile dysfunction?
Benign enlargement can contribute, and some treatments for it more so — finasteride and dutasteride can reduce libido and cause erectile difficulty, and alpha-blockers can cause retrograde ejaculation. Discuss alternatives with the prescriber rather than stopping.
What does a raised PSA mean?
That further assessment is needed, not that you have cancer. PSA rises with benign enlargement, prostatitis, urinary infection, recent ejaculation, cycling and recent examination as well as with cancer.
Should I avoid anything before a PSA test?
Yes — avoid ejaculation, vigorous exercise and cycling for around 48 hours beforehand, and delay testing if you have a urinary infection, as each can raise the reading.
Does early prostate cancer cause symptoms?
Usually not. That is the most important thing to know about it — symptoms tend to appear only at an advanced stage, so waiting until something feels wrong is not a strategy.
Can I get a PSA test on the NHS?
There is no national screening programme, but men over 50 can request one from their GP. Men at higher risk — black men, and those with a father or brother who has had prostate cancer — may wish to discuss it earlier.
Is pain when ejaculating serious?
It is most commonly prostatitis, which is treatable, but it should be assessed rather than endured — particularly if there is blood in semen or any urinary difficulty.