FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

FAMILY HISTORY OR AGE OVER 50 MEANS YOU NEED YEARLY PROSTATE EXAM

Question: What are the signs of prostate cancer, and how do you check for it?

Answer: The prostate gland is an important part of the male reproductive system. It is located next to the urinary bladder, and it actually surrounds the urethra, the tube that empties urine from the bladder and at times also carries semen. The gland's principal function is to make fluid that is mixed with sperm and other fluids to make semen. In a 20 year-old man, the gland is about the size of a walnut. Thereafter, it slowly enlarges.

Prostate cancer is the second most common cancer in men, striking about 8 percent of us. It develops twice as frequently in African American men than in Caucasians and is relatively uncommon in Native Americans and Hispanics. There are about 180,000 American men diagnosed with it each year, and 37,000 die from it. This cancer is quite rare before age 40 and uncommon before 50. However, studies done at autopsy have shown that up to 40 percent of men in their 50s have microscopic amounts of prostate cancer. This increases to almost 100 percent by age 80.

Prostate cancer has no symptoms when it is small. As a prostate tumor increases in size it can produce a decrease in the force of the urine stream, difficulty initiating urination and other symptoms that are indistinguishable from the far more common non-cancerous enlargement of the prostate called benign prostatic hyperplasia.

The normal course of prostate cancer is a slow, decades-long growth. Many men with it die from other conditions not related to the cancer. Unfortunately for about 37,000 men each year who die from it, the cancer can display a much more aggressive nature. This is more likely for those who are diagnosed with it when they are younger.

The problem we face is how to diagnose the condition when it is small and curable with surgery. Unfortunately, so far there is no perfect solution for this dilemma. The current recommendations are for all men 50 and older to have a yearly digital rectal exam. In this procedure, the doctor feels for the changes in the gland that are typical of cancer. Unfortunately, only part of the gland is located where it can be easily examined, and also adding to its inaccuracy, very small cancers don't make a "lump" large enough to be felt.

Another tool for identifying those with prostate cancer is a blood test called prostate specific antigen or PSA. This test is also not perfect in that PSA blood levels can be abnormally elevated by several non-cancerous conditions. Also, about 25 percent of those with early prostate cancer do not have an elevation of PSA.

Transrectal ultrasound is an additional test that is often used to help evaluate individuals who have some abnormality on digital rectal exam or PSA. It utilizes sound waves and a special computer to create an image of the gland. This can identify areas of the gland that seem suspicious for cancer. Then, a fine needle is passed into that area to obtain a sample of tissue for study under the microscope.

Determining who should have which test and when it should be done is still an issue that is debated by physicians, researchers, insurance companies and patients. I'd suggest that if you are over 50 or if you have a blood relative who has had prostate cancer, you talk to your doctor this year about the best choice for you.

"Family Medicine" is a weekly column.

To submit questions, write to: John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.