Should i get my prostate checked?

What is prostate cancer?

Prostate cancer happens when normal cells in your prostate gland become abnormal cells and grow in an uncontrolled manner. The prostate gland functions to make fluid that is a constituent of semen.

Prostate cancer is usually a disease of older men and generally occurs in men aged >50. Although very common, most men do not die from it. This is because it is a cancer that grows very slowly.

What are the symptoms?

Prostate cancer very commonly causes no symptoms in the beginning. But if symptoms develop most men experience:

– A need to urinate more often than usual (as you can see in the above diagram the enlarged prostate begins to press on the bladder and act as if someone was pressing on your bladder- you then feel the need to go more often)

– The flow of urine out into the toilet is usually slower than normal (as the outflow of urine out of the bladder is narrowed and obstructed as you see in the above diagram)

These symptoms can also be caused by conditions that are not related to prostate cancer. But if you experience these symptoms, you need to inform your health professional.

How do we test for prostate cancer?

If indicated, we use a PSA blood test and perform an examination of your rectum to check for prostate cancer. This sounds worse than it actually is! It is a little uncomfortable but is not usually sore. We insert a finger into your anus and then feel the rectal wall looking for abnormal areas on the prostate gland.

If we are concerned by these results, we will refer you to a Urologist who will perform more tests which can include;

-Biopsy –here we insert probe into your rectum and take a small sample of tissue from the prostate. Then we look at the sample under a microscope to see if there are any signs of cancer

-Ultrasound, MRI scan, or other scans may be necessary to clarify the diagnosis.

Should every male have a PSA blood test and if so at what age?

Any male who has symptoms should get assessed for prostate disease with tests including a PSA blood test.

If you do not have symptoms it is not clear if getting a PSA blood test for prostate cancer is beneficial for men. This sounds strange but for the following reasons we are cautious about doing PSA blood tests if you have no symptoms;

– If you have no symptoms but subsequently have a raised PSA test and are ultimately diagnosed with prostate cancer, there is very often no way of telling whether this is a cancer that can do harm. This means that you might be diagnosed with a cancer that will do no harm but can lead to unnecessary psychological distress. It is different if you have symptoms and have prostate cancer- you greatly benefit from treatment in this scenario.

– In addition, the PSA test sometimes is elevated for no good reason ie it can be raised due to a bout of recent exercise or recent ejaculation. In these cases, it is not raised because of prostate cancer but it will still cause you to worry until further tests are done.

Latest international guidelines recommend that each man (without symptoms) should talk to his health professional about possible screening for prostate cancer around the age of 50. Men with other risk factors that might put him at risk of prostate cancer (eg black men or men who have a history of prostate cancer in their family) should consider prostate cancer screening at age 40 to 45.