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Ask the expert Prostate
Last updated August 22, 2019. 4 minute read

5 enduring prostate myths, busted

This gland has an important job: to produce prostatic fluid that acts as a protective environment for sperm in on their journey to fertilize an egg. But it can cause problems and does for a significant percentage of men.

Dr Seth D Cohen Md Mph

Dr. Seth D. Cohen, MD, MPH

Dr. Seth Cohen, MD, is Assistant Professor in the Department of Urology and Obstetrics and Gynecology, and the Director of the Sexual Dysfunction Program at NYU Langone Health. His current research is being conducted on erectile dysfunction, male sexual dysfunction, low testosterone and peyronie’s disease. Dr. Cohen is board-certified in urology.

Reviewed by Dr. Mike Bohl, MD, MPH

Myth #1: It’s bad to have an enlarged prostate.

If you’re born with a penis and testicles, you’re born with a prostate. This gland has an important job: to produce prostatic fluid to mix with the sperm that comes from your testicles, providing a protective environment for it in on its journey to fertilize an egg.

It’s a widely held belief that all the fluid that comes out in your semen is coming from your testicles. In actual fact, just a small portion of that comes from your testicles, and that portion—between 2 and 5%— is sperm. 20-30% of a man’s ejaculate is from his prostate and the majority comes from the seminal vesicles.

Now, as we age, two things happen. Firstly, semen volume may decline. Many men in their seventies or eighties tell me that, when they have an orgasm, they don’t see as much fluid as they used to or any fluid at all. Secondly, the prostate grows. Eventually, you’re going to notice the effects of that growth, particularly when it comes to urination.

When you urinate, you push fluid from your bladder out of your penis via the urethra. The urethra is a tube that goes from your bladder to the tip of your penis. At the base of the bladder, the urethra is enveloped by the prostate. This means that, as the prostate grows, it begins to squeeze the urethra making it narrower and narrower. This narrowing can lead to urinary hesitancy, a weak or intermittent stream, the feeling of incomplete bladder emptying, dribbling, and other symptoms besides.

So while a lot of the effects of an enlarged prostate certainly aren’t fun, a benign enlargement is inevitable and certainly not harmful in and of itself. The prostate is just a dumb organ. It doesn’t have a mind. It simply continues to grow.

Myth #2: Prostate cancer always causes symptoms. 

The majority of prostate cancer cases are diagnosed from an elevated PSA. PSA—which stands for prostate-specific antigen—is a protein that can be detected in the blood. Symptoms of prostate cancer would only usually show up once the cancer has spread beyond the prostate or metastasized. Those symptoms could include lethargy, bleeding when you urinate, or back pain from metastatic disease to your spine. At this stage, the cancer is life-threatening.

Most men who have prostate cancer are symptomless, however. Now, if you’re diagnosed with prostate cancer in your sixties, you may also have some trouble with urination, but so do many men in their sixties. Difficulty with urination is most commonly due to the prostate getting larger. It’s hard to know if this is due to benign growth or if it is a symptom of cancer.

Myth #3: PSA comes from prostate cancer.

PSA comes from the prostate. If you own a prostate, which all XY chromosomal men do, then you make PSA too. PSA is a protein that is secreted by the prostate. Once you go through puberty, that sucker starts to grow, and you start producing PSA. As your prostate grows, so does the level of PSA in your blood.

So what’s a normal PSA level? Well, anything below four is what we consider normal, though that number changes throughout a man’s life. A guy who is 18 shouldn’t have a PSA anywhere near 4, for example. Young men—below the age of say 35 or 40—should have PSAs that are still reasonably low: less than one or perhaps between one and two. For men who are over the age of 50 or 60, the PSA could start to go up to two or three. Once you get above four, we start thinking, “Hey, something may be growing on here (Other than an enlarged prostate). Something like prostate cancer.”

Myth #4: All prostate cancer can be deadly.

We put prostate cancer into three categories: low risk, medium risk, and high risk. In the1980s and 1990s, we used to say any prostate cancer should be removed or radiated. But we now know that low-risk prostate cancer is very unlikely to hurt you or kill you. That means we prefer to keep an eye on low-risk prostate cancer rather than treat it. The reason why we take this approach is that the side-effects of treatment (which may include difficulty with erections and difficulty with urination) can often be worse than the impact of the cancer itself.

So the choice is this: you either live with a very low-risk cancer in your prostate, which we keep a close eye on with PSA testing and biopsies to ensure that it’s not progressing or we treat. In the first instance, the man has to live with prostate cancer, but he gets to live with his anatomy intact. If however, one is to undergo surgery or radiation to the prostate, we’re going to alter that man’s life forever. He’s never going to get that back. There’s no amount of down the road surgery you could give him to make his erections normal or his urinary function normal again.

Myth #5: Recurrent prostate cancer is a death sentence.

If you have a recurrence of your disease, and it’s localized, your doctor can cut it out, radiate it, or offer special chemotherapeutic agents and you’re cured again. Then you’re what’s referred to as NED which means no evidence of disease.

Most patients come in for continuous follow-up. If their PSA goes up again after surgery or radiation, we can re-treat him with more radiation or we can offer them repeat surgery. Most of those guys do quite well. If treated prostate cancer patients fail to come in for follow up testing, however, they would have a higher risk of dying from it. But that’s rare.