Mind Your Prostate

April 6, 2005

By Greg Sanders, MD

Prostate cancer is the second leading cancer killer of men in the United States. One out of six men will get prostate cancer.

The good news is it doesn’t usually start until you are older. (One exception is if you have a family history of prostate cancer, then it may strike at a younger age.) The other good news is it is usually very slow growing.

If it hits older men and is usually slow growing, then what is the big deal? Well, we are all going to live longer than our parents. Middle age can extend into the 60’s and that is when prostate cancer is more prevalent. It is becoming more of an issue for us to address in middle age.

More good news is prostate cancer is easily curable, with one caveat. The catch is it has to be caught before it spreads outside of the prostate. Fortunately, a simple blood test, prostate specific antigen (PSA), will tell if you may have cancer. If the PSA level is going up or if it is elevated, then you will need a biopsy of the prostate. This will show if it is cancerous or a non-cancerous enlarging prostate. Checking the PSA every year after age 50 will typically be all you need to do, unless there is a family history of this cancer. A rectal exam has not always proven to be effective in screening for prostate cancer, but you should talk to your doctor about this.

There are multiple ways to treat prostate cancer. The most common is to surgically remove the prostate, and you are cured. (Remember, that is the case when the cancer is just in the prostate. The level of the PSA, the biopsy, and often imaging will tell if cancer is outside the prostate.) Another kind of prostate cancer treatment is radiation of the prostate, either with radioactive implants, or with external radiation. Hormone shots are also sometimes used in treatment.

Common side effects of prostate cancer treatment are some urine incontinence and loss of the ability to get an erection. These are prices paid for cure. I think most people are willing to accept these problems in exchange for ridding their body of a cancer that, left untreated, can kill. However, what if you were 80 years old, and your PSA came back suspicious for early prostate cancer? Should you have the full evaluation and surgery? The cancer may take 10 or more years to kill you. If you do nothing, and die naturally of some other typical old age aliment, you may be healthy without the side effects of surgery during those years. It is helpful to talk to your doctor before deciding to get a PSA, because you may be of an age where you wouldn’t want treatment, so why get the test?

What causes prostate cancer? If only we knew. I worked for Dr. Harold Varmus, who received the Nobel Prize in medicine for the co-discovery of oncogenes. We all have these cancer genes, and they are the cause of cancer at the molecular level. Somehow, our heredity, diet, and the environment can affect these genes. They cause a cell to divide without reservation, which is essentially the definition of a cancer. Certainly a healthy lifestyle may make these genes less likely to become active. There is however a need for more research in determining the cause of this specific type of cancer.

There are not always symptoms of prostate cancer, especially early in the disease. Some symptoms include:

- A need to urinate frequently, especially at night;
- Difficulty starting urination or holding back urine;
- Weak or interrupted flow of urine;
- Painful or burning urination;
- Difficulty in having an erection;
- Painful ejaculation;
- Blood in urine or semen; or
- Frequent pain or stiffness in the lower back, hips, or upper thighs

There are other causes of these symptoms, not just prostate cancer. Your doctor can help you sort this out. Please remember to ask whether you should be getting annual testing for prostate cancer. One in six odds of getting prostate cancer are not good. You need to be proactive and catch prostate cancer early, when it is curable.