September is National Prostate Health Awareness Month, a good time to remind men of various prostate health concerns, such as prostate cancer, enlarged prostate and prostatitis.
The prostate is a walnut-sized gland that sits below the bladder and wraps around the urethra, the tube that carries urine away from the bladder. Part of the male reproductive system, the prostate is responsible for producing fluid for the semen that carries sperm.
Cancer of the prostate is the second-most common cancer that affects men, after skin cancer. Many prostate cancers are slow-growing and may never result in serious health concerns. However, some are more aggressive and can lead to significant problems.
Known risk factors for prostate cancer include:
- Age: the older you are, the greater the likelihood of getting prostate cancer.
- Race: African American men have a significantly elevated risk. They are twice as likely to get prostate cancer, twice as likely to die of prostate cancer and more likely to get it a younger age.
- Smoking: Men who smoke have a higher risk.
- Heredity: 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 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
- Painful urination
- Blood in semen or urine
- Painful ejaculation
- Continuous pain in the back, hips or pelvis
Screening & Diagnosis
Screening for prostate cancer is challenging. The prostate-specific antigen (PSA) blood test may detect prostate cancer, but it also has downsides.
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.
There is considerable debate within the medical community about the value 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. Ultimately, prostate cancer can only be diagnosed accurately through a biopsy.
The U.S. Preventative Services Taskforce (USPSTF), an organization of medical doctors and disease experts, released the following prostate cancer screening guidelines in 2018:
- Men ages 55-69 should make individual decisions about whether or not to have a PSA test
- Before making that decision, men should consult with their physician about the pros and cons of PSA testing and other forms of tests and treatment if cancer is actually diagnosed
- Men over 70 should not be routinely screened for prostate cancer
The USPTF also advises against using a digital rectal examination (DRE) to diagnose prostate cancer. In a DRE, the physician inserts a gloved, lubricated finger into the patient’s rectum to feel for abnormalities in the prostate. The USPTF found that DREs do not produce any reliable information for purposes of diagnosing cancer.
“Privia Medical Group North Texas supports the shared recommendations of the U.S. Centers for Disease Control and Prevention and the U.S. Preventative Services Taskforce,” says Dr. Jeffrey Moore, an internal medicine physician. “Our guidance is that men 55 and older should discuss the benefits and risks of 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. While a biopsy will result in a clear diagnosis, it may also lead to additional health complications, including pain, blood in the semen and infection. This is another factor to consider when deciding whether to screen for prostate cancer.
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. Finally, radiation therapy may be employed to kill the cancerous cells. Several additional therapies are being evaluated for effectiveness in treating prostate cancer.
Both surgery and radiation therapy can produce lasting side effects, including sexual health issues, urinary incontinence and bowel problems. That’s why physicians are cautious about rushing to diagnose and treat prostate cancer, as the odds of dying from this condition are low.
“With prostate cancer, one of our goals is to avoid an overdiagnosis situation,” explains Dr. Charles Cook, a family medicine physician. “Overdiagnosis might occur if we biopsied the prostate, found cancer and then took extraordinary measures to remove it via surgery or radiation, which may lead to the patient experiencing side effects and a reduced quality of life. We could argue that’s an acceptable risk if the cancer would ultimately have been deadly, but what if the cancer was slow-growing and was never going to cause any symptoms?”
“That’s why we must remember that 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,” adds Dr. Andrew Hoover, a family medicine physician.
Other Prostate Conditions
An enlarged prostate – Benign Prostatic Hyperplasia (BPH) – is rare among men younger than 40 but commonly experienced by men over age 50. About one-third of men experience moderate to severe BPH by age 60 and half do by age 80.
The tube that transports urine out of the bladder, the urethra, passes through the prostate. Therefore, an enlarged prostate can interfere with urine flow and create uncomfortable pressure on the bladder. Symptoms of BPH include:
- Frequent urge to urinate
- Needed to urinate overnight
- Difficulty starting urination
- Weak or intermittent urine stream
- Dribbling 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.
Diabetes, heart disease, obesity and lack of physical activity may also play a role in developing BPH. There is some evidence that a healthy diet can reduce the likelihood of BPH, including eating more fruits and vegetables, as well as getting regular exercise.
Your physician may prescribe medications to help with 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.
Prostatitis is a bacterial infection of the prostate, which can lead to painful urination, difficulty urinating and pain in the lower back, abdomen, groin area or testicles. It is often caused by urine leaking into the prostate, causing infection. Prostatitis primarily affects men under the age of 50.
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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