April 23, 2014

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“Why not just take the damned thing out?” asked a woman recently, referring to her husband’s prostate, which contained proven but low-grade cancer by biopsy. His urologist and I were treating this man with cancer-suppressing injections (Lupron) with the belief that he would live longer and more comfortably this way.

Before looking at som

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e promising advances in prostate cancer management, please consider with me the far and away most common prostate disorder — benign prostate hypertrophy, or BPH.

The prostate gland surrounds the urination tube from the bladder to the penis and secretes a sexual lubricant, although it is not required for sexual function. BPH affects most men to some degree, as we get older, as the prostate gland enlarges into and narrows the urination tube. This narrowing of the passage leads to gradually increasing difficulty starting and completing the urination process, in turn causing frequent urination, day and night.

Several medications improve the symptoms of BPH, but at times surgery, and even a newer laser vaporization technique, to open the channel, is necessary, and normally not a major procedure.

Now returning to our man with low-grade prostate cancer, why not surgery?

Surgery could, indeed, be helpful, but several important reasons make us all think twice.

First, any operation is stressful, saying nothing of expensive. Second, a cure might not be possible, while a low-grade cancer could spread only slowly. Third, control of urination, starting and stopping the flow, may be upset by surgery. Finally, sexual performance may be impaired or even ended. This couple did in fact consider this aspect important when they had the information.

Radical surgery, especially in younger men, can be completely curative. Newer methods of sparing the nerves often help preserve sexual function after surgery. Detecting early prostate cancer is getting better every year.

Your doctor will first feel the back of the prostate with his gloved finger through the rectum. Any hard or nodular areas may be suspicious and need a sample piece taken with a needle biopsy by a specialist. This procedure is not painless, but is an office procedure.

Your doctor will likely test your blood for Prostate Specific Antigen (PSA), much as women in your family may have mammograms and pap tests for cancer screening every year or two.

The good news is that PSA testing, while not perfect, is improving. The bad news is that prostate cancer in its early stages is completely without symptoms, so unfortunately feeling just fine does not mean you always are fine. And if surgery does not prove to be curative for prostate cancer, radiation and chemotherapy have been very helpful, with men living many years comfortably with the disease.

So, please give yourself and your doctor the best chance of detecting prostate cancer early by going in for a visit once a year. And if benign prostate enlargement (BPH) is giving you symptoms, your doctor can help you with this, too.