WHO’S AT RISK
Prostatic disease affects more than 50% of American men over age 50, becoming increasingly widespread with age. “As many as one in eight men will develop prostate cancer in their lifetime, and benign prostatic disease (BPH) is even more common, affecting 60% of men age 60 and 80% of men age 80,” says Lowe. “The good news is that the latest generation of drugs and surgical advances allow us to offer treatment that helps men recapture their quality of life. When it comes to urinary symptoms, you don’t have to grin and bear it.”
The prostate is a gland that produces the fluid for sperm. “The prostate sits at the base of the bladder and wraps around the urethra,” says Lowe. “As the prostate enlarges with age, it increasingly blocks the passage of urine, causing symptoms like a weak urine stream, dribbling, and waking up at night.” Because both the benign and malignant forms of the disease cause similar symptoms, urinary symptoms call for evaluation by a doctor.
While both prostate cancer and benign prostate enlargement are extremely common as men age, some groups are at higher risk of developing malignant disease than others. “We usually start seeing prostate cancer in patients after the age of 50,” says Lowe. “The other major risk factors are having a family history of the disease and being African-American, Prostate cancer is at least twice as common in African-American men.”
SIGNS AND SYMPTOMS
Prostate cancer and BPH often cause almost identical symptoms. “An enlarged prostate gland causes urinary symptoms and problems, including urinary tract infections,” says Lowe. “Prostate cancer doesn’t usually cause symptoms that differ from benign enlargement until the cancer has spread into the bones, at which point it becomes much harder to treat.”
The goal for prostate cancer is always early detection, while the cancer is still localized. “Since we can’t rely on symptoms if we are going to catch prostate cancer early, we use screening tests — the digital rectal exam and the PSA test, which is a blood test,” says Lowe. “There is a lot of controversy around the PSA test right now, but my advice is that it can help us to find the prostate cancers that need to be treated.” African-Americans and patients with a family history of prostate cancer should talk to their doctors about a screening plan.
Both prostate cancer and benign prostatic disease are highly treatable. “Patients should always talk to the doctor about the risks and benefits of treatments,” says Lowe. “But we have really good treatment options available, especially when we can detect cancers early.”
Benign prostatic disease affects many more people than prostate cancer. Unfortunately, men often assume there is nothing to help them. “Many men don’t seek treatment for urinary symptoms for two reasons: they fear it will be found to be cancer, and they fear that treatment will cause erectile dysfunction,” says Lowe. “But actually, their symptoms are much more likely to be BPH than cancer, and the risk of sexual dysfunction is much lower than they think.”
Twenty years ago, the only treatment for an enlarged prostate was surgery. “We now have a host of medications that can ameliorate the symptoms by shrinking the prostate, or causing alterations in the tone of the prostate,” says Lowe. “These medications carry only a low risk of sexual dysfunction, and when side effects do occur, they are almost always reversible.” Some men find relief with alternative medicines including herbal supplements, though studies have not been able to confirm the anecdotal evidence.
There is a lot of controversy around the PSA test right now, but it can help us to find the prostate cancers that need to be treated.
For prostate cancer, the treatment options depend on the age and health of the patient, as well as how aggressive the cancer is. “The treatment options are surgery, radiation, alternative treatments like cryosurgery, high-intensive ultrasound therapy, and hormonal treatments,” says Lowe. “More and more, we are turning to the treatment option of no treatment — what we call watchful waiting or expectant management, in which we respond to slow-growing prostate cancers with careful surveillance.” Some prostate cancers grow so slowly they may never require surgical intervention.
Increasingly, treating prostate cancer is compatible with retaining sexual and urinary function. “Not only are the majority of cancers very amenable to treatment and cure, but our latest surgical techniques decrease the risk of side effects,” says Lowe. “When men do experience incontinence or sexual dysfunction, we now have medications and procedures that can fix the side effects in the majority of patients.”
The treatment of prostate diseases both benign and malignant is continually improving. “Things have come a long way from 20 years ago — for BPH we now use lasers that allow us to operate less traumatically, and the latest generations of medications are very safe; for prostate cancer the use of robotic surgery,” says Lowe. “The biggest improvement is in our ability to treat disease in a way that preserves patients’ quality of life.”
QUESTIONS FOR YOUR DOCTOR
A question every man could benefit from asking is, “What can I do to keep my prostate healthy?” Lowe advises men to limit caffeine and alcohol — which irritate the prostate as you age — and to continue with ejaculations. If you are weighing the option of prostate cancer surgery, always ask the surgeon, “How many times you have performed this surgical procedure?”
“The important thing is that men should not avoid investigating urinary symptoms,” says Lowe. “We have medicines and surgical techniques that have much improved the options and outcomes, so you don’t need to suffer. We can help you without causing damage.”
WHAT YOU CAN DO
Get informed. Start your online search with two reliable sites: the National Institutes of Health (nlm.nih.gov/medlineplus/prostatediseases.html) and Mount Sinai (mountsinai.org/patient-care/health-library/diseases-and-conditions/prostate-cancer).
Don’t ignore symptoms. There’s a temptation to avoid addressing urinary symptoms, but Lowe urges patients to consult their doctor: “We have such strong treatment options.”
Heart healthy = prostate healthy. A low-fat diet and regular exercise can cut your risk of prostate cancer, as well as heart disease.
Know your family history. Be sure to inform your doctor if one or more of your relatives had prostate cancer. You may need additional screening.