Should You Screen for Prostate Cancer?

A visit to St Pete Urology to screen for prostate cancer is also an opportunity to have a variety of health issues resolved. St Pete Urology operates according to the principle that most health issues affecting men are interconnected and can only be treated effectively through a comprehensive and multidisciplinary approach. When you visit our urologists for prostate cancer information, screening, diagnosis and treatment, we extend our role to include screening for signs of mental health disorder, make efforts to influence behavior change and speak with you candidly about psychological and medical care beyond our direct involvement in treatment of urologic disease.

At St Pete Urology, we are committed to safe, holistic and effective care for all our patients. We handle diagnosis and treatment of prostate cancer using the latest technological, medical and psychosocial approaches.

Tackling mental health issues during prostate cancer screening

Helping patients with mental health problems is a familiar territory for urologists at St Pete Urology, Fl. For instance, during prostate cancer screening, the urologists also screen for signs of distress, educate patients on their diagnosis, treatment and potential side effects, and provide support through referral to psychosocial services or rehabilitation programs. For men experiencing urinary tract symptoms, the urologist may conduct a functional analysis to assess the effect of the symptoms on everyday activities, recommend practical solutions such as Kegel exercises, and provide psychosocial referrals to help deal with issues related to interpersonal relationships and self-esteem. Working with our urologists not only provides the opportunity to detect and treat urological problems like prostate cancer, but also for early detection and treatment of mental health disorders.

Should you undergo prostate cancer screening?

Prostate cancer is a very common cancer so it is very important to get checked for its presence. While screening tests will not show with certainty that you have cancer, they help to find warning signs and help to detect the cancer when it is still at an early stage, making treatment easier and more effective. If one of the screening tests gives an abnormal result, you will need a biopsy of prostate tissue to confirm whether or not you have cancer. Men who want to be checked are tested using the PSA (prostate-specific antigen) blood test and the DRE (digital rectal exam).

1. PSA (Prostate-specific antigen) blood test

PSA (Prostate-specific antigen) is an essential substance made by the cells of the prostate, typically by both normal and cancerous cells. It is predominantly found in semen. However, it also may be found in small quantities in blood. The majority of men with no prostate cancer do have PSA levels below 4 nanograms-per-milliliter [abbreviated as ng/mL] of blood. Those with higher PSA readings have a greater likelihood of developing cancer of the prostate.

While the PSA usually goes up beyond 4ng/mL as prostate cancer develops, a reading below 4 is not a guarantee that you do not have the cancer. In fact, about 15 percent of men whose PSA is under 4ng/mL are found to have the cancer upon a biopsy. Similarly, men with PSA between 4 and 10 have 25 percent chance of having the cancer, while those with PSA above 10 have a 50 percent chance of developing prostate cancer. If you have elevated PSA, your urologist may indicate that you either wait for a period of time and you repeat the test or take a prostate biopsy to confirm the cancer.

2. DRE (Digital Rectal Exam)

During a DRE (digital rectal exam), your urologist will insert a gloved and lubricated finger into your rectum in order to feel or detect any hard areas, nodules or bumps on your prostate, which may be due to cancer. Prostate cancer usually starts at the back of the prostate and this can be felt through a rectal exam. The DRE may be a bit uncomfortable, particularly for men with hemorrhoids, but it is not usually painful and often takes a very short time. Although the DRE is less accurate than PSA in screening or detecting prostate cancer, its ability to occasionally find cancer in men whose PSA values are normal makes it a vital component of prostate cancer screening.

Making screening decisions

It is important to work closely with your doctor in order to make informed screening decisions. At St Pete Urology, we recommend that men should screen for prostate cancer at:

  1. Age 50 for those men who are at average risk of getting prostate cancer and are still expected to live for more than 10 years.
  2. Age 45 for men who are at high risk of developing prostate cancer, such as African Americans and men whose first-degree relative [father, son or brother] had the cancer before the age of 65 years.
  3. Age 40 for men with even greater risk, especially those who have had more than one first-degree relative get prostate cancer at a very early age.

For more information, visit the “St Pete Urology” site.

6 Reasons Men Should See A Urologist

Given the close relationship between a man’s mental health and his overall health-related quality of life, it is increasingly clear that men suffer a significant burden of mental health issues, most of which go untreated. The situation is worsened by barriers to access to mental health services such as maladaptive coping, stigma and lack of awareness of the support services available in the community. At St Pete Urology, we treat a visit to our facility as the first regular contact between a patient and health care, using the opportunity to attend to a variety of health problems affecting our patients.

Relationship between mental health and urological disorders

At St Pete Urology, we appreciate that specific urological conditions, such as urinary tract infections, urologic cancers, kidney stones, urinary incontinence and erectile dysfunction, are usually accompanied by mental health issues like anxiety and depression. For example, about 10 percent of men with erectile dysfunction usually suffer from depression while 2.5 percent to 37 percent usually suffer from anxiety. Likewise, men with urinary incontinence tend to also have increased psychological distress, with anxiety rates of 3 percent to 10 percent and depression rates of 6 percent to 21 percent. Furthermore, men suffering from prostate cancer are four times more likely to commit suicide than men of similar age without the cancer.

At St Pete Urology, we cherish every contact with each patient and use it to treat urological disorders and associated mental health problems. For instance, when handling a patient with prostate cancer, we also take the role of screening for signs of anxiety and depression, educating him on the diagnosis, treatment and management of related side-effects, and providing support through referral of the patient to psychosocial services and the right rehabilitation programs. Similarly, for a man having urinary incontinence, we perform a functional analysis to assess the effects of the symptoms on daily life, recommend practical solutions like Kegel exercises and offer referrals to psychosocial services to address issues of interpersonal relationships and low self-esteem.

Comprehensive and effective treatments in urology

St Pete Urology offers an all-inclusive, multidisciplinary approach to urology. We emphasize the latest techniques including minimally-invasive, robotic and scarless procedures, develop personalized treatment plans that entail both surgical and medical approaches, and strive to make every visit as convenient as possible.

Our core specialty services include:

  1. Percutaneous nephrolithotomy treatment of kidney stones.
  2. Ureteroscopy for kidney stones and other urological conditions.
  3. Continent urinary diversion.
  4. Caval surgery for kidney and renal cancer.
  5. Treatment of prostate cancer, including nerve-sparing surgery and robotic radical prostatectomy.
  6. Male infertility and male sexual dysfunction.
  7. Vasectomy and vasectomy reversal.
  8. Urinary reconstruction.
  9. Complex urinary incontinence surgeries.
  10. Radiation oncology.
  11. Minimally-invasive treatments for benign prostatic hyperplasia.
  12. Laparoscopic renal surgeries.

A highly specialized care team

If a urology problem is causing you pain, discomfort or embarrassment, turning to a urologist at St Pete Urology who listens, responds compassionately and has the expertise to treat urinary disorders can help you to overcome your problems. Our urologists are a highly-specialized and knowledgeable team that went to the University of Pennsylvania and understand their work well. We have board-certified urologists who are experienced in treating low testosterone, prostate cancer, testicular cancer, enlarged prostate, erectile dysfunction and many other urological conditions.

So why should men visit a urologist?

  1. Recurrent urinary tract infections.
  2. Interstitial cystitis.
  3. Urinary incontinence and overactive bladder.
  4. Male infertility and male sexual dysfunction.
  5. Kidney stones.
  6. Enlarged prostate.
  7. Cancers throughout the urinary tract, such as prostate, bladder, kidney, penile and testicular cancers.

Are you looking for quality treatment for your urological problem? Would you like to be treated by a urologist who will appreciate your mental health issues during the diagnosis and treatment of your urological disorder? If so, then St Pete Urology is the right place for you. Visit St Pete Urology, Florida today for comprehensive, patient-centered medical care. For more information, visit the “St Pete Urology” site.

2 Effective Screening Tests for Prostate Cancer

Prostate cancer is the most frequently diagnosed non-skin cancer in men in the United States, currently carrying a lifetime risk for diagnosis of around 15.9 percent. In most cases, prostate cancer shows a good prognosis even when not treated, though some may be quite aggressive. Presently, the lifetime risk of death due to prostate cancer is 2.8 percent, and the condition is quite rare in men younger than 50. In fact, very few men die of the cancer before age 60, and more than 70 percent of the deaths due to the cancer occur after age 75.

Even though prostate cancer typically grows very slowly or not at all, it is still advisable to start screening early before the symptoms appear. Early prostate cancer screening may help to discover any aggressive type of the cancer and ensure prompt treatment. Today, there two most effective and recommended tests for screening are prostate specific antigen (PSA) test and digital rectal exam (DRE).

PSA

All contemporary recommendations for prostate cancer screening incorporate the prostate specific antigen (PSA) levels in serum because there is convincing evidence that PSA-based screening detects many cases of asymptomatic prostate cancer. Studies also have shown that a vast majority of men who have asymptomatic cancer detected through the PSA test have tumors that either will fail to progress or will grow so slowly that they would have shown no symptoms for the patient’s lifetime. If your PSA level is high, your urologist will recommend either waiting for a period and then repeating the test or doing a prostate biopsy to confirm if you have the cancer. When interpreting your PSA results, your urologist will consider many factors, such as race, age and family history.

Digital Rectal Exam (DRE)

During DRE, the urologist inserts a gloved, lubricated finger into the rectum to feel for any hard areas or bumps on the prostate, which might indicate cancer. The exam may be slightly uncomfortable, but is never painful and just takes a short time. While the digital rectal exam may be less effective than the PSA in detecting prostate cancer, it sometimes can detect cancer in men with normal PSA levels. For this reason it is a critical component of prostate cancer screening.

What next after screening?

PSA and DRE tests are simply used to detect the warning signs of prostate cancer, but in reality they do not actually confirm if you have cancer. If the test results are abnormal, your urologist will use a prostate biopsy for confirmation. If there is cancer, a prostate biopsy also will help determine the aggressiveness and influence the urologist’s decision as to whether or not you need treatment. Not every patient must be treated and those with non-aggressive cancer will just be actively monitored. The decision on whether you get treated is very important and is usually based on results of these tests. For more information on early prostate cancer diagnosis and treatment, visit the site, St Pete urology.

What is The Prostate and Prostate Enlargement?

The prostate gland (commonly called prostate) is a small, chestnut-sized organ in men located beneath the bladder and in front of the rectum (back passage). The urethra, the tube that passes urine from the bladder to the penis, