September is Prostate Health Awareness Month, a time to raise awareness about prostate cancer and other common prostate issues.
Prostate health is a key component of men’s overall health and is something every man in his 40s and older should be aware of. Prostate issues are not uncommon as men age, and they should always feel comfortable talking with their doctor about any questions or concerns they have.
What is the Prostate?
The prostate is a part of the male anatomy and a key component of a man’s reproductive system. It’s a gland – about the size of a walnut – that sits below the bladder and wraps around the urethra, the tube that transports urine out of the body. The prostate’s role in the reproductive process is to produce the fluid for the semen that carries the man’s sperm.
Prostate Cancer
Not counting skin cancer, cancer of the prostate is the most common cancer to affect men. 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.
According to data from the U.S. Centers for Disease Control & Prevention, out of every 100,000 men, 119 will be diagnosed with prostate cancer and 19 will die from the disease.
The five-year survival rate for prostate cancer is nearly 98% – that’s great news, and it’s largely due to many prostate cancers growing very slowly. However, the fact remains prostate cancer can be deadly for some men – and that’s why awareness of this disease is so important.
Risk Factors for Prostate Cancer
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.
- Heredity: Men who have a family member, such as a father or brother who had the disease, are at higher risk.
- BRCA1/BRCA2 gene mutations: while these inherited traits are most commonly associated with breast cancer and ovarian cancer in women, they also raise risk of prostate cancer in men.
Prostate Cancer Symptoms
Prostate cancer does not always produce symptoms. When it does, symptoms may 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
These symptoms do not necessarily mean a man has prostate cancer. They can be caused by other prostate conditions or by something completely unrelated to prostate health.
Screening & Diagnosis
Screening for prostate cancer is challenging. The prostate-specific antigen (PSA) blood test may detect prostate cancer, but it also has downsides.
The PSA test is a simple blood test that can be done alongside routine health screenings, such as a cholesterol and blood sugar test.
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.
PSA Testing
There is considerable debate within the medical community about PSA testing. While the test can have value in detecting cancer, it can result in both false-positives (indicating cancer when none is present) and false-negatives (indicating no cancer when the disease is present).
In addition, because 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. Preventive Services Taskforce (USPSTF), an organization of medical doctors and disease experts, last issued prostate cancer screening guidelines in 2018:
- Men ages 55-69 should make individual decisions about whether 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 diagnosed
- Men over 70 should not be routinely screened for prostate cancer
“Privia Medical Group North Texas doctors agree with the recommendations of the U.S. Preventive Services Taskforce,” explains Dr. Wilder Diaz-Calderon, an internal medicine physician in Fort Worth. “Our guidance is that men should discuss the benefits and risks of prostate cancer screening with their doctor, taking into account medical history and other factors, make a decision together as to whether or not a PSA test is beneficial.”
Biopsy of the Prostate
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.
Multiparametric MRI (mpMRI) guided biopsies are increasingly used to diagnose prostate cancer. This technology produces detailed and clear images of the prostate, helping ensure the correct part of the prostate is biopsied. The mpMRI may result in fewer biopsies being conducted.
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. Given that prostate cancer is slow growing, a biopsy may not be the best course of action for all men. This is another factor to consider when deciding whether to screen for prostate cancer.
Prostate Cancer Treatment
Prostate cancer is traditionally treated in three main ways: surveillance, surgery and radiation treatment. In recent years, hormone therapy and immunotherapy treatments are showing promise in treating prostate cancer, as well.
With active 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. Surveillance rates of low-risk prostate cancer doubled between 2014 and 2021, meaning more men are forgoing more aggressive treatment if there is not a clear indication that it’s necessary.
Doctors may recommend “watchful waiting” for older prostate cancer patients. This is a form of surveillance that involves less frequent testing and a focus on providing symptom relief.
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.
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.
“Prostate cancer is a disease in which it is possible to over-diagnose, something we try to avoid,” says Dr. Diaz-Calderon. “Overdiagnosis might occur if we biopsied the prostate, found cancer and then took extraordinary measures to remove it via surgery or radiation. This may in turn lead to the patient experiencing lasting side effects and a reduced quality of life. If the cancer was slow-growing and unlikely to cause any serious problems, would that have been worth it?”
The bottom line is, every man’s circumstances are unique and there is not a one-size-fits-all treatment approach for prostate cancer.
Other Prostate Conditions
Enlarged Prostate
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 symptoms of 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, as well as create uncomfortable pressure on the bladder.
Symptoms of BPH include:
- Frequent urge to urinate
- Needing 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 and obesity 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. There is not a drug that will shrink the prostate, but prescription medications can help relax it and increase blood flow, both of which help ease the symptoms of 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
A bacterial infection of the prostate, prostatitis 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.
What About Prostate Supplements?
As with numerous other health conditions, it’s easy to find supplements marketed to improve prostate health. Men should be skeptical of these claims, however.
Some supplements are said to help with BPH; others to reduce the risk of prostate cancer. However, there is no consistently reliable research to support these claims. While some studies have suggested supplements such as saw palmetto, selenium and zinc produce positive results for prostate health, other studies have shown no benefit.
“If you’re experiencing BPH symptoms, talk to your doctor before starting any supplements,” says Dr. Mauricio Ruiz-Barron, an internal medicine physician in Fort Worth. “We may be able to prescribe proven, effective medication as opposed to you spending money on a supplement that may not help at all.”
Prostate Health: An Important Part of Men’s Health
The prostate is a vital part of a man’s reproductive and overall health. If you’ve noticed changes in your body or are experiencing unexplained symptoms, including difficulty urinating, it’s definitely something to discuss with your doctor.
“Remember, plenty of men will experience prostate issues at some point in their lives, so there is absolutely nothing to be embarrassed about if you develop symptoms,” says Dr. Ruiz-Barron. “Please talk to your doctor about what’s going on so we can help protect your health and improve your quality of life.”
This article has been reviewed and approved by a panel of Privia Medical Group North Texas physicians.
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