By Dr. Vincent Michael Bivins
June is designated as Men’s Health Month, a time dedicated to generating awareness of the importance of prostate health, along with screenings as one ages. The walnut-size gland located in front of the rectum just below the bladder, the prostate wraps around the urethra, which carries urine out of the body. The prostate is responsible for producing fluid that is part of semen and is considered part of the male sex organs.
Prostate problems frequently occur in men over the age of 50 and are among the most common conditions for which patients seek the care of an urologist. Fortunately, most prostate problems are not cancer, but regardless of age, it is important men see a doctor immediately if they notice any of the following signs, which could indicate prostate problems:
- Frequent urge to urinate
- Having to get up during the night to urinate
- Presence of blood in urine or semen
- Feeling pain or a burning sensation while urinating
- Inability to urinate
- Painful ejaculation
- Recurrent pain or stiffness in the lower back, hips, pelvic area or upper leg
Diagnosing prostate problems may involve several tests, the first of which is usually the digital rectal exam (DRE). During a DRE, the physician inserts a gloved finger into the rectum to feel the prostate and evaluate its size, shape and condition. A prostate-specific antigen (PSA) blood test may be ordered to screen men without symptoms. Magnetic resonance imaging or computed tomography scans can also be used to identify abnormal structures.
The most common prostate problem diagnosed in men over 50 is prostate enlargement or benign prostatic hyperplasia (BHP). This condition occurs because the prostate continues to grow as a man matures, potentially squeezing the urethra and affecting bladder control.
If BHP is diagnosed, the condition can be managed several ways. Mild symptoms may not require any treatment. However, regular checkups are necessary to make sure the condition does not worsen. Other options include surgery or taking medications to shrink or relax the prostate so it does not block the bladder opening.
Acute prostatitis can start suddenly and cause fever, chills or lower back pain. Another form of prostatitis, called chronic bacterial prostatitis, is an infection that occurs repeatedly. Both may be treated with antibiotics. Chronic bacterial prostatitis is a condition that is difficult to treat and may need more than one round of treatment.
One out of every nine men will be diagnosed with prostate cancer in their lifetime. Men should be aware of their family history and risk of prostate cancer and consider screening for the disease as appropriate, which includes a PSA blood test and/or a DRE. The American Cancer Society’s general guidelines say a screening should be discussed or considered – including uncertainties, risks and potential benefits of screenings − at age 50 for men at average risk; and at age 40 or 45 for men at higher risk.
Men at higher risk include African Americans and men who have a father, brother or son who has been diagnosed with prostate cancer younger than age 65, and men with more than one “first-degree” relative (father, brother or son) who has had a diagnosis.
According to a recent observational study to be presented at the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting, younger African American men undergoing frequent prostate cancer screening appear to have both a lower risk of metastasis at the time of prostate cancer diagnosis and a lower risk of fatal disease. Specifically, increased PSA screening intensity was associated with a nearly 40 percent reduced risk of metastatic prostate cancer at the time of diagnosis and a nearly 25 percent decreased risk of death from the disease in younger African American patients.
The findings add weight to the importance of discussing the pros and cons of prostate cancer screening with patients to develop a tailored approach to prostate care.
In sum, there is no one size fits all approach to screenings. Overall health status, and not age alone, is important when making decisions about screening, and changes in a man’s health, values and preferences should also be taken into account.
In no uncertain terms, be sure to have your well visit each year and talk to your doctor about your prostate health and screening.
Vincent Michael Bivins is President, Urology Centers of Alabama and Chairman, Department of Surgery − Princeton Baptist Medical Center.