If you're a man in your 40s or older, you may well harbor prostate cancer without realizing it.
If you don't get it checked, that's too bad, since the disease kills many who would have survived had they sought treatment in time.Often the symptoms are overlooked until too late. Still, if a man has some of the indications, that doesn't necessarily mean he has prostate cancer, says Dr. James C. Jensen, a urologist at LDS Hospital and at Salt Lake Regional Medical Center, Eighth Avenue and C Street.
How can you know? Get checked.
Non-cancerous infections of the prostate, called prostatitis, are common, said Jensen. "Urologists see a huge amount of that. Most of the time it is cured or significantly improved with antibiotics. Fortunately, we're getting better antibiotics all the time."
Jensen and a fellow urologist - Dr. George Middleton of Cottonwood Hospital and Salt Lake Regional Medical Center - are the experts scheduled for Saturday's edition of Health Care Hotline. They will be able to answer call-in questions about all aspects of urology, from kidney stones to incontinence, from prostate cancer symptoms to treatments.
Prostate ailments of one kind of another make up some of the most common afflictions that hit men. "It really boils down to diseases which are infectious and diseases which result from either benign or malignant growth," Jensen said.
Some infections may be caused by micro-organisms that physicians don't understand yet. "Unfortunately, those people (with the infection) sometimes develop very chronic pain and other things that are difficult to eradicate," he said.
For about 40 percent of men, the prostate will naturally enlarge with age, leading to discomfort. It is a condition that might require treatment.
The symptoms include a decreased force of the urinary stream, dribbling, incontinence, feelings of incomplete emptying. In past years, surgeons would trim the prostate gland to cure these problems, even when the patient did not have a malignancy.
Today, however, new kinds of therapy are available, such as pills that relieve the symptoms. The treatment may not actually reverse the disease or cure it, he believes, "but many people feel vastly improved when taking the medications, which relax or shrink the prostate."
Recently developed surgical procedures promise to substantially improve the control of the ailment, in addition to reversing the symptoms. The new procedures "come down to delivering some kind of thermal (heat) energy to the prostate, which results in its shrinkage over time."
Much more serious is a malignancy of the prostate gland, which is a killer cancer.
"It frequently results in the death of the person it afflicts," Jensen said. "More than 200,000 cases will be diagnosed in the United States this year and something like 40,000 to 45,000 men will die in the United States this year."
Only about 1 percent of prostate cancers are discovered in men younger than 50. But that may be because they often don't get checked as soon as they could and the disease goes unnoticed until it is further advanced. The earlier it is caught the better the chance of a cure.
Unfortunately, a large number of men in their later 50s and 60s come to doctors with advanced disease. "They've had it many years."
The American Medical Association recommends that a man with a first-degree relative (father or brother) who had prostate cancer should get yearly screenings starting at age 40. So should others at high risk, including black men, who have an unusually high incidence of prostate cancer.
The American Urological Association and the AMA recommend that men who are not in those high-risk categories should get screened yearly starting at age 50.
Screening requires a quick physical examination by the physician "in combination of a widely used and readily available blood test called PSA," he said. The initials stand for prostate specific antigen.
"The screening for prostate cancer is really quite simple. In patients with problems urinating, there's a clear indication that it should be done."
Symptoms of prostate disease, any of which should prompt a trip to the doctor's office, include:
- Difficulty initiating the urinary stream.
- Diminished force of the stream.
- The stream becoming intermittent.
- Dribbling after urinating.
- Getting up at night to urinate.
- Extreme frequency of urination.
- Extreme urgency to urinate.
- Incontinence associated with an extreme urge to urinate.
- Blood in the urine.
- Urinary tract infections.
Jensen said the symptoms fall into two classifications, which overlap. They are obstructive problems, caused by some kind of obstruction of the urinary system, and irritation of the bladder.
The good news is that recently, men have become more diligent about screening. "This has resulted in the discovery of a huge number of prostate cancers," he said. "We're finding prostate cancer at a very early stage of the disease."
Even better, for the first time, this year the American Cancer Society discovered "a decrease in mortality for prostate cancer." Urologists think that's because more men are aware of the risks and symptoms of prostate cancer and are getting screened earlier, he said.