6/21/2021
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Posted by Alan J. Wieder, MD
While September has been designated as Prostate Cancer Awareness and Prevention month, it is never too early to learn about this disease.
Cancer of the prostate (a walnut-sized gland located just under the bladder and in front of the rectum) is the second most common cancer in men. The risk of developing prostate cancer increases with age, especially after the age of 65. African-American men, and in men with close relatives with prostate cancer have an increased chance of having prostate cancer.
Most prostate cancers grow slowly and never cause any symptoms. Symptoms that may occur include trouble passing urine, frequent urination, blood in the urine, and pain or burning with urination. Symptoms of advanced disease may include bone pain. It should be noted that these symptoms may be caused by conditions other than cancer.
If caught early, the death rate from prostate cancer is low. Common treatments for early prostate cancer include watchful waiting (close monitoring of the cancer to see if it grows or causes symptoms before starting any treatment), surgery, radiation therapy, and hormone therapy.
Now that you have some basic information about prostate cancer, are there ways to prevent prostate cancer? Are there ways to detect early prostate cancer? Is treating early prostate cancer always necessary?
The answer to the first question is, not really. At this time there are no known risk factors for prostate cancer that are under our control. We can’t control our age, race, or family history.
In terms of early detection of prostate cancer, otherwise known as “screening”, two tests are commonly used – a digital rectal exam (DRE) and a prostate specific antigen (PSA) test.
During a DRE, your examiner places a finger into your rectum and checks for any abnormalities that may require further testing for cancer. A limitation of this test is that it may miss many early prostate cancers.
PSA is a chemical that is normally produced by your prostate and measured with a blood test. High levels of PSA can be due to prostate cancer. The problem is that your PSA level may be normal even if you have prostate cancer. Or, your PSA level may be high due to non-cancer causes, which may lead to anxiety, and unnecessary tests and treatments.
Also, even if early prostate cancer is detected, it may be slow-growing and never cause a problem. Again, this may lead to anxiety and unnecessary tests and treatments.
The bottom line is that screening for prostate cancer remains controversial. Some men would like to do everything possible to check for cancer, even if the tests aren’t perfect, and even if the cancer may never cause them any problems. Others would rather not be tested since the results may not be reliable, and they may end up having tests and/or treatments that they don’t really need.
So what can you do? You can have a discussion with your health care provider and decide whether screening for prostate cancer is right for you. Also, contact your health care provider if you have any of the symptoms listed above.