As Men, Do We Let a Little Discomfort Keep Us
From Getting Our Prostate Checked?
O.K., guys can we talk about the prostate? Yes, that mysterious gland that all guys possess, but few of us want to discuss. A quick look at WebMD gives us a clear picture of what we’re talking about:
The accompanying article gives the basics: “The prostate is a walnut-sized gland located between the bladder and the penis. The prostate is just in front of the rectum. The urethra runs through the center of the prostate, from the bladder to the penis, letting urine flow out of the body. The prostate secretes fluid that nourishes and protects sperm. During ejaculation, the prostate squeezes this fluid into the urethra, and it’s expelled with sperm as semen.”
But the experiences most men have are not easily captured with a scientific description of the prostate. Here’s how author John Irving describes his experience in his book The Water Method Man: “Odd and painful peeing is not new to me. Seven times in the last five years, I have suffered this unnamable disorder…Urinating is often a challenge, the sensation always new and surprising. Also, it’s time consuming going through your day in anticipation of the next time you’ll have to pee. Sex, typically, is unmentionable. Orgasm is truly climactic. Coming is a slow experience like the long, astonishing journey of a rough and oversized ball-bearing. In the past I had given up the act altogether. Which drives me to drink, which makes the pee burn: an unfriendly circle.And always the non-specific diagnosis.”
I remember having these kinds of experiences and learned that I had the first of the three main conditions men are likely to deal with during some part of our lives.
- Prostatitis: Inflammation of the prostate, sometimes caused by infection. In some cases, it is treated with antibiotics.
- Enlarged prostate: Called benign prostatic hypertrophy or BPH, prostate growth affects virtually all men over 50. Symptoms of difficult urination tend to increase with age. Medicines or surgery can treat BPH.
- Prostate cancer: It’s the most common form of cancer in men (besides skin cancer), but only one in 35 men die from prostate cancer. Surgery, radiation, hormone therapy, and chemotherapy can be used to treat prostate cancer. Some men choose to delay treatment, which is called watchful waiting.
Common Prostate Tests
- Digital rectal examination (DRE): A doctor inserts a lubricated, gloved finger into the rectum and feels the prostate. A DRE can sometimes detect an enlarged prostate, lumps or nodules of prostate cancer, or tenderness from prostatitis.
- Prostate-specific antigen (PSA): The prostate makes a protein called PSA, which can be measured by a blood test. If PSA is high, prostate cancer is more likely, but an enlarged prostate or a prostate infection can also cause a high PSA.
Why Am I Afraid of The PSA?
Most guys dread bending over the table and having our prostates examined by the doctor poking a finger up our butts and feeling the prostate. The truth is, it’s not pleasant, but it’s over quickly, and we are on our way with a “see you next year.” However, the PSA is a number which can vary depending on many factors.
I’ve known for some time I have an enlarged prostate, which elevates my PSA, but like most men, I worry about prostate cancer. My worry about the PSA is that it leads many doctors to recommend interventions such as a biopsy and possible surgery if there is evidence of prostate cancer. From my experience, there are way too many interventions that cause more harm than good.
For me the problem isn’t getting the PSA, but what happens when the doctor reads the numbers and what he (my urologist, like most, is male) might recommend based on what my PSA numbers are.
To PSA or Not to PSA: The Answer Is PSA Testing, Plus
If our PSA is elevated, there is a tendency for doctors to recommend getting a biopsy. The problem, for me, with the biopsy is that it is invasive (little needles are shot through the walls of the anus into the prostate to take sample cores to analyze for prostate cancer). Further, once you start doing prostate biopsies there is a tendency to continue to repeat them. Eventually it is likely they will find some abnormal cells and if prostate cancer is detected the recommendation is often surgical removal.
Jay Cohen, M.D. is a nationally esteemed medical practitioner and researcher. He is the author of eight health books and more than a hundred medical articles. His latest book is Prostate Cancer Breakthroughs: New Tests, New Treatments, Better Options. He speaks from many years of professional experience, but also from his own journey with prostate cancer.
“I was diagnosed with prostate cancer in December 2011,” he says. “Steered immediately toward radical treatment, the doctors said, ‘Your PSA is very high and your biopsy is positive, so your only alternatives are surgery or radiation.’ Luckily I heard about the new methods and was able to avoid these aggressive treatments.”Dr. Cohen’s experience can guide all men as we deal with our prostate issues:
- When PSA testing was initiated in 1990, it reduced the death rate from prostate cancer 40%, from 50,000 to 30,000 deaths per year.
- Men need to start testing at age 50. At-risk men, at 40. At older ages, keep testing annually as long as you enjoy living.
- Our current method of using PSA and prostate biopsy to determine who needs aggressive treatment is highly fallible. PSA and biopsy are simply not reliable enough to assure accurate diagnosis.
- Overtreatment of prostate cancer is rampant. Of the 50,000 prostatectomies done annually, 40,000 are unnecessary. The same with radiation therapy. This must be fixed.
- When approximately 80,000 men a year are receiving unneeded, aggressive treatment that often causes life-long impairment of sexual functioning and/or bladder control, overtreatment must be avoided.
- Continue getting PSAs, but if they are elevated get the new MRI. Although MRIs have been used for almost three decades for every other part of the human body, previous MRIs could not differentiate normal prostate tissue from cancerous tissue. Now, with the advanced 3.0 Tesla MRI machines, we can. Known as the multi-parametric MRI, this cutting-edge test is a game changer.
“When I was diagnosed with prostate cancer in 2011, I spoke to four urologic surgeons, and each told me unequivocally I needed surgery,” says Cohen. “I believed them. They are good doctors. But I heard about the new MRI, obtained one, and it showed one localized tumor in a safe area of my prostate gland. I took myself off the surgery list.”
Every man must make his own decision about dealing with prostate problems, including potential prostate cancer. But there is new information that can benefit us all. Learn as much as you can as soon as you can.
For more information about Dr. Cohen’s work visit him at http://www.medicationsense.com/.