September is National Prostate Health Awareness Month, a time to think about men’s health issues involving the prostate. This includes prostate cancer, as well as other conditions. The prostate is a walnut-sized gland that sits below the bladder and wraps around the urethra. The prostate is a part of the male reproductive system, as it produces fluid for the semen that carries sperm.
Cancer of the prostate is the second-most common cancer that affects men, after cancers of the skin. Many prostate cancers are slow-growing and will not lead to death. However, some are more aggressive and can lead to serious problems.
There are a few known risk factors for prostate cancer:
Age is the greatest risk factor – the older you are, the greater the chances of getting prostate cancer
African-American men have a significantly elevated risk
Men who smoke have a higher risk
Men who have a family member, such as a father or brother who had the disease, are at higher risk
Prostate cancer does not always produce symptoms. When it does, symptoms can be very similar to other prostate concerns, such as an enlarged prostate. These possible symptoms include:
Difficulty beginning urination or experiencing a weak or interrupted urine flow
Frequent urination and urge to urinate during the night
Difficulty completely emptying the bladder
Blood in semen or urine
Pain in the back, hips or pelvis
“These symptoms could be the result of another condition altogether, so the presence of these conditions does not necessarily indicate prostate cancer,” says Dr. Keith Livingstone, a family medicine physician. “You should visit with your doctor if you are experiencing any of these symptoms.”
Screening & Diagnosis
There are two primary ways to screen for prostate cancer: a digital rectal exam (DRE) and the prostate-specific antigen (PSA) blood test.
For a DRE, the physician will insert a gloved, lubricated finger into the patient’s rectum to feel for abnormalities in the prostate. While this method can detect potential problems with the prostate, it cannot, by itself, indicate if cancer is present or not.
The PSA screening is a blood test. Essentially, a low level of PSA in the blood indicates a healthy prostate, while an elevated level could indicate cancer. However, an elevated level may also be indicative of another, unrelated prostate issue, such as enlarged prostate or an infection of the prostate.
There is considerable debate within the medical community about the appropriateness of PSA testing. While the test can have value in detecting cancer, it is also known that the test can result in both false-positives (indicating cancer when none is present) and false-negatives (indicating no cancer when the disease actually is present).
In addition, due to the fact that many forms of prostate cancer are slow-growing and do not pose an immediate risk to a man’s health, a diagnosis may result in unnecessary surgery to remove the cancer, as well as elevated apprehension and stress for the patient.
“Privia Medical Group North Texas supports the shared recommendations of the U.S. Centers for Disease Control and Prevention and the American Urological Association,” says Dr. Louis Zegarelli, a family medicine physician. “Our guidance is that men over 50 should discuss the pros and cons of a prostate cancer screening with their health care provider and, taking into account medical history and other factors, make a decision together as to whether or not a PSA test is in order.”
The only way to know for sure if prostate cancer is present is to biopsy the prostate. A biopsy is a surgical procedure in which a portion of the prostate is removed so it can be analyzed for the presence of cancerous cells. Cancer of the prostate can be treated in three main ways: surveillance, surgery and radiation treatment.
With surveillance, the prostate is checked every few months to determine if the cancer is spreading. If it is not, your physician may advise simply continuing to monitor the prostate. If a determination is made that the cancer is spreading, surgery may be performed to remove the prostate altogether. Alternately, radiation therapy may be employed to kill the cancerous cells.
Both surgery and radiation therapy can produce lasting side effects, including sexual health issues. That’s why physicians are cautious about rushing to diagnose and treat prostate cancer, as the odds of dying from this condition are quite low.
“All men are different, and there is not a one-size-fits-all approach when it comes to PSA screening for prostate cancer, nor is there a singular approach to treating this cancer,” says Dr. Andrew Hoover, a family medicine physician. “It is definitely something to talk over with your physician, taking into account any risk factors or symptoms you may be experiencing so that you can make the most informed decision together.”
An enlarged prostate – Benign Prostatic Hyperplasia (BPH) – is a very common condition in men over age 50; roughly half of men between ages 51 and 60 have BPH and 90 percent of men over age 80 do.
Since the prostate is located next to the bladder, enlargement can cause urinary complications, such as having to urinate more frequently and difficulty fully emptying the bladder. Men experiencing these symptoms should visit with their physician to determine if there are steps that can be taken to improve the situation.
There is some evidence that a healthy diet can reduce the likelihood of BPH, including eating more fruits and vegetables. Obesity and lack of physical activity may also play a role in developing BPH. It is important to note that BPH is neither a cause or a result of prostate cancer; however, it is possible to have both conditions at the same time.
Another prostate condition – one that primarily affects men under the age of 50 – is prostatitis. Prostatitis is a bacterial infection of the prostate, which can lead to painful urination, difficulty urinating and pain in the lower back, groin area or testicles. Note these symptoms are very similar to those associated with prostate cancer, so it’s important to consult with your physician. Prostatitis can be treated effectively with antibiotics. Like BPH, prostatitis has not been shown to cause or be a result of prostate cancer.
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