LEWISBURG – Each year, approximately 200,000 men are diagnosed with prostate cancer for the first time. Prostate cancer is the second leading cancer-causing death among males — after lung cancer. However, it is often another health issue coupled with the prostate cancer that causes death.
“Many prostate cancers grow slowly and are confined to the prosate gland, where they may not cause serious harm. However, while some types of prostate cancer grow slowly and may need minimal or even no treatment, other types are aggressive and can spread quickly. Prostate cancer that’s detected early — when it’s still confined to the prostate gland — has the best chance for successful treatment,” said Dr. Scott Niditch a urologist with UPMC North Central PA.
Niditch, along with Dr. Matt Meissner with Geisinger Health System, and Dr. Manzoor Shah with Evangelical Community Hospital said it is important to understand that not all prostate problems are cancer.
The prostate gland is a golf-ball or walnut shaped gland located just below the bladder and near the rectum. It’s function, said, Shah, is to add fluid to semen and, as a man ages, the gland becomes larger naturally. “After age 40 there is a significant difference in size,” Shah said of the gland.
Shah explained the top three causes of prostate issues in men are benign prostatic hyperplasia (or BPH), prostatitis, and prostate cancer.
BPH is a noncancerous or benign growth in the gland. Shah said men who suffer with BPH typically struggle to empty their bladders, may dribble in their underwear or might have a constant urge to urinate.
“There are some good medications out there,” Shah said, to treat BPH, but sometimes surgery is necessary. The surgery is known as transurethral resection of the prostate or TURP. It involves the removal of the middle section of the prostate gland. Shah also recommends men with BPH drink less before bedtime.
Prostatitis is most common in men under the age of 40. It is an infection of the gland that may require antibiotics for several weeks. This infection may be caused by the sexually transmitted disease chlamydia. The infection can also be chronic.
Prostate cancer is very rare in men younger than 40. Six out of 10 men diagnosed are over the age of 65, Shah said, and it is more common in African American men. It is least common in Asian men. Symptoms may include trouble urinating, blood in the urine or semen, erectile dysfunction and unintentional weight loss.
Blood in the urine, Meissner said, “is a very big deal. Something is abnormal.”
Niditch pointed out that, “Prostate cancer may cause no signs or symptoms in its early stages.”
Risk factors for prostate cancer include a positive family history. Men who have a father, brother, son or grandfather who were diagnosed with prostate cancer are at greater risk.
Men whose mothers were diagnosed with breast cancer or ovarian cancer and also had the BRCA 2 gene, are also at risk.
Men exposed to pesticides, this includes some farmers, or industrial chemicals are at risk for prostate cancer. Men who consume a lot of animal fat, Shah said, are also at risk.
“Vegetarians and Japanese men experience the least episodes,” Shah said.
The common way to screen for prostate cancer is a blood test known as prostate-specific antigen or PSA. Doctors admitted this is not the most accurate screening, but it can help with diagnosis. If there is a strong family history, men may have the test between the ages of 45 and 55. The general population can be tested at age 55 and older.
If the test results are considered normal, the patient is not tested again for two years. A PSA under four is considered normal. A PSA over 10 is a concern. Any PSA over 20 is “highly concerning,” Meissner said.
However, Meissner said, the numbers can also be deceiving. “I have had guys whose PSA is in the 20s and have been biopsied many times,” and there is no cancer.
While Shah said he has known patients to have a PSA less than four who are diagnosed with prostate cancer.
Because the PSA is not specific enough, men should see a urologist when the numbers rise. “The only way to really know is with a biopsy,” Meissner said. He also said MRIs are used more often than they used to be. “If the MRI is normal, it makes me feel better,” he said. “Then we can check the PSA again in four to six months. If those numbers go up, we will do a biopsy.”
Because of the inconsistency with the blood test, urologists may opt to do a digital rectal exam, the most dreaded procedure for everyone involved, Shah noted. This process involves the urologist inserting a gloved finger into the rectum. “That is the only way to reach the prostate,” Shah said.
“Men are still concerned about being screened and having a prostate biopsy should it be necessary,” Niditch said, “ Today this is accomplished as an office procedure. The doctor can use numbing medication, like going to the dentist, making the experience much better than years ago. Men are back to work or doing whatever they want to do in a few days.”
Shah said it is best to do the PSA test before a digital rectal exam. The PSA number can be elevated if the rectal exam is done first. The PSA can also be elevated if the patient recently had an endoscopy of the rectum or had an infection of the prostate.
When performing the exam, Shah said if the doctor feels a bulge in the middle of the gland and the sides are smooth, it is likely a BPH and not prostate cancer. “If you find hard nodules on the sides of the gland it is nearly definitely cancer,” Shah said.
Meissner said other reasons for an elevated PSA could include inflammation and frequent riding of a bicycle or lawnmower, though these are rare causes.
If cancer is discovered, a patient may continue to be monitored without treatment.
“Today research has found that not all patients need treatment,” Niditch said. “Many patients are watched and do not need treatment, but should it eventually be necessary, the results are the same as those who had immediate treatment and patients do well.”
The patient may also have radiation or in more aggressive cases, he may have surgery to remove the nodules.
“The important thing is to realize how aggressive the prostate cancer is under a microscope,” Meissner said. This can determine the best method of treatment.
Prostate cancer can be prevented not only by screening, but also with diet.
Shah said diet “is very important” for all men in order to prevent prostate cancer. Cruciferous vegetables such as broccoli, cabbage and spinach are great, Shah said. He noted whole food and whole grains as opposed to processed foods are best, too.
Chickpeas, lentil and beans are helpful. Shah noted lycopene sources such as tomatoes and watermelon or other red fruits are huge cancer fighters.
Foods to avoid include high calcium products and fatty foods.
Men should talk to their urologist with any concerns and consider screenings regularly.
It is better to be checked than to be sorry later, Niditch said.
“Over the last year because of COVID-19 many people have stayed away from seeing health professionals and now it is time to catch up and take care of yourself,” he said.