Movember November to keep the prostate in check

Dear Dr G,

I have been waiting all year to build up the courage to ask you about prostate cancer. Truthfully, I am terrified to discuss this subject, so what better time to do it than in Men’s Health November?

My fear of prostate cancer stems from my youth when I saw my father admitted to hospital with the disease. He underwent an operation to unblock his urinary system, and the sight of the catheter coming out of his penis and the bleeding for days traumatised me.

Although my dad turned out well after the treatments, the mere mention of the prostate still sends chills down my spine.

I am now reaching my father’s age and had to undergo a body check-up for work. I dreaded the rectal examination, but it turned out to be fine.

Despite having no urinary symptoms, I am facing the prospect of visiting a urologist due to high cancer markers, PSA. Before taking this step, I thought it would be a good idea to seek clarification from Dr G.

Can you tell me what exactly the prostate is and where it is located?

What are the signs and symptoms of prostate cancer?

What is PSA, and is its elevation a sign of cancer?

How do urologists determine the diagnosis of prostate cancer if PSA is high?

What are the complications of such tests?

Please help me alleviate my PSA (Persistent Stress and Anxiety).

Regards,

Stressed Steven

The prostate is an organ responsible for producing semen, which helps sperm survive. Prostatic secretions – also known as seminal fluids – provide nutrients for sperm and enzymes to help them penetrate the cervix’s barriers.

Most seminal fluid ejaculated comes from the prostatic gland, so men will continue to produce semen despite having had a vasectomy.

Anatomically, the prostate is a walnut-sized organ located between the base of the bladder and the penis. This organ also surrounds the passage through the prostatic urethra, allowing urine to drain during urination.

Therefore, an enlarged prostate often results in urinary symptoms such as poor flow, difficulty initiating, and terminal dribbling. Post-void residual urine may also be associated with frequent urination during the day and night. Although such symptoms are generally linked with age-related benign prostatic hyperplasia (BPH), they can also be caused by prostate cancer, so thorough assessment is important.

Contrary to what is portrayed by the media, medical prostate examinations are generally straightforward and painless. Most men are surprised when the process is less daunting than anticipated.

The assessment of prostate health usually begins with symptom evaluation using the International Prostate Symptoms Scores (IPSS). The physical examination includes an overall abdominal examination followed by the Digital Rectal Examination (DRE), which is quick and only mildly uncomfortable.

The examination usually ends with urine flow tests and some lab investigations, including renal function and cancer markers.

Prostate-Specific Antigen (PSA) is a natural marker produced by the prostate, hence absent in women or men after prostatectomy. PSA is not a definitive test for cancer, as levels may rise due to non-cancerous conditions like infections and age-related enlargement. Transient PSA elevation can also occur after ejaculation or long-distance cycling. Therefore, many men with elevated PSA levels fear further tests to evaluate cancer risk.

The definitive way to detect cancer after PSA elevation is a Trans Rectal Ultrasound (TRUS) guided biopsy of the prostate. However, recent scientific advancements have improved the detection of abnormal prostatic tissues.

Detailed MRI scans can delineate certain cancer characteristics, avoiding unnecessary biopsy risks in men with high PSA levels but without cancer. The MRI can also accurately locate abnormal tissue, reducing the chance of false negatives in tissue sampling. However, MRI scans can be costly and may not be affordable for many men with elevated PSA levels.

The month of November is often marked by the Men’s Health Movement. The Movember campaign is especially important given statistics in Malaysia reveal that more than two-thirds of men with prostate cancer present with late-stage disease and this indicates a lack of awareness among ageing men and unnecessary fear about prostate diseases.

When Dr. G is put on the spot by men haunted by the stress and anxiety or aging prostate, his view is that if you have enjoyed the pure pleasure that comes from a healthy prostate in younger days, perhaps it is time to confront some degree of anxiety and get the prostate in check for many more pleasurable years ahead!