The familiar quote from Nike is appropriate when discussing prostate cancer screening. Who wants to be told that they are at risk for prostate cancer or worse, even have prostate cancer? Who wants to bend over an exam table, exposed, and have a person put a finger inside their rectum and probe? Answer, no one. However, I get them done and if you are a male over the age of 45, you need to get a PSA (prostate specific antigen) blood test and a DRE ( digital rectal exam), as quickly as possible. This is particularly true if you are : A) African-American; B) have a relative that had prostate cancer; C) use tobacco.

What is the prostate? The prostate is a gland that only men have; although women may have something similar, called the skene glands. The prostate contributes about 20-30% of the acidic fluid used to compose semen. Normally, the prostate is the size of a walnut and surrounds the urethra. The urethra is the tube from which we urinate or ejaculate. If the prostate becomes enlarged it can squeeze on the urethra and slow urine flow-just like squeezing a garden hose. This can cause urinary hesitancy; frequent urination; or make you feel like you have not completely emptied your bladder. Advanced prostate cancer can also produce similar symptoms; therefore, it is necessary for you to get screened for prostate cancer as the treatment for enlarged prostate is completely different from that of prostate cancer.

Prostate cancer is the most common diagnosed cancer among American men. African-American men have the highest numbers of persons who get prostate cancer and also who die from prostate cancer. Latino men have lower rates of death compared to Caucasian men; however, depending upon the source, Latino men have higher rates of new diagnoses. Prostate cancer is highly associated with advancing age; the male hormone, testosterone, genetics and diet. Men rarely get prostate cancer under the age of forty, men more likely get the cancer over the age of ….However, men who have prostate cancer at the age of 70 and beyond, may not die from prostate cancer but from other illnesses such as heart disease. One reason is that prostate cancer can vary and be slow growing or fast growing. This discrepancy leads to the confusion about organizations that provide guidelines.

One organization states that men over the age of 75 should not have routine screening for prostate cancer. Another organization states that we should reserve prostate cancer screening for high risk men over the age of 45. High risk men include African-Americans and persons who have either a brother or father who had prostate cancer. Still another organization states that screenings may not be effective as they can reveal asymptomatic cancer growths which will remain slow growing and will subject asymptomatic men to invasive procedures that increase health risk.This organization believes that although screening can identify prostate cancer, screening may not reduce mortality.

Prostate cancer screenings consist of a blood test for PSA level and a DRE. During the DRE, a provider will stick a lubricated GLOVED finger into your rectum and feel for any “lumps” or bumps in the prostate. If the PSA is elevated ( greater than 4.0 ng), or there is a bump or hardness – you should be referred to a urologist. A urologist will then perform a special ultrasound or MRI of the prostate and will insert a lighted small tube in the urethra and look at your prostate and bladder. The urologist will then take biopsies of the areas in question. The biopsied cells will be compared to normal cells. The larger the difference the higher the pathology, or Gleason score. Depending upon the Gleason score, the person either will be sent for treatment or observed over time (watchful waiting). If the PSA doubles in less than a year, they are referred back to urology for treatment.

Treatments vary depending upon any other co-morbidities, age, and lifestyle and what type of prostate cancer you may have. Early stage prostate cancer ( Stage I and II- confined to the gland), treatment can be surgery, cryotherapy ( freezing tissue) or radiation therapy. If the cancer has spread out of the prostate ( Stage III and IV) then treatment might include hormone therapy to reduce testosterone levels, surgery, chemotherapy.

According to SEER Data, the five year survival rate for prostate cancer is great as long as the cancer has not spread. Five-year relative survival by race was: 99.6% for white men; 96.2% for black men. Most prostate cancers are diagnoses when localized. The five year survival rate for confined prostate cancer is 100%. Even if the cancer has spread to regional lymph nodes, found in 12% of prostate cancers; the five year survival rate is 100%. The five year survival rate drops dramatically if the cancer spreads and metastasized, it drops to 28%.

How to prevent: 1) get screened; 2) dietary changes ( vegetarian, to increasing omega 3 fatty acids, low fat, low red meat diets); 3 ) pick your parents. Seriously, “ just do it”.. go get screened.
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