I was recently at my favorite Italian restaurant when I overheard two old-timers from Bridgeport discussing their prostate problems. Apparently, one of them had been recently diagnosed with early stage prostate cancer and he was told that he had an excellent prognosis.
U.S. cancer statistics provided by the Centers of Disease Control state there were almost 184,000 new cases of prostate cancer in 2015, the year for which the most recent data is available. Almost 29,000 men in the United States died from prostate cancer in that same year.
Black men were disproportionately represented in the mortality group (17 percent) despite black Americans comprising only 13 percent of the U.S. population. Black men are at higher risk because of some genetic factors and often have a reluctancy to go to the doctor. This reluctance can needlessly delay early diagnosis and treatment.
Men should start being evaluated for prostate cancer at age 40. If there is a family history or if the man is African American, evaluation should be started earlier. These decisions should be made in consultation with a physician.
The prostate is a small gland that sits below the bladder in a man’s pelvis area. The urethra –– the body’s urine drainage tube –– passes through the prostate on its way from the bladder into the penis. When the prostate becomes enlarged, urine flow can be slowed. One of the effects of this urinary flow problem is that the bladder doesn’t completely empty, causing the frequent need to urinate.
The prostate can become enlarged even without cancer being present, and there are prescription medications that can help with improving urine flow. The prostate also makes some of the fluid that comprises semen and many of the nerves that are involved in normal sexual function are also located near the prostate.
Luckily, physicians are able to perform a digital prostate exam from the rectum, which helps them examine the size of the prostate and whether there are abnormalities. Although there have been reports about whether or not the digital examination is beneficial, for many patients they remain an important part of the initial workup.
Another essential component of the workup should be a blood test which measures the prostate specific antigen (PSA) level of a patient. The PSA is a substance that is made in the prostate. When it is elevated, cancer may be present.
There is some controversy about what should be considered an elevated PSA level. Traditionally, a prostate specific antigen level above 4 ng. / ml. is considered elevated. Again, it is best for a man to consult his physician for an individualized plan.
In some cases, prostate cancer is slow-growing. And, in older patients only careful observation is required without any medical or surgical interventions. But many patients will require therapy.
Of course, many patients are concerned about loss of sexual function or other side effects from surgery or radiation therapy.
My colleague, Dr. Paul Yonover, has had great success with reducing complications from radiation therapy by using a thin hydrogel spacer, which is injected into an area between the rectum and prostate.
While researchers continue investigating the role of genetics, environmental causes and viruses in the development of prostate cancer, I recommend that all men get their prostate checked.
Finally, I recommend that all men do like my two old-timers and get their “prostate” checked.
Dr. Alan Jackson is an assistant professor of medicine at Rush University. He is also a member of the board of directors of the Chicago Sun-Times.