Will you die from cancer of the prostate?

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There has been some interest in prostate cancer in the social media, which prompted me to write this article.  Let me state, right at the outset for all the men reading this, that most probably you will not die from prostate cancer.  Let me also state quite categorically that the old finger in the bottom is a test that has been surpassed as a diagnostic necessity.  When I was a medical student we were told, “If you don’t put your finger in it, you’ll put your foot in it!”  However, since those days we invented many other ways of ‘visualizing’ internal glands, the prostate being just one of them.

Now for some statistics: Prostate problems are very common, something we men have to live with.  The incidence increases with age.  For a man in his 40’s – 1 in 1000; for a man in his 50’s – 12 in 1000; for a man in his 60’s – 45 in 1000; for a man in his 70’s – 80 in 1000.

With all our older friends getting prostate problems, does this mean there is a rise in the incidence?  Are our underpants too tight?  Simple answer – No!  One reason for the ‘apparent’ increase in prostate cancer is the fact that prostate cancer is a disease of aging, and we are all living longer.  The statistics would also 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.  While the numbers quoted above look fearsome, the real situation is not quite so bad.  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.  This means I must be OK, as my three friends with prostate problems hopefully make up the three percent of my acquaintances.

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 and ‘buyer resistance’ was high, 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 this growth, another good reason for regular check-ups.

Like many other cancers, prostate cancer can only be fully diagnosed by examining prostate tissue samples under the microscope.  The definitive diagnosis will need a biopsy.

So let’s imagine that now you have had a positive biopsy.  You’ve got it!  What are the real options?  Actually very many and depend mainly upon the ‘stage’ of the cancer and your age.  Discuss this and the options with your doctor.  There may be no need for any operation.