Time out for a brief anatomy lesson. The prostate is a gland that is about the size of a walnut and sits just below the bladder. It completely surrounds the urethra, which is the tube that allows us to expel urine from the bladder. If you find yourself getting up a night for a trip to the bathroom, you may have a growing problem.
Perhaps you are asking yourself, "Why is this such a big deal?" Better you should ask your doctor.
"Believe me, I understand that a digital rectal exam (DRE) may not be high on your to-do list," sympathized Dr. Andrew Wagner, director of the Center for Minimally Invasive Urologic Surgery at Beth Israel Deaconess Medical Center. "Prostate issues are almost inevitable. And often, a urinary obstruction or infection can be addressed by your primary care doctor."
"But when you consider that prostate cancer is the most common cancer in men, and as we get older our risk increases, it makes sense to include it as part of a regular checkup after age 40. African-American men have a higher incidence and family history is a factor, so men in either of those two groups should consider it even earlier."
Because of the high incidence (one in six men will be diagnosed with prostate cancer in their lifetime), researchers began looking for some sort of "marker" to indicate the presence of the disease. That search led to the development of the Prostate Specific Antigen, or PSA Test, which has been widely used as a screening tool since 1994.
"Since the introduction of the PSA test, the death rate from prostate cancer has been cut almost in half. That's remarkable," noted Dr. Sanda. "But it's not a perfect test. You can't say, 'A high PSA equals cancer.' A high PSA would most likely be followed by a simple biopsy to determine whether cancer was present or not. And even if biopsy shows a prostate cancer, we have come a long way with regard to treatment options."
"If a man comes to a center like BIDMC, he will have access to the most appropriate therapies for his specific case," explains Dr Wagner. "That might be external radiation therapies or radioactive seed implants if the cancer is in an early stage. If a patient's age or the progress of the disease makes surgery a better choice we can offer nerve-sparing techniques -- minimally invasive surgeries and robotic-assisted surgery. "
"In some cases, we can actually take a wait and see approach. We call it active surveillance," offered Dr. Sanda. "If the biopsy shows a less aggressive cancer we can choose to increase the monitoring -- that means having a PSA test every six months and maybe an MRI or biopsy once a year."
There are a number of factors to consider, such as the patient's age, family history and other risk assessments, he said. But studies have shown that for some men, treatment can be postponed without adverse outcomes.
"We're going to recommend immediate treatment about two-thirds of the time," Dr. Sanda adds. "Honestly, I think that some guys are more worried about the side effects of treatment than they are about the cancer."
Well, when the side effects can include bladder control issues and erectile dysfunction, can you blame anyone for not thinking straight?
"The satisfaction rate of patients who have had prostate cancer treatment is pretty high," said Dr. Sanda. "When asked about the impact on their life overall, 85 to 90 percent say they are very satisfied. Less than 10 percent have urinary or bowel trouble one year or later after treatment. I have to be honest and say we are not as far along with the sexual side effects, but if you were active before treatment the prospects are good that you will recover that function in a year or two."
"Ultimately, it's about curing cancer," noted Dr. Wagner. "It helps to have an understanding partner. We also have a network of patients who have gone through treatment. They are a great sounding board for men who are trying to understand their options."
So, if you find that you often feel the urge, I urge you to go -- to your doctor that is. There are a number of prescription drugs that can help with that issue. An enlarging prostate is normal and it doesn't necessarily mean cancer. But, do yourself and your family a favor and find out for sure.
As Woody Allen said in the movie Sleepers, "My brain? It's my second favorite organ."
What do you say we use ours?