Why men should pay attention to their prostate gland
“Where the heck is the prostate, anyway?” asked one of my hockey-playing friends recently.
This is an incredibly common question regarding one of the most enigmatic glands in the male body – the cause of well more than 30,000 cancer deaths per year, billions of dollars spent on the prevention, diagnosis and treatment of both cancer and even more-common benign diseases that occur in this walnut-sized gland.
Despite this gigantic impact on men’s health, there is a surprising lack of understanding about the prostate, and specifically prostate cancer.
While there are quite literally books that far outweigh the diminutive gland that they discuss, my goal is to provide a few basic facts about prostate cancer.
As always, these are purely informational guidelines and are no substitute for close interaction with your personal physician.
The prostate functions to assist with fertility. It is a secretory gland that is about the size and shape of a walnut in the middle-aged adult, and produces a variety of proteins that assist in conception.
The gland is located right at the outlet of the bladder, and with aging, it commonly enlarges, interferes with the outflow of urine and cause the common (but treatable) symptoms of difficult urination that are quite common in the aging man.
Importantly, this is NOT related to cancer. In fact, it is uncommon to have cancer of the prostate present with difficulty urinating.
Prostate cancer, when it develops, is generally on the outer portion of the gland and is almost always entirely silent while it grows. Symptoms generally develop when it has spread to bones or other areas of the body.
Unfortunately, by the time this spread (called metastasis) has occurred, it is no longer possible to cure the cancer.
The good news for men has been the development of a test that can help detect this cancer long before it spreads, and while it is still highly curable.
This test is called PSA (Prostate Specific Antigen) and it is based on the fact a small amount of one of the proteins secreted for release with ejaculation is actually absorbed into the bloodstream, where the test can find it.
The level of PSA in the blood increases with cancer, and can help your physician decide when to do further tests to attempt to detect the cancer.
The PSA test is not 100 percent accurate and can be elevated by infection, benign enlargement and other complicating factors.
Despite these imperfections, PSA is believed to have resulted in the decrease in prostate cancer deaths and the increase in the detection of far more early stage, curable cancers.
Much debate focuses on what level should be considered abnormally high. Many authorities are proposing that a value over 2.5 should at least prompt a discussion with your physician.
The blood test needs to be done in concert with a direct examination of the prostate, which still detects many cancers that the blood test misses.
For the man with a suspicious PSA result or an abnormal examination of the prostate, the next step is frequently a biopsy of the gland.
This is the only way to confirm or disprove the presence of cancerous cells. Another welcome development is a technique to numb the gland before biopsy.
Numerous studies have shown that the tolerability of biopsy, which is necessary to gather tiny pieces of tissue for study, is much better than it was.
Men are, in general, only mildly bothered by this 20-minute procedure when done with modern equipment and good technique.
Treatment of men with cancer that has not spread beyond the gland can essentially be broken down to surgery, radiation or watchful waiting. Numerous alternative treatments exist, but few of these have been shown to be of any benefit.
Prostate cancer is generally a slow-growing process, and different approaches are appropriate for different instances.
Both radiation and surgery, when performed with the latest techniques and equipment, result in excellent cure rates for appropriately selected tumors.
Decisions about what treatment is best in a specific instance can vary widely, and should be left to each individual patient and their physician.
Can prostate cancer be prevented?
The answer is unclear but while we await the results of a few clinical trials addressing this question, there are some guidelines to follow.
Diets that are high in fat appear to contribute to the development of this malignancy and should be avoided.
Diets rich in both lycopene, found especially in tomatoes, and soy products may be preventative.
Also, deficiencies in the micronutrient selenium and vitamin E may turn out to play a role. Studies are under way.
The recommendations of the American Urological Association are that men begin screening with a PSA and examination at 50, and continue yearly thereafter.
Men of African-American heritage and those with a family history of prostate cancer should begin at 40; conversely men with a PSA that is under 1.0 may be able to go longer than a year before their next checkup.
The Shaw Cancer Center in Edwards will be sponsoring a Prostate Cancer Screening Day Jan. 10 . Call (970) 479-7800 to schedule an appointment.
Dr. Lloyd lives in the Blue Lakes area near Hoosier Pass. His urology practice is in Vail. He will assist in the screening day testing.
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