As a doctor, I would love to talk about prostate cancer tests with many more patients than I currently do.
With around 3,500 Australian men dying from the disease each year, what GP wouldn’t?
The mere mention of the prostate and the prospect of a digital rectum examination is a source of anxiety for most men.
ON THIS PAGE
- What is prostate cancer?
- Diagnosis: There’s no perfect test
- The PSA blood test
- A GP’s advice
- About Dr Michael Macpherson
Few know there are less invasive ways to screen for prostate abnormalities.
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?
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, BPH can cause these symptoms and 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 Test for Prostate Cancer
The medical community recognises that no single test can determine if a patient has prostate cancer. Often, a change in prostate-related symptoms can be the first sign something may be wrong.
Cancer screening aims 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, breast, 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.
Blood Test for Prostate Cancer (PSA)
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 physically examining the prostate can cause elevated PSA levels.
A digital examination involving the doctor inserting a finger into the anus, is equally unreliable. In saying this, such examinations can help monitor if a patient has a sudden prostate enlargement or experiences a change in symptoms.
GP Advice on Prostate Disease
If you’re over 50 years old (or over 40 with prostate cancer in the family) or simply worried about your prostate, chat with your GP.
Talking about symptoms is often a useful and vital first step. Together we can decide the appropriate treatment and 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 I have these conversations with men every day. Talking about the prostate is nothing to be embarrassed about.
Moreover, a proper discussion will likely make you feel less anxious about any symptoms you may be experiencing.
Dr Michael Macpherson is a local GP at Doctors of South Melbourne.