Managing the Symptoms of Advanced Prostate Cancer

Dr. Roach: Urologist Demands That Patient Get A Biopsy For His Prostate

Your browser is not supporteddetroitnews.Com

detroitnews.Com wants to ensure the best experience for all of our readers, so we built our site to take advantage of the latest technology, making it faster and easier to use.

Unfortunately, your browser is not supported. Please download one of these browsers for the best experience on detroitnews.Com

Dear Doctor: Making Decision On Prostate Cancer Screening Requires Good Understanding Of Risks And Benefits

DEAR DR. ROACH: A very healthy male friend in his upper 50s has to make a decision whether to accept or decline his very aggressive urologist's decision to do a biopsy of his prostate. It seems that the only thing prompting this decision is a recent prostate-specific antigen (PSA) reading of 4 ng/mL, which has actually fluctuated a bit between 2-4 ng/mL over the past two years. His doctor states that at his age, it should be under 3 ng/mL.

The physician's attitude is almost dismissive of my very knowledgeable friend's concerns about jumping into a biopsy when he is extremely healthy, has no symptoms, and has no family history. So, as a compromise, he suggested that he'd come back in three to four months for another reading and see how things progress. The doctor's response essentially was that my friend can do what he wants, but the doctor emphasized that this is serious and that he needs a biopsy.

We both recently read a review of the literature on prostate cancer (regarding diagnosis and treatments) by the National Library of Medicine. It stated that the recommendations for screening for prostate cancer using a PSA test are unclear! They also seem to say that early detection and resultant post-screening treatments can lead to over-diagnosing, unnecessary biopsies (with sometimes serious side effects), and the over-treatment of patients. -- N.C.

ANSWER: You are quite right that the optimal strategy for screening for prostate cancer is unclear. Making the right personal decision requires a good understanding of the risks and benefits of testing, as well as the spectrum of aggressiveness of the prostate cancer. Remember, screening always means that there are no symptoms present.

There are a few men who can develop an aggressive form of prostate cancer that grows very quickly. Unfortunately, it is hard to catch most of these cancers because they grow so quickly. You have to be really lucky to get your screening test while the cancer is big enough to be detected and hasn't yet spread.

There are many men who get a very slow-growing, almost indolent form of prostate cancer. This kind of cancer is destined to never bother most men who get it, and the majority will die of something else before they ever know they had it (unless they get a screening test). Treatment of this type of prostate cancer is unnecessary since it will never cause problems.

Finally, there is a group of men who have prostate cancer that can be detected by screening, hopefully in time to prevent the cancer from spreading. These are the cancers we want to find with screenings, as treating these men effectively saves lives. However, there are far fewer of these cancers than there are of the indolent-type of cancers.

The fact that his PSA level has been stable for two years argues against an aggressive cancer, but it isn't definitive. Men can have prostate cancer with a PSA of 2 or have benign prostate disease with a PSA of 10, but usually, the higher the PSA, the greater the likelihood of cancer. However, your friend's risk with a stable PSA level under 4 is small.

The most important time to be cautious in suspected prostate cancer is when the diagnosis has been made and the patient is deciding on treatment. His urologist would have much more information available after a biopsy, including pathology and genetic testing.

It bothers me that the urologist is belittling your friend's reasonable concerns. This situation calls for respect, discussion and understanding -- not an ultimatum.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.Cornell.Edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

(c) 2022 North America Syndicate Inc.

All Rights Reserved

If you purchase a product or register for an account through a link on our site, we may receive compensation. By using this site, you consent to our User Agreement and agree that your clicks, interactions, and personal information may be collected, recorded, and/or stored by us and social media and other third-party partners in accordance with our Privacy Policy.

Prostate Cancer In Men: Early Detection Through Symptoms, Diagnosis

Prostate cancer is one of the most common cancers among men worldwide. The incidence of prostate cancer has been steadily rising, attributed to factors such as aging populations, improved screening techniques, and increased awareness. Understanding the early signs and symptoms, along with the diagnostic processes, is crucial for early intervention and better outcomes.

Early signs and symptoms

Story continues below Advertisement

Prostate cancer often develops slowly and may not show symptoms in its initial stages. However, as the disease progresses, men might experience various symptoms that warrant medical attention, says Dr Vigyan Mishra, chief of lab-Neuberg diagnostics, Noida.

Urinary problems: Difficulty in urinating, weak or interrupted urine flow, and frequent urination, especially at night, are common early signs, says Dr Mishra. These symptoms occur because the prostate gland, located below the bladder, can enlarge and press on the urethra.

Blood in urine or semen: Haematuria (blood in urine) and hematospermia (blood in semen) can be alarming signs of prostate issues, including cancer.

Erectile dysfunction: Difficulty achieving or maintaining an erection can be related to prostate cancer, though it is also linked to other health conditions.

Pain and discomfort: Persistent pain in the lower back, hips, or thighs can indicate advanced prostate cancer, which may have spread to the bones.

Urinary tract infections (UTIs): Frequent UTIs can also be a sign, as they can result from an obstructed urinary flow due to an enlarged prostate, says Dr Mishra.

Story continues below Advertisement

Diagnosis of prostate cancer

Diagnosing prostate cancer involves several steps to confirm the presence and stage of the disease.

Prostate-specific antigen (PSA) test: This blood test measures the level of PSA, a protein produced by both cancerous and noncancerous prostate tissue. Elevated PSA levels can indicate prostate cancer, although high levels can also result from benign conditions.

Digital rectal exam (DRE): During this physical exam, a healthcare provider inserts a gloved finger into the rectum to feel the prostate gland for abnormalities such as lumps or hard areas.

Imaging tests: Ultrasound, MRI, and CT scans can provide detailed images of the prostate and surrounding tissues to detect abnormalities.

Biopsy: If PSA levels are high or abnormalities are found during a DRE, a prostate biopsy is usually performed. This involves taking small samples of prostate tissue to be examined under a microscope for cancer cells.

Genetic testing: For men with a family history of prostate cancer or those with certain genetic markers, genetic testing may be recommended to assess risk.

Nivedita is a Delhi-based journalist who writes on health, fashion, lifestyle and entertainment. Views expressed are personal.

---