Only males have a prostate gland. It sits in front of the rectum and surrounds the urethra, the tube structure that carries urine from the bladder to the outside world.
Become familiar with the potential symptoms prostate cancer can cause. The initial symptoms of prostate cancer are usually related to the gland getting larger and squeezing the urethra, which in turn can slow down the urinary stream and make it difficult to completely empty the bladder so one ends up needing to urinate more often. Benign enlargement of the prostate can also cause these same symptoms of urinary hesitancy and frequency. Less commonly, prostate cancer can lead to erectile dysfunction or the presence of blood in the urine or ejaculate fluid. If the cancer spreads outside of the gland it can cause bone pain and weight loss.
Learn about screening tests. It is important to note that prostate cancer is often fairly advanced by the time it ever causes any symptoms. Screening tests try to identify people who may have a disease before they develop symptoms. Discovering the disease before it has progressed means subsequent treatment will be more likely to succeed. There are two main prostate cancer screening tests:
- Digital Rectal Exam. The Digital Rectal Exam (DRE) involves the examiner placing a gloved and lubricated finger into the patient's rectum in order to feel the prostate gland. A lump or nodule on the usually smooth surface of the prostate or unusual firmness or irregular shape of the gland can be signs of cancer.
The advantages of this test are that it is simple and inexpensive. The main disadvantage is that an examiner can at best feel only half of the gland surface; cancers in other areas of the prostate, or deep within the gland, could be missed.
- Prostate Specific Antigen (or PSA) test. The Prostate Specific Antigen (PSA) test is a blood test that looks for abnormally high levels of an enzyme produced by the prostate. Anything above the normal range of 0 to 4.0 raises the possibility of cancer. A trend of steadily increasing PSA values over time, even if all are still below the "normal" cutoff, can also raise concern.
The advantages to the PSA test are that it is convenient and relatively cheap. The biggest disadvantage is that other common prostate conditions, such as benign enlargement or infection, can also increase PSA readings, meaning many patients who do not have cancer endure anxiety and prostate biopsies.
Another limitation to this test is that it can still miss some patients who do have prostate cancer. Any abnormal PSA measurement should be confirmed by a repeat test before any other action is taken, as levels can fluctuate naturally.
Prostate cancer testing is a complex issue. It is important to be familiar with the unique nature of prostate cancer. It can indeed act aggressively and lead to death, but it is more common for this cancer to progresses at a slow rate. The rate can be so slow, in fact, that many older men with prostate cancer would probably end up dying from another unrelated cause if the disease was left untreated.
So even when the digital rectal exam and PSA test accurately identify men with prostate cancer, there is no way at this point in time to reliably distinguish between the aggressive and non-aggressive cases. In other words, a significant number of men could go through the discomfort and expense of prostate cancer treatments such as radiation and surgical removal of the gland, and potentially suffer complications such as impotency and urinary incontinence from these procedures, all for a disease that was never going to affect their health in the first place. In fact, the U.S. Preventive Services Task Force says that "the evidence is insufficient to recommend for or against routine screening for prostate cancer using PSA or DRE."
Discuss with your healthcare provider whether or not you should be tested. Most medical organizations recommend that a patient discuss the risks and benefits of prostate cancer screening with his healthcare provider and then make an informed decision. Those who should have this discussion with their doctor are all men over the age of 50, all African-American men over 40, all men over 40 with a close relative affected by prostate cancer, or any man suffering from possible prostate symptoms.