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Time for a prostate cancer screening? Read this first

Whether your clinician has brought up the topic of a prostate cancer screening, or your experiencing new urinary symptoms, here’s the need to know on how to care for yourself

For men in their 50s, discussion of a prostate cancer screening is likely to happen at some point with their clinician. For men at higher risk–African Americans and/or those with a first-degree relative diagnosed with prostate cancer before age 65–that discussion may happen even sooner.

Curious about the pros and cons of a prostate-specific antigen (PSA) test or digital rectal exam (DRE)? Not sure even what or where a prostate is? Share this article with the men in your life and stay up-to-date on current clinical guidelines.

The prostate: what is it?

The National Cancer Institute has this to say:

The prostate is a small gland in men. It is part of the male reproductive system. The prostate is about the size and shape of a walnut. It sits low in the pelvis, below the bladder and just in front of the rectum. The prostate helps make semen, the milky fluid that carries sperm from the testicles through the penis when a man ejaculates. The prostate surrounds part of the urethra, a tube that carries urine out of the bladder and through the penis.

In short, your prostate is likely something you’re not thinking about when everything is working fine. However, this gland tends to grow larger with age. That often means new symptoms for men in their 30s and 40s.

Are men’s and women’s health really that different? Read here.

Urinary symptoms to watch out for

Because the prostate surrounds part of the urethra, it can squeeze the urethra as it enlarges or is inflamed. This is why, as men age, they often experience:

  • peeing more than usual during the day
  • an urgent need to pee
  • less or “weaker” urine flow
  • a burning session when peeing
  • getting up multiple times at night to pee

The prostate gland tends to grow larger with age. That often means new symptoms for men in their 30s and 40s.

If you’re experiencing any of the above, you should bring it up with your doctor. If it’s prostate cancer, it’s important that it’s found early. Everside Regional Medical Director Dr. Mary Jean Vorwald notes, “The keys to surviving cancer have always been about recognizing and addressing risk factors and early detection.”

Do these symptoms mean I have prostate cancer?

Not necessarily. The three most common prostate problems are inflammation, an enlarged prostate, and prostate cancer. And one change does not lead to another. That means having inflammation or an enlarged prostate (or both!) does not increase your risk of prostate cancer.

Inflammation can be caused by:

  • a bacterial infection–the least common, but easiest to treat with antibiotics
  • chronic bladder infections–can be treated with antibiotics over a longer period
  • chronic prostatitis or chronic pelvic pain–several treatment plans possible, including anti-inflammatory medications and/or muscle relaxants to improve urine flow

You may also have inflammation but not know it, called asymptomatic inflammatory prostatitis. It’s usually found when you’re being screened for something else.

Likewise, an enlarged prostate (also called benign prostatic hyperplasia, or BPH) can have similar symptoms to prostate cancer. But it’s not life-threatening. While the prostate gland is about the size of a walnut for a man in his 20s, it can grow to the size of an apricot in his 40s and to a lemon in his 60s. BPH can’t be cured, but drugs and/or surgery can help relieve painful symptoms.

No matter what, always share with your doctor any new symptoms you’re having. “Regular communication with your primary care provider is always best answer to maintaining your health and well-being,” says Dr. Vorwald. “Your primary care provider knows you, and wants to help.”

So…should I get screened?

It depends. By age 50, very few men have symptoms of prostate cancer. Yet some precancerous or cancer cells may be present. In fact, more than half of all American men will have some cancer in their prostate gland by age 80. Most of these cancers never pose a problem or become a serious threat to health.

“The keys to surviving cancer have always been about recognizing and addressing risk factors and early detection.”

Everside Regional Medical Director Dr. Mary Jean Vorwald

However, age, race, family history, and diet are all possible risk factors. Your clinician may recommend a screening in your 50s, or sooner, if:

  • you are African American–the disease tends to start at younger ages and grows faster than in men of other races
  • you have a family history–fathers or brothers who have had prostate cancer mean a higher risk for you; there also appears to be a slight increase in risk with family histories of breast cancer
  • you eat a high-fat diet

A healthy diet pays huge dividends. Need some ideas?

The most common tests for prostate cancer

If you’re experiencing urinary symptoms, or any of the above risk factors are true, it’s a good idea to bring up a prostate screening with your clinician. They may bring it up with you, as well.

The most common tests are:

A digital rectal exam (DRE) – this tests lasts about 10-15 seconds. Your doctor will feel the prostate from the rectum with a gloved and lubricated finger. They’ll check for size, firmness, and texture; any hard areas, lumps, or growth; and any pain caused by touching or pressing the prostate.

A prostate-specific antigen (PSA) test – PSA is a protein made by prostate cells that sometimes leaks into the blood. Levels in the blood can be higher when cancer is present, but a high PSA blood level does not necessarily mean cancer.

It’s important to note that neither test is perfect. Everside Regional Medical Director Dr. Kelly Omalia has this to say about the PSA test:

“It can be elevated in men who have BPH and not prostate cancer. Before checking a PSA level, I tell my patients not to panic if it comes back slightly elevated. By waiting to see if the (protein) levels rise before we perform further testing, we avoid doing biopsies in men that do not need invasive testing.”

“PSA screening is a topic where shared decision-making is key.”

Everside Regional Medical Director Dr. Kelly Omalia

Likewise, she notes the U.S. Preventive Services Task Force no longer recommends the DRE due to a lack of evidence of benefits. “For men ages 55 to 69,” she adds, “PSA screening is a topic where shared decision-making is key.”

Many health risk factors are in your control. Try getting outside!

Talk with your provider about your options

In conclusion, getting screened for prostate cancer is a choice to be considered between you and your doctor. There are numerous factors that determine whether or not a PSA exam is needed. But always share with your doctor any changes you feel or see with your bladder or when peeing. And be aware of your family history.

Looking to make an appointment today? If you’re an Everside member, your care team is here for any health questions you have.