Prostate cancer is the second leading cause of death in men, second only to heart disease. Prostate cancer has become the most diagnosed cancer in the U.S. In 2008, more than 186,000 men were diagnosed with prostate cancer, and more than 28,000 men died from the disease. One new case occurs every 2.5 minutes and a man dies from prostate cancer every 19 minutes. As the population ages, these numbers will increase every year.
Even though we hear about it on TV and read about it in newspapers and magazines, most people don’t have a real understanding of prostate cancer and how it can be found. Hopefully, after reading this information you will be more informed about prostate cancer and will have less uncertainty about the exams and tests used for finding it early. Maybe this basic information will provoke you to act on behalf of your own health. Maybe it will persuade you to have the routine exams needed to find cancer in its early stages, when it can be cured.
The Prostate Gland
The prostate is actually a collection of glands and is part of the male reproductive system. Its function is to produce fluid that becomes part of semen. The prostate is about the size of a walnut. It is located below the bladder. The outside of the prostate is a thin capsule of fibrous tissue. Just outside the prostate is a layer of fat.
The prostate is divided into the right and left sides, called lobes. The widest part of the prostate, up next to the bladder, is called the apex. The tip opposite the bladder is called the apex. The word anterior is used to describe the front, and the word posterior is used to describe the back.
Just below the prostate is the wall of the rectum. On each side of the prostate are blood vessels and nerves that play an important part in making choices for cancer treatments. The glands right next to the prostate are called seminal vesicles, and fluid from them drains into the prostate. The vas deferens are tubes from the testicles which also drain into the prostate.
The prostate surrounds the urethra. The urethra is the tube that comes from the bladder, passes through the prostate, goes past the urinary sphincter muscle and through the penis. Its purpose is to carry urine from the bladder to the outside of the body. The urinary sphincter muscle is a circular muscle that prevents urine from leaking.
There are lymph nodes clustered along the sides of both walls of the pelvis. These lymph nodes are part of the lymphatic system. The lymphatic system cleans all of the cells in the body with lymph fluid. The fluid is filtered through the lymph nodes. Any impurities, germs and cancers are captured. After the fluid has been filtered, it is recycled into the bloodstream. There are veins that take blood from the prostate to the heart. These veins run along side the spinal column.
Because of its anatomical position in the body, continued growth of the prostate causes problems, called symptoms. As long as your body produces male hormones, your prostate will continue to grow. Also, cancer in the prostate can cause the prostate to grow. The position of glands and structures closest to the prostate is also important, as they are the first places that prostate cancer spreads when it grows outside of the prostate gland.
The Prostate Exam
The prostate exam is a basic, relatively painless exam, that is performed by your primary care physician or a urologist. You can expect to have several of these exams over your lifetime, especially if you are actively watching the health of your prostate.
The prostate exam is often called a rectal exam, prostate exam, or digital rectal exam. Digital comes from the word digit, meaning finger, and has nothing to do with digital imagery, sound, or computers. The examination is done by the physician inserting a gloved, lubricated finger into the rectum. Fortunately, the wall of the rectum is thin enough that cancers can be felt on the back side of the prostate.
The physician is feeling to “see” if there are any areas that are not smooth or are not soft. The prostate should feel symmetrical, that is, both lobes should feel the same. There should not be any hard nodules or firm areas. If an abnormal area is felt, there may be a reason for it other than cancer, such as previous surgery or a past infection in the prostate. There are growths that are not cancer that can cause nodules or areas that are not smooth.
To rule out the abnormal area as cancer your physician will probably have you go though additional testing. Also, only the back side and not the entire prostate gland can be felt through the rectum. The digital exam is like feeling the back of your head and trying to decide what your face looks like. For these reasons the PSA blood test is often done in addition to the prostate exam if there is a reason to think cancer may be present.
The PSA Blood Test
The PSA Blood Test and the digital rectal exam combined provide the best information needed to determine whether or not prostate cancer is present. A PSA test alone can help detect prostate cancer before it can be felt. Especially, prostate cancer that occurs in areas of the prostate that cannot be reached by a digital rectal exam.
PSA stands for Prostate Specific Antigen. The PSA blood test is testing for the presence of an enzyme that is produced by the cells of the prostate gland. It is produced by both normal prostate cells and cancerous prostate cells. Significant amounts of PSA are not found anywhere else in the body.
A small amount of PSA is released into the blood stream all of the time. If the prostate becomes irritated, more PSA leaks into the bloodstream and can be measured by taking a blood sample. The PSA is a very good test for identifying cancer of the prostate as well as other non-cancerous problems.
Normal Ranges for a PSA test are from 0.0 to 4.0. PSA levels can go up into the 100′s. When cancer is diagnosed, the PSA levels are often consistently in the 10′s or 20′s. A PSA level that is extremely high almost always means advanced prostate cancer is present. If PSA test results are in the higher levels, other test are usually ordered to determine if the cancer has spread into the lymph nodes or the bones.
If your PSA test results are in the normal range and your prostate exam was normal, you can feel pretty sure that everything is probably normal and cancer is not present in the prostate. However, this is only a snap shot in time. One exam does not mean you can go for the rest of your life without an exam. As a matter of fact, you should keep records of your exam results and compare them. Keeping records will allow you to watch for trends, such as slight increases, over time. A sudden change in your exam results may mean a problem. There are guidelines discussed later that show you how often to have your prostate checked.
Having a higher than normal PSA level does not mean that you have cancer! It is simply a warning signal. The PSA blood test can tell you that you have a problem with your prostate gland, but it can’t tell you exactly what the problem is. Cancer is only one of the problems it could be. A high PSA level can be caused by those items shown below. If your first reading is high, and your digital rectal exam is normal, your doctor will probably try treating you with medicine first and then a repeat PSA about 6 weeks after treatment. Six weeks may seem like a long time to wait, but enough time has to pass to make sure the repeat test is as accurate as possible.
Causes For A Higher than Normal Elevated PSA Level
- Urinary tract infection
- Urinary catheter in the bladder
- Urinary retention
- Stones in the prostate
- Cancer of the prostate
- Recent prostate surgery or biopsy
- Noncancerous enlargement of the prostate
- Infection of the prostate
- Guidelines For Having PSA Exams
The following are general guidelines only! You should talk with your doctor about your personal needs for this or any other medical test.
If you are not at high risk, you should begin having a PSA blood test by age 50. If you are over age 80, there is no consensus on recommended guidelines for annual PSA tests. Following your doctor’s advice is probably the best course of action for you.
If you are at risk for prostate cancer you should have a PSA and digital rectal exam more often than someone that is not at high risk. Being at high risk means you are more likely to get prostate cancer than someone who is not at high risk. However, being at high risk does not mean that, for certain, you will get prostate cancer. Just as not being at high risk does not mean that, for certain, you won’t get prostate cancer.
You are at high risk if you have a family history of prostate cancer. That means, you are at high risk if your grandfather, father, or a brother have had prostate cancer. You should have a PSA blood test by age 40. You should have a PSA blood test every year thereafter.
African-American men have a higher risk of getting prostate cancer than other men. African-American men should have a PSA blood test every year beginning by age 40.
Just Do It!
Your doctor will not call on your 40th birthday and tell you it’s time to start having prostate exams. He will not call you every year and remind you to have a prostate exam and PSA blood test. It’s up to you to remember, to schedule an appointment, and to keep it! Try picking a meaningful day and do it on the same day every year. Do it on your birthday as a present to yourself. Do it on your wife’s birthday as a present to her. Do it on your anniversary as a present to you both. Just do it!