September Is Prostate Cancer Awareness Month: What You Need to Know

by Virginia ‘Ginya’ Carnahan

First of all, the disease is prostate cancer, not prostrate cancer. 

Much more importantly, however, is the fact that more men are diagnosed every year with prostate cancer than women are diagnosed with breast cancer. It’s true. You just don’t hear or read about it as much. It’s time to change this.

The prostate gland is a mysterious, walnut-sized gland that sits below the bladder, in front of the rectum and surrounds the urethra – and only men have one. Its purpose is to provide fluid to propel sperm.

Most men are unaware of their prostate until it starts giving them trouble. Around middle age, the gland can begin to enlarge and put pressure on the bladder, making urination difficult. This is called BPH: benign prostatic hyperplagia. It is not prostate cancer.

Prostate cancer, like many cancers, happens when something goes “wonky” (real medical term) in the cells. We can’t always tell why, but we do know that exposure to certain chemicals (Agent Orange, for one) can increase the risk of prostate cancer. There is also a genetic link. If a father, brother or other close relative has had prostate cancer, it greatly increases your risk of developing the disease.

What should you do? As with all cancers, early diagnosis is critical to the cure. It is recommended that every man have a baseline screening prostate exam at age 50, but earlier if there is a family history of prostate cancer. The exam consists of two parts: a PSA (prostatic-specific antigen) blood test and a DRE (digital rectal exam – a finger test). If both are normal, then these tests should be repeated annually to track any changes.

If you are at least 50 and your doctor has not mentioned a prostate exam, be proactive by asking for one! A lot of men are reluctant to have the DRE because it may be a little uncomfortable, but it lasts only 10 to 15 seconds. It’s far less uncomfortable than suffering a fatal case of prostate cancer.

You may ask what symptoms you should look out for. Sorry, but in most cases, there aren’t any real symptoms in the early stages, making the screening exam doubly important. Some things to look out for might be difficulty urinating (hard to get started and not emptying fully), frequent urination, lower-back pain, night sweats and unexplained weight loss.

Should your screening exam reveal an abnormality (an elevated PSA score or a nodule found though the DRE), don’t panic. And most of all, don’t hide your head in the sand. Most likely your doctor will want to repeat the tests in a few weeks.  

Sometimes the PSA can be elevated because of physical circumstances, such as having recently ridden a motorcycle, bicycle or horse; or having ejaculated within the previous 48 hours. The screening results are not a diagnosis; they’re just an indication of an abnormality.

If the same results appear during a repeat screening, your doctor will refer you to a urologist, who may elect to do a biopsy of the prostate gland. Again, many men resist this critical step. You must remember that for any cancer – every kind, from simple skin cancer to complex brain cancer – there must be a biopsy to identify the cells under a microscope. There is no other way. 

I advise you to let your urologist know that you’re aware that the best biopsy is the one that takes many samples, not just six or eight. Hopefully you will have a biopsy only one time, if it’s thorough.

The pathologist’s review of the biopsy cores will determine whether there are cancer cells in those samples. If so, they are graded using a Gleason Score, which tells two things: how advanced the cancer is and how much cancer is present. The Gleason Score is expressed as two numbers, such as 3 + 3 = 6 or 4 + 3 = 7. The highest score would be 5 + 5 = 10, indicating a very advanced, serious cancer.

If you are found to have cancer, you have many choices of treatment: surgery, robotic surgery, radiation, seed implant and others. Whatever you choose, please do your homework and get second opinions! Don’t rush into a decision you might regret later.  

Today there are nearly 700,000 American survivors of prostate cancer. You can be one, too.

Virginia ‘Ginya’ Carnahan, APR, CPRC is a freelance medical writer visiting Door County who offered this article as a public service to all readers. If you have comments or questions, email her at [email protected].