I’d love to talk about diagnosing prostate cancer with many more patients than I currently do. With around 3,500 Australian men dying from the disease each year, what diligent GP wouldn’t?
The mere mention of the prostate and the prospect of a digital rectum examination (DRE) is a source of anxiety for many men. Few know there are other ways to screen for prostate abnormalities – more on this later.
For now, let’s jump in and get a few facts straight.
What is Prostate Cancer?
The prostate gland sits below the bladder in men (women don’t have one) and produces a lot of the fluid that makes up semen. It also provides nourishment for sperm. Like several other organs, the prostate can be affected by cancer.
There are different kinds of prostate cancer. The majority are slow-growing and rarely cause harm, often only discovered as a man ages.
On the other hand, some cancers are quite aggressive. They can quickly spread to other body parts to cause more serious harm, even death.
Risk factors for prostate cancer include:
- advancing age
- family history of the disease (especially in male relatives <65 yrs old)
- lifestyle factors like a lack of exercise, excess alcohol and smoking.
What Are the Symptoms of Prostate Disease?
Prostate cancer is one of the three common types of prostate disease. The other two are prostatitis, which affects men of all ages, and benign prostatic enlargement (BPH). BPH is the most frequently diagnosed prostate disease, typically affecting older men.
Symptoms of prostate disease may involve changes in:
- urinary flow or stream – either ‘stop-starting’ or having difficulty passing urine
- urgency – needing to pee without warning
- control, such as dribbling.
Waking overnight from time to time to urinate is normal. Getting up more and more frequently can suggest something is going on with the prostate.
In saying this, such symptoms can be caused by BPH as well as prostate cancer. A change in any of the above symptoms over the last 3-6 months should prompt a conversation with your doctor.
There’s No Perfect Way to Screen for Prostate Cancer
It’s widely recognised that no single test can tell us if a patient has prostate cancer. Often, a change in prostate-related symptoms can be the first sign something may be wrong.
Cancer screening is designed to detect a disease before any signs or symptoms are present. This allows us to treat the cancer with better outcomes before it has a chance to cause harm.
Bowel cancer, breast cancer and cervical cancer all have recognisable, reliable screening processes that we follow. Unfortunately, cancers afflicting the ovaries and prostate do not.
There’s ongoing medical debate surrounding prostate cancer screening as most detected cancers are the low-risk kind (slow-growing) that don’t warrant treatment.
However, testing for and treating these low-risk cancers often results in unnecessary invasive investigations or significant complications.
The PSA Blood Test
A prostate-specific antigen (PSA) blood test can help screen for prostate cancer. Yet, the PSA test can be falsely positive (elevated levels but not due to cancer) and sometimes falsely negative (a ‘normal’ level even if the patient has early prostate cancer).
Physical exercise, sexual intercourse, benign prostatic growth or examining the prostate itself can cause elevated PSA levels.
Conducting a DRE, involving the doctor inserting a finger into the anus, is equally unreliable. In saying this, a DRE can help monitor if a patient has a sudden prostate enlargement or experiences a change in symptoms.
Advice About Prostate Disease
Have a chat with your GP if you‘re worried about your prostate.
Talking about symptoms is often a useful and vital first step. Together we can decide the appropriate next steps, such as:
- safely monitoring symptoms over time
- referring you for a PSA blood test
- examining the prostate
- referring you for imaging (ultrasound or MRI)
- referring you to a urologist (prostate specialist).
The most important thing to remember is that as GPs, we have these conversations every day. Talking about the prostate is nothing by which to be embarrassed.
What’s more, a proper discussion will often allow someone to feel much less anxious about symptoms they may be experiencing.