Symptoms and diagnosis
Prostate: urinary and sexual symptoms, and diagnosis
Waking up at night, straining to urinate, never feeling empty. These urinary symptoms have a precise mechanical cause—and tests can quantify it before even considering treatment.
Prostate: where do these symptoms come from
The mechanism
The prostate is located below the bladder and the urethra passes through it. When it increases in volume, it compresses this canal. The caliber is reduced, urine flows less well, and the bladder has to compensate.
All prostate symptoms stem from this compression. However, they do not all come from the gland itself: after years of effort against the obstruction, the bladder muscle thickens, becomes irritable, and then exhausts itself. This is why two men with the same prostate size can experience very different symptoms.
Prostate size has no bearing on discomfort. What matters is the impact on urination and the bladder.
Prostate Center — ParisProstate: urinary symptoms
In practice, these symptoms fall into two categories. They often coexist in the same patient, but they do not have the same meaning at all.
Obstructive signs
The mechanical obstacle.
- Weak or interrupted urine stream
- Delay before urination starts
- Need to strain to urinate
- Feeling of incomplete emptying
- Post-micturition drips
Irritative signs
Bladder pain.
- Repeated night awakenings
- Pollakiuria: urge to urinate every 30 to 60 minutes
- Urgent urges difficult to hold back
- Urge incontinence
Among them, getting up at night weighs by far the heaviest on the quality of life. It is therefore these that lead most men to consult a doctor — rarely the weakness of the urinary stream, to which one insidiously grows accustomed.
The intensity of these disorders is measured by the IPSS score, an international questionnaire with seven questions. It makes it possible to monitor changes over time and objectively measure the effect of a treatment.
Prostate: Associated sexual symptoms
Furthermore, prostatic hypertrophy and its treatments can affect sexuality. Three distinct situations occur, and it is important to differentiate between them.
- Decreased libido — often indirect: permanent discomfort and repeated night-time awakenings alter desire before any other mechanism.
- Erectile dysfunction — frequent in this age group, but rarely caused by the adenoma itself. They share common risk factors with it: age, diabetes, cardiovascular diseases.
- Retrograde ejaculation — semen is redirected into the bladder instead of being expelled. This is primarily a consequence of certain treatments, in particular surgical resection techniques.
This point deserves to be clearly stated during the consultation: several treatments for the adenoma, both medical and surgical, can worsen these disorders. The risk of ejaculation disorder after prostatic embolization is low, which explains why many patients are interested in it.
When to seek immediate medical attention
Persistent urinary discomfort already warrants a consultation. Certain signs, on the other hand, make it imperative not to delay it.
- Complete inability to urinate with a full and painful bladder — acute retention, it is an emergency
- Blood in the urine — the cause is often benign, but it must be identified
- Recurrent urinary tract infections or fever associated with urinary disorders
- Pain when urinating, pelvic or perineal
Do your symptoms bother you on a daily basis?
Send your file. We will tell you which examinations are missing and what conclusions they will allow to be drawn.
The diagnostic assessment
Symptoms guide the diagnosis, but they are not enough. This is why the assessment has three objectives: to confirm that the prostate is indeed involved, to measure the impact, and to rule out cancer.
- Consultation and IPSS scoreHistory of symptoms, clinical examination including digital rectal examination, and an IPSS questionnaire quantifying severity and its effect on quality of life.
- Prostate, renal, and bladder ultrasoundVolume of the gland, presence of a median lobe, protrusion into the bladder, post-void residual, condition of the kidneys, and evaluation for stones or diverticula.
- PSA testBiological marker interpreted according to age and context, intended to rule out cancer before initiating treatment.
- Prostate MRIWhen indicated: reliable volume assessment, characterization of the adenoma, screening for associated cancer.
- Arterial CT scanBefore embolization: mapping of the prostate arterial network to prepare the procedure.
Endorectal ultrasound, which is more invasive, is not performed systematically: it is reserved for situations where it provides information that the suprapubic approach does not.
