Prostate Cancer: What Every Man Should Know

Last month The New England Journal of Medicine published a fantastic article about the use of MRI in prostate cancer screening and I thought it’d be a great opportunity to talk about prostate cancer in general.

Prostate cancer can be an extremely complex topic and there’s a lot of conflicting information out there, but the info below should be a quick primer on what every man should know about this critical aspect of men's health. If you’d like to see more posts like this, let me know in the comments below!

What is the prostate?

The prostate is a gland that sits in front of the bladder and surrounds the urethra. Think of an apple after it’s been cored out and you’ve got the general idea. The prostate helps make semen and deposits it into the urethra during sex, which is what allows it to be expelled during orgasm.

Cross-sectional illustration showing the prostate in relation to neighboring structures.

Testosterone stimulates the growth of the prostate, which means that the prostate keeps growing throughout a man’s life (much like hair or fingernails). This typically isn’t a problem for most young men, but it can start causing men problems around middle age.

What type of problems?

The prostate can basically cause problems in one of three ways:

1)    It can grow so large that it can obstruct the flow of urine. Known as benign (aka not cancer) prostatic hyperplasia or BPH, this will affect virtually every man at some point in their life.

2)    The prostate can become inflamed or infected leading to a condition known as prostatitis.

3)    Or the prostate cells can start to grow in a disorganized fashion – leading to prostate cancer.

Each of the above are totally separate entities – just because you’re not urinating as well as you once did does NOT mean that you have prostate cancer.

How do I prevent prostate cancer?

Unfortunately, there’s no ‘magic bullet’ to prevent prostate cancer. In 2013, a study showed that the drug finasteride (aka Proscar or Propecia) reduced the risk of LOW-grade prostate cancer. But as we’ll see below, LOW-grade prostate cancer generally isn’t a threat to the men who develop it. Most tested vitamins and supplements have been shown to not affect prostate cancer.

There are certain men who are at increased risk of developing prostate cancer, and these include men with a family history (aka if your father, uncles or grandfather had it) and African American men.

How do you detect prostate cancer?

From a patient perspective, prostate cancer screening is pretty straightforward. We generally recommend that men start screening at age 50, unless they have a family history. Your urologist will draw a blood test known as a PSA (prostate-specific antigen) and perform a physical exam that includes a prostate exam. (Yes, this means a finger in the butt. Is it awkward? Yes. Painful? No.)

What is PSA?

PSA is an enzyme that’s made by the prostate and found in the blood. It can be elevated following infection or irritation, but it can also be elevated in men who have prostate cancer. An elevated PSA doesn’t mean you have prostate cancer, but it could mean that you’re at an increased risk and may benefit from further testing.

What further testing should I expect?

If your doctor thinks you have an abnormal physical exam OR you have an elevated PSA, he may recommend a prostate biopsy. This is an outpatient procedure where your urologist will sample the tissue of the prostate to ensure you’re cancer-free. This is actually where some of the most exciting developments in prostate cancer are taking place, including advanced genetic screening of the biopsied tissue and MRI-guided ‘fusion’ biopsies. This is the focus of the article I cited above, but we’ll get into more detail with that in a later post.

What should I do right now?

If you’re over the age of 50 – make an appointment with your local urologist to discuss prostate cancer screening. If you’re younger than that, screening generally isn’t recommended unless you have a strong family history of prostate cancer.

If you have any questions about prostate cancer or any other men's health issue (like low testosterone, vasectomy reversal, or erectile dysfunction) - sound off in the comments below!