Within the list of medical problems for men, the prostate causes many issues. The prostate gland, although relatively simple in its function, causes concern and confusion for men, the physicians who take care of them, and the partners in their lives.
The prostate gland is an organ in the pelvis that is part of the male genital tract. It encircles the urethra and therefore has a role in urinary tract function. The prostate also creates the fluid that comes out with an ejaculation. That is pretty much all that it does, but because of its position, problems with the prostate cause problems in other areas.
There are basically three categories of prostate pathology. No. 1 is pain and infection; No. 2 is benign prostatic hyperplasia; and No. 3 is prostate cancer.
In category No. 1, we are dealing mainly with bacterial prostatitis and nonbacterial prostatitis. Urinary tract infections in men are basically seated in the prostate. This can happen at any adult age. Urinary tract infections in preadolescent males are bladder-based, as the prostate has not yet fully developed. An infection of the prostate can cause an elevated PSA blood test. Usually bacterial prostatitis responds nicely to a relatively long course of antibiotics, 2 to 4 weeks on average.
The prostate continues to enlarge as men age beyond their mid-30s. This is a byproduct of normal maturation and can be annoying. In a lot of men, we never have to do anything about the enlarged prostate, but in significant numbers we need to use medical therapy or sometimes surgery to alleviate constriction on the urethra.
There are several operations that we sometimes need to utilize, depending on specific aspects of the patient’s problem. A urologic surgeon is expert in employing these surgeries. Oftentimes, if we catch the patient early in the process of having an enlarged prostate, we can utilize medications and hopefully avoid surgery. Having an enlarged prostate can also cause the PSA to be elevated, as more prostate tissue creates more PSA to be leaked into the bloodstream.
Prostate cancer is the most common non-skin-based malignancy in men in the United States. Approximately 1 in 9 men will develop prostate cancer in their lifetime and approximately 165,000 will be diagnosed with prostate cancer in 2019. This is not a pathology to be taken lightly.
There are three statements about prostate cancer that seem to not make sense when considered at the same time. No. 1, a man with prostate cancer usually dies from something else; No. 2, if a man dies of cancer in the United States, the second-leading cause of that cancer death is prostate cancer. No. 3, men who have localized prostate cancer (i.e., that is still contained within the prostate gland and not spread) almost never causes symptoms.
Because this is a silently developing cancer in the vast majority of cases, in order to find it we have to go looking for it. Over the past decade, different organizations have gone back and forth on ideas for screening. Really, finding an apparently localized prostate cancer depends on getting a PSA blood test every year and having a digital rectal exam every year or two. Because of confusion about screening recommendations, this issue boils down to what the individual man wants to do for his health.
The PSA blood test can be critical in this process. We have been using it for three decades, and the PSA test we use today is what we used when it was first FDA-approved in 1988. Our views toward a normal PSA value have evolved. When we first started checking those tests, a value between 0 and 4 was considered safe. A value between 4 and 10 was considered suspicious for possible prostate cancer, and a value greater than 10 was considered very worrisome.
Now, mature data has been utilized to give us the idea that any PSA in men in their 40s, 50s or 60s greater than 1.5 should cause concern and evaluation. When we become convinced that there is significant concern for prostate cancer, we usually move on with a biopsy. Any PSA greater than 1.5 does not need to lead to a biopsy, but it needs to be looked at critically.
In this era of prostate cancer screening, death from prostate cancer has steadily gone down. This is very encouraging. In addition, over the past 10 years, we have developed novel and groundbreaking medications that do not involve chemotherapy to help manage prostate cancer that is advanced beyond our initial efforts to cure the cancer. This is very encouraging, and now most urologists view advanced prostate cancer as a disease of chronic management as opposed to a death sentence.
If you have questions about the status of your prostate health, have a discussion with your primary care physician, who will help you decide whether to see a urologist.
Dr. Joe Williams is a founding member of Idaho Urologic Institute and is medical director of the Surgery Center of Idaho. He also is a certified primary investigator with the Association of Clinical Research Professionals, and served as a board member on the Idaho State Board of Medicine from 2011 to 2017. He is currently president-elect of the Idaho Medical Association.
Rally and fundraiser
The Idaho Urologic Institute, Boise Jeep Club, Idaho British Car Club and Valley Corvettes are hosting the 7th Annual Blue Ribbon Rally for Prostate Cancer Awareness on Sept. 28 from 10 a.m. to 2 p.m. at the Idaho Urologic Institute, 2855 E. Magic View Drive in Meridian. Registration for cars is $20; it’s free to attend.
Proceeds benefit Idaho2Fly and the Saint Alphonsus Prostate Cancer Assistance Fund. There will be food, a live auction, raffles and the chance to win a 7-night Alaskan cruise for 2.
Go to facebook.com/blueribbonrally123/ ot call 208-639-4900 for details. If you have a vehicle you would like to enter, register at https://idaho2fly.z2systems.com/np/clients/idaho2fly/eventRegistration.jsp?event=84.