The PSA: what the number says, and what it doesn't say
The PSA, prostate-specific antigen, naturally increases with age. There is therefore no single threshold, but rather reference values by age group.
| Age | Total PSA considered normal |
|---|---|
| Before 50 years old | less than 2.5 ng/mL |
| 50 to 60 years | less than 3.5 ng/mL |
| 60 to 70 years old | less than 4.5 ng/mL |
| 70 to 80 years old | less than 6.5 ng/mL |
However, a high PSA does not mean cancer. Indeed, it rises temporarily after ejaculation, a rectal examination, intense exertion, a urinary tract infection or prostatitis — and permanently in the case of benign prostatic hyperplasia, simply because the gland is larger.
Orders of magnitude help put things into perspective: among men with a PSA level above 4 ng/mL, approximately 30 % have a prostate cancer. Conversely, a PSA level below 4 ng/mL rules out cancer in about 90 % of cases. This is a clue to be interpreted, never a definitive diagnosis.
Namely
After prostatic embolization, PSA interpretation becomes tricky for several months. This is one of the reasons why cancer screening is performed before the procedure, and not after.
Prostate MRI
Many patients undergo an MRI before embolization. There is still no formal recommendation on this point, but the examination provides four useful pieces of information.
- A reliable assessment of prostate volume
- The morphology and vascularization of the adenoma, elements that will weigh more and more in the technical choice
- The search for bladder complications diverticula, stones
- The cancer screening associate, before the PSA becomes difficult to interpret
L'multiparametric MRI is currently the best imaging method to detect and locate prostate cancer, particularly in patients whose PSA remains elevated despite negative biopsies. It also serves as the reference standard for pre-treatment staging and follow-up.
CT angiography: mapping before intervention
Before embolization, a'angioscanner map the arterial network around the prostate and identify the vessels that supply it. This step determines the duration and safety of the procedure.
The inferior vesical artery usually gives off several branches:
- The most common vesicoprostatic branches, which penetrate the base of the gland near the bladder neck and descend along the urethra. They enlarge considerably in cases of hypertrophy, to supply the adenoma.
- The most common prostatic branches, which run along the lateral and posterior surfaces and vascularize the major part of the gland.
- L'internal pudendal artery, which participates in the vascularization of the fibromuscular zone.
- Incidentally, the artery of the vas deferens and the middle rectal artery.
This anatomy is delicate and highly variable from one man to another. Preoperative imaging is particularly recommended in patients presenting with marked atherosclerosis or tortuous vessels, in whom catheterization can be difficult.
Frequently asked questions
How many night-time awakenings are abnormal?
Waking up once a night remains common after 60. Beyond two regular awakenings, or as soon as they impair your sleep and your day, an evaluation is warranted. The IPSS score allows this discomfort to be quantified rather than estimated.
Does a high PSA mean I have cancer?
No. Many benign situations increase PSA, starting with prostate enlargement itself. Its interpretation takes into account age, prostate volume, changes in the level over time, and the clinical examination.
Are erection problems caused by the prostate?
Rarely directly. It'adenoma and erectile dysfunction mostly share common risk factors related to age. On the other hand, certain treatments for adenoma can worsen them, which must be discussed before any decision is made.
Is an MRI necessary before an embolization?
It is not mandatory, but often useful: it measures the volume, characterizes the adenoma and helps screen for cancer before the PSA becomes difficult to interpret. The indication is discussed on a case-by-case basis.
Is the digital rectal examination essential?
There remains a simple and rapid examination that provides information that imaging does not always give: the consistency of the gland and the presence of a suspicious hard area. It is part of the initial clinical examination.
Have your symptoms evaluated
Send your urinary report, your ultrasound, your latest PSA test, or your MRI if you have one. We will tell you what is missing and what the available tests already allow us to conclude.
Prostate Center — Blomet Clinic
136 bis rue Blomet, 75015 Paris · Monday to Saturday, 9 AM – 6 PM · +33 6 32 84 14 31
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Editorial responsibility. Medical content written and validated under the responsibility of Dr. Antoine Hakimé, interventional radiologist. Last medical review: September 2026. The information presented is for informational purposes and does not replace a medical consultation. The numerical values cited are benchmarks from the literature: their interpretation depends on each individual situation.