Sometimes as men get older, they notice
changes going on in their bodies that are uncomfortable. This column is for
the men who may be experiencing these problems now or might some day, and for
the women who live with them.
Guys have a gland that women don’t. It’s called the prostate, and its purpose
is to provide the fluid that sperm live in. It’s normally about the size of
a walnut and surrounds the urethra. The urethra is the tube that leads from
the bladder (where the urine is stored until you decide to let it out), which
then passes through the prostate and down the penis to the outside of the body.
As men age (usually after 50), the prostate gland often gets larger, putting
pressure on the urethra. This happens to so many men that there are a few folks
in medicine who think this may be a normal part of the aging process. It’s called
Benign (noncancerous) Prostatic (referring to the prostate) Hypertrophy (hypertrophy
means “gets bigger”), or BPH for short. When the man tries to urinate, the flow
is hesitant; the urine stream comes out a little, stops, and then starts again.
If it’s severe, he may not be able to urinate at all.
A man may notice he is getting up more at night to go to the bathroom. Sometimes
the prostate is enlarging, however, and it is not a benign process. It might
be cancer. In this case, you would want to see a health care provider to help
determine what is causing your discomfort and whether you need to see a urologist
(specialist in urinary and prostate health) to have tests done to determine
if you have cancer or not. And what if it’s not cancer? The good news is that
there are medicines that can help shrink the size of the prostate and allow
urinary flow to get back to normal. For those of you who like the more natural
approach to things, saw palmetto is a plant extract that may be useful for these
symptoms and might even prevent enlargement of the prostate. You can buy it
in your local supermarket or health food store without a prescription.
Screening is usually done for people who don’t have any symptoms. It’s possible
to have an illness at an early stage where you have still not developed discomfort
from it. Prostate cancer is a greater problem among African American men and
men whose fathers or brothers had prostate cancer. Annual screening for these
folks should start happening at age 40 or 45. For other men, age 50 is usually
the time to start. What exactly does screening involve? One part of screening
is a blood test called a PSA. If there is a cancer in the prostate, a substance
called Prostate Specific Antigen is released into the bloodstream and will be
picked up by this test. That’s the way it works most of the time. But sometimes,
for some reason, the PSA does not get higher in the blood even when a cancer
is present.
It’s very tempting to just leave it at doing a PSA; easier for the patient and
easier for the practitioner. However, this is where the dreaded rectal exam
comes in. Because the PSA blood test is not 100% accurate all the time, the
other part necessary for prostate cancer screening is the rectal exam. The examiner
can tell from the size and the way the prostate feels if it is normal. If the
gland feels abnormal to the examiner, even though the person has a normal PSA,
further evaluation should be done. On the contrary, sometimes the person has
a normal feeling prostate but the PSA is high. In either case, the man should
see a urologist either for more blood tests or a biopsy. A biopsy is a procedure
in which little bits of tissue are taken from the prostate and sent to a lab
to be looked at by a pathologist, a doctor who specializes in determining if
cells are normal or abnormal.
So, what if it’s cancer? Many times prostate cancer is very slow growing, so
slow growing in fact, that if a person has other serious health issues, they
may die from those before dying from prostate cancer. In younger men and African
American men, cancers may be rapid growing and more aggressive. There are many
good treatments for prostate cancer - surgery, implantation of radioactive seeds
that destroy the cancer, hormone treatments and others. The important thing
is to know if it’s cancer early so you can make decisions about your treatments
rather than finding out when there is little left to be done. One way or the
other, you will end up dealing with it. Why not deal with it when you have more
choices and a little more control over your treatment decisions?
However, there is controversy about whether or not prostate cancer screening
is really useful or if it should be done routinely on all men. Some organizations
say that is has helped lower the number of deaths from prostate cancer; others
say it hasn’t, and that it only subjects men to unnecessary biopsies. There
are some possible down sides to treatment for prostate cancer, among them impotence
(inability to have an erection) and urinary incontinence (inability to control
urination). Some men are simply not willing to run that risk and would rather
not know if they have cancer. The Centers for Disease Control suggests that
you discuss screening with your health care provider so that you understand
the risks and benefits of it and then decide if it’s something you want to do.
This would be true of any screening you have.
There are many websites you can go to for more information about prostate health.
If you perform an online search for “Prostate Health” literally millions of
matches will be found. As always, and with any health problem you may have,
the more you know about it, the more questions you can ask your provider. In
that way, you and your provider can come to acceptable screening and treatment
decisions together.
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2004 10-4 Magazine and Tenfourmagazine.com
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