As men age, health risks become more prevalent. One health risk that should be monitored is prostate disease and prostate cancer.
According to the American Cancer Society, other than skin cancer, prostate cancer is the most common cancer in American men. The most recent statistics say that about 240,890 new cases of prostate cancer will be diagnosed and about 33,720 men will die of prostate cancer.
September is National Prostate Cancer Awareness Month and one of the goals of this month is to try to being attention to prostate health and prostate disease and men’s health.
Board Certified Urologist Dr. Benjamin Bernstein at New Albany Urology, said, “Prostate cancer is the most common male form of cancer as men age. This disease is frequently related to prostate disease in both non-cancerous and cancerous forms.”
“About one in six men will be diagnosed with prostate cancer during his lifetime. More than two million men in the United States who have been diagnosed with prostate cancer at some point are still alive today,” according to the American Cancer Society. “Prostate cancer is the second leading cause of cancer death in American men, behind only to lung cancer. About one man in 36 will die of prostate cancer.”
Bernstein suggests that caucasian men should start getting screened for prostate cancer and prostate disease at age 50 or as early as 40 if there is a family history. In African-American males, the suggestion is to start getting screened at age 40 because some reports show that the disease may be a little more aggressive in African-Americans than in caucasian males.
“Prostate cancer frequently doesn’t exhibit any symptoms. One of the ideas behind creating this month where we try to place attention on prostate disease in men, is that you screen for the disease,” said Bernstein. “Screening basically consists of getting a digital rectal exam and getting a blood test, which is called a PSA. PSA stands for prostate-specific antigen. Those are two of the best ways to try to detect prostate cancer. For years, the disease could be relatively indolent and won’t manifest itself with any symptomatology.”
Later on, if a man has developed prostate cancer, symptoms may arise, such as frequency, urgency of urination, difficulty voiding, which may suggest that the disease has progressed.
Bernstein said, “Benign disease of the prostate is a disease in older men and it can present as difficulty with urination, straining to urinate, frequency, hesitancy, urgency, waking up at night to go to the bathroom a lot. Those are all possible manifestations of benign enlargement of the prostate and that is very different from prostate cancer. Prostate cancer can cause these symptoms particularly late in the course.”
Bernstein said that in some men, there is some reluctance for men to have the tests run, but he said that the importance is that if you are able to detect a potentially life-threatening situation early on and cure a patient, then a 20 or 30-second exam that may be a little uncomfortable is worth it.
“An important caveat is that 30 percent of patients with prostate cancer can have a normal PSA, so the PSA is not a perfect test. You really need to have your doctor steer you through what that blood test means. The PSA does not tell you if you have prostate cancer; it tells you whether you should have a biopsy of the prostate. A prostate biopsy will then tell you if you have prostate cancer or not. That is typically done under transrectal ultrasound guidance. The ultrasound itself will not tell you if you have cancer or not,” said Bernstein. “The digital rectal exam and the PSA test does not tell me that you have prostate cancer; it tells me that we need to rule that out as a possibility. The biopsy may reveal cancer, chronic inflammation of the prostate, or other pathological diagnoses.”
According to Campbell-Walsh Urology, 10th edition, “PSA screening may have a beneficial effect on prostate cancer mortality; however, the absolute effect is small relative to the number needed to screen and treat to cure a single individual.”
Bernstein said that there is a spectrum with prostate cancer than determines its aggressiveness.
He said, “That is one of the major issues that has come to the forefront because there are prostate cancers that can cause metastasis, particularly to the bone and it can spread other places too. Then there are prostate cancers that are very, very slow-growing.”
He said that one of the challenges after a patient has been diagnosed with prostate cancer is to determine how dangerous the cancer is, because depending on the aggressive nature of the cancer, it may take 10-12 years before it spreads.
In determining how aggressive it is, the doctor would look at the stage of the progression of the cancer, look at the PSA test, and determine other factors.
Bernstein said, “The PSA test is not a perfect test. The patient will need to sit down and talk to their doctor about it. Screening tests is really only valuable if it prevents cancer deaths. I would recommend that men start getting a prostate exam done when they become of age and if there are any questions, call their doctor and ask questions.”