Confront Prostate Problems Before It’s Too Late
Written by: John Cavallo, M.D.
Published in The Enterprise & The Patriot Ledger
Among primary care doctors like me, there’s an open secret about men’s health that everyone knows but no one likes to talk about. It’s that if you live long enough, you are likely to face prostate problems such as enlarged prostate or prostate cancer.
While this might not be the most comfortable topic for us guys, there’s no better time to confront the issue than in June, when we mark Men’s Health Month. I commonly see men, especially those over age 50, with prostate problems. A number of these men end up getting diagnosed with cancer. That’s the bad news.
The good news is that when detected early enough, prostate problems, including cancers, are often treatable. In fact, as scary as prostate tumors sound, nowadays they are a malignancy that can frequently be managed, contained and, if the patient is older, simply lived with.
But let’s back up a bit and talk about what the prostate is. This gland is found only in men and plays an important role in producing semen – the liquid containing sperm. It’s located between the rectum and penis and just below the bladder. In younger men, the prostate is about the size of a walnut, but it enlarges as we age. In general, three things can go wrong – one or more of which probably will at some point in a man’s life – with the prostate: infection, enlargement and tumor growth.
Prostatitis, an infection of the prostate, typically occurs in younger men when bacteria in the urine infects the gland and causes painful urination and ejaculation as well as abdominal pain. Antibiotics can usually wipe out the troublesome germs, and the quicker the diagnosis, the better.
An enlarged prostate, which happens to older men, is exactly what it sounds like. The gland becomes larger and takes up too much space. This can cause problems, such as putting pressure on the urethra, the tube that urine flows through. When this happens, you feel the need to urinate frequently and urgently, especially at night. But when you go, the urine often flows weakly, stops and starts, and it seems like the bladder is not emptying out completely. Patients often complain to me that they’re waking up two or more times a night to urinate. These symptoms are often the same as those for prostate cancer, so anyone experiencing this should tell their doctor.
Ruling out a tumor is not the only reason for a visit with a physician. Because the prostate is essentially in the middle of your “plumbing” system, if it causes a backup and low flow, it can lead to kidney and bladder problems, urinary tract infections, or other conditions that affect your quality of life and health. Fortunately, an enlarged prostate is usually treatable, often with medication, surgery, or other procedures such as laser therapy, depending on the severity of the condition.
Screening and treatment of prostate cancer is less straightforward. The U.S. Preventive Services Task Force has gone back and forth on its advice for the prostate-specific antigen (PSA) test that can help identify potential prostate cancer, but also can give false positive readings, leading to unnecessary worry and procedures. The most recent advice is for doctors to discuss the risks and benefits of PSA tests with men aged 55 to 69 and test if the patient agrees. The task force recommended against testing in men aged 70 or older due to lack of proven benefit.
In my practice, I take a slightly more aggressive approach to screening, keeping in mind that this is a personal decision for my patients. While informing my patients of the pros and cons, I tend to advise men to take the test starting at age 50. But I’m against it for men aged 75 or older. Another method for screening is the digital rectal exam, which is a relatively simple internal check of the prostate by a doctor.
The drawback to aggressively screening for and treating prostate tumors is that the risks can sometimes outweigh the benefits. This is mainly because some types of prostate cancer may never pose any significant health risks in older patients, but treatment with procedures such as prostatectomy (removal of the prostate) or radiation therapy may lead to erectile dysfunction and a loss of bladder control, among other side effects that significantly affect a patient’s quality of life.
It’s hard for most people to hear that they have tumors that they should just leave be. That’s why many doctors believe there’s little use in looking for prostate cancer in men age 75 and older – they’re more likely to die of other natural causes than from the cancer itself. More than 98 percent of men with the malignancy live for five years after the diagnosis, according to the National Cancer Institute.
On the other hand, more than 11 percent of men will be diagnosed with prostate cancer, with African American men being at highest risk, and it will cause nearly 30,000 deaths this year. In addition, finding tumors early can greatly increase the chance of survival. So, spotting this common cancer early can help save lives, especially because some forms can be aggressive and spread quickly.
Because many men may not like discussing prostate health with their doctor out of embarrassment or a fear of the unknown, I ask patients questions proactively, encouraging them to disclose any symptoms that may need follow-up. I encourage all men in the age range noted above and/or who are experiencing these symptoms to discuss this with their doctor.
Remember, what you don’t know can hurt you.