Men’s Health Special: Prostate Health
Andrew PERRETT, Family Medicine Physician
It’s a fact – even though men do not statistically live as long as women, they also do not seek medical help as often! Men’s Health Week is in June. In an effort to increase awareness of men’s health issues and promote early detection and prevention, let’s have a closer look at prostate health, a very male specific concern and one that all men should know about.
What is the prostate?
The prostate is a small male gland about the size of a walnut which surrounds part of the outlet from the bladder (urethra), and usually goes unnoticed in the first few decades of life. However, symptoms and problems related to the prostate gland become increasingly common with advancing age.
What can go wrong with the prostate?
Prostatitis is usually caused as a result of an infection in the prostate gland. This can be painful and may result in passing urine more often, sometimes with discomfort. These symptoms can also be associated with an ‘ordinary’ urine infection or with a sexually-transmitted infection. As a result, a diagnosis is made based upon symptoms, physical examination and laboratory tests, and can usually be treated with antibiotics.
Benign Prostatic Hyperplasia (BPH)
Benign prostatic hyperplasia (BPH) simply means enlargement of the prostate gland. This is found in the majority of men over 60 years of age. Often this causes no problems, but other times it can partially block the urethra. The most common symptoms include having to pass urine often (including getting up several times at night) and trouble with starting and stopping the act of passing urine. Effective medication is available for sufferers and when necessary. Surgical treatment can also make a dramatic improvement.
Prostate cancer is the second most common type of cancer in men in the United States and a major concern the worldover. Prostate caner can cause similar symptoms to BPH, so as a result doctors will test for prostate cancer in men with symptoms of urinary outflow obstruction. Early prostate cancer can be completely asymptomatic, while advanced disease can cause many other symptoms. Prostate cancer is increasingly common with advancing age, with 80% of prostate cancers occurring in men over 65. However, it does not always progress to cause serious illness. This leaves doctors and patients with difficult decisions to make about screening.
How can you screen for prostate cancer?
Digital Rectal Examination (DRE)
A DRE allows the prostate gland to be felt by a gloved finger in the rectum. This examination is not comfortable or dignified, but it should not be painful and is a routine part of an annual medical review for men greater than 40 to 50 years of age.
Prostate Specific Antigen (PSA)
A PSA blood test measures levels of a protein from the prostate gland circulating in the blood. In up to 80% of prostate cancers, it can be increased. However, PSA can also increase with prostatitis and other diseases of the prostate. PSA testing is not 100% sensitive or 100% specific for cancer.
A transabdominal or transrectal ultrasound can be used to view the prostate gland, particularly if one or both of the DRE and the PSA test results are abnormal. When necessary, ultrasound can also be used to guide a biopsy of the prostate.
Should I do prostate cancer screening?
With the availability of prostate screening comes the debate over whether healthy men should be screened for prostate cancer, what method to use, how often to screen, and what age to start. If you ask six doctors, you might get six slightly different answers.
While the disease can occur at any age, generally speaking men less than 40 years old should not be tested routinely. It is reasonable to consider whether or not to screen for prostate cancer from age 50 onwards. However, if you have a family history of prostate cancer or if you are ethnically African-American, you are at higher risk for the disease and could discuss screening with your doctor from age 40 onwards.
The screening tools available are not recommended for everybody because there is no absolutely clear evidence so far that doing these tests saves lives overall, and the investigation and treatment of prostate cancer can cause adverse effects. So here is a list of important things to know about prostate cancer screening to help be better informed when making your decision:
- Screening with the PSA blood test can detect cancer at an earlier stage than if no screening is performed.
- Prostate cancer screening might or might not reduce the risk of dying from prostate cancer. The evidence is mixed.
- If prostate cancer is detected by screening, we cannot accurately predict who will most likely benefit from treatment and who will not.
- Once cancer is detected, treating for prostate cancer could lead to complications. These include problems of bladder control, bowel symptoms and sexual dysfunction. Sometimes these are minor and temporary, but they can be significant and permanent.
- The PSA and DRE tests can produce false-positive or false-negative results on some occasions. Therefore a positive result must be confirmed with follow up tests and a negative result does not give 100% reassurance.
- Abnormal results from screening with PSA and DRE are sometimes followed by prostate biopsies. This can cause pain and lead to complications such as infection or bleeding.
- Even if prostate cancer is detected through screening, it may not require immediate treatment. Sometimes doctors advise repeated blood tests over time or repeated prostate biopsies to monitor the situation and guide future treatment.
What should I do?
Speak with your doctor about any symptoms that you might be experiencing and seek their advice about whether or not you should start screening.
In addition to age appropriate screening you can also try to eat a ‘prostate-healthy diet.’ Here are a few tips you can follow:
- Reduce your intake of red meats and cheese
- Increase your intake of vegetables, especially broccoli, cauliflower and perhaps tomatoes
- Increase your soya intake, such as tofu
- Increase your fruit intake
- If you take multivitamins, do not exceed the stated dose (usually one daily).