Prostate Cancer in the news again

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Every week some male asks me about the PSA test, and even knowing exactly what their PSA numbers have been for the past 10 years. You think I joke? I do not.

The male child is born with a subconscious fascination for the anatomy he finds in his nappy. Watch an infant learning this. As the boy turns into man, what goes on in his underpants becomes a major pre-occupation. As the man turns older, fear of cancer in the underpants is an even greater pre-occupation.

Unfortunately prostate problems are extremely common, a situation we men have to live with. Like all things, there is a downside as well as the fun side. In fact this year in the United States, almost 180,000 men will be told that they have prostate cancer.

With all our older friends getting prostate problems, does this mean there is a rise in the incidence? Are our underpants too tight? One reason for the ‘apparent’ increase is the fact that prostate cancer is a disease of aging, and we are all living longer. The statistics show that by age 50, almost 50 percent of American men will have microscopic signs of prostate cancer. By age 75, almost 75 percent of men will have some cancerous changes in their prostate glands. Do the maths. By 100 we’ve all got it!

So does this mean that life really ends at around 76? Fortunately no. Most of these cancers stay within the prostate, producing no signs or symptoms, or are so slow-growing, that they never become a serious threat to health. The good news is you die of something else before the prostate gets you! You die with it, rather than from it.

The real situation is that a much smaller number of men will actually be treated for prostate cancer. About 16 percent of American men will be diagnosed with prostate cancer during their lives; 8 percent will develop significant symptoms; but only 3 percent will die of the disease. Put another much more positive way, 97 percent won’t die from prostate cancer.

While prostate cancer can be ‘aggressive’, breaking out from the prostate gland itself and attacking other tissues, including brain and bone, fortunately this is the minority scenario. The great majority of prostate cancers are slow growing, and it can be decades between the early diagnosis and the cancer growing large enough to produce symptoms.

So let’s look at diagnosis and get the “blood test” out of the way first. The blood test is called Prostate Specific Antigen, or PSA for short (we medico’s love acronyms). Up till then we had another test called DRE (digital rectal examination), which, quite frankly, was not all that popular. So when news came through about a “blood test”, millions of men began rejoicing and the sale of rubber gloves plummeted. Unfortunately, PSA is not a go/no-go test. A normal range test doesn’t guarantee you haven’t got it, and an elevated result doesn’t automatically mean that you are about to claim early on your life insurance (or your dependents, anyway).

However, there is good news. We are becoming smarter with the PSA test. Serial PSA examinations can show the rate of growth. This gives us ‘Staging’ with four main grades. Stage I cannot be felt and is diagnosed through pathological testing. Stage II can be felt, but it is confined to the prostate. Stage III is coming out of the gland and Stage IV has grown into nearby tissues.

There is also the biopsy to contend with. Sticking a needle into the prostate isn’t fun either, and in my opinion is a bit hit and miss, but now there is the application of the MRI to try to avoid biopsy.

This is where you need to discuss your options with your doctor. If you are a young man with stage IV, then you have to make up your mind quickly. But if you are 75 with stage I or II, then you have more time, as you will most likely die of other causes rather than prostate cancer. “Watch and Wait” has much going for it, but you must be prepared to get to know your urologist. Pick a young one!