It’s something most men of a certain age dread and has served as a popular topic of jokes for years, but one leading urologist for OSF HealthCare St. Francis Hospital & Medical Group in Escanaba, Michigan, sees a decline in men getting properly screened for prostate cancer as a real danger.
According to urologist Michael Harris, MD, all men over the age of 50 with a life expectancy greater than 10 years should get screened for prostate cancer every year. If you have a family history of prostate cancer or you’re African-American, you should begin getting screened annually at the age of 40. Prostate cancer is very treatable, and the earlier it’s detected, the better.
The prostate sits in front of the rectum and below the bladder. It wraps around the urethra and makes the fluid part of semen. If you catch prostate cancer when the tumor is small, surgery to remove the tumor will result in less damage to the nerves and sphincter, which means you can better maintain your potency and continence.
Heading in the wrong direction
Since the U.S. Preventive Task Force recommended against the blood test portion of the prostate cancer screening process in the mid-2000s, Dr. Harris has seen the gains made in catching prostate cancer early revert to the days before regular screening became the norm.
Between 1992 and 2012, there was a greater than 50 percent reduction in the death rate from prostate cancer in the U.S., thanks to the addition of blood test to the screening process and more aggressive and effective treatments for younger men.
“The recommendation against screening has hurt American men,” Dr. Harris said.
The average tumor size Dr. Harris was removing in the ’90s was 12 grams. By the mid-2000s, the average was down to 3 grams, which means he was removing cancers early, before they could spread or cause more harm.
Since 2008, however, the average cancer size has risen to more than 10 grams, almost back to the pre-screening era. The percent of patients whose cancer has spread beyond the prostate is at least 40 percent right now. Those men have a higher risk of cancer recurrence, too.
How to get proper screening
Proper screening consists of two tests: the digital rectal exam and the PSA blood test.
Most people are aware of the rectal exam because a lot of men find it uncomfortable and embarrassing, and it makes for an easy premise in a comedy movie or television show. But it only takes 10 seconds, and 10 seconds of mild discomfort is much better than letting cancer go unchecked, which can lead to serious consequences, including death. Delaying diagnosis of prostate cancer can lead to the need for hormone therapy, which Dr. Harris said “turns the testicles off,” or can require the removal of the testicles altogether.
“Basically, early detection prevents major damage,” Dr. Harris said.
The blood test checks for the presence of prostate specific antigen (PSA). It’s typically only found in the blood if something is wrong with the structure of the prostate, allowing the antigen to leak into the blood stream.
“If you have an elevated or rising amount of PSA in your blood, it’s a sign something might be wrong in the prostate, and cancer could be one of those things,” Dr. Harris said.
Both exams are necessary because one can turn up an issue that the other might miss, Dr. Harris said. During a rectal exam, your doctor could find a suspicious nodule, while the blood test appears normal. Likewise, the blood test could reveal the presence of PSA in your blood, while the rectal exam fails to turn up anything.
So, do both screenings, and if either one turns up something abnormal, you need to pursue further examination with an urologist to identify the problem. Talk to your doctor about regular prostate exams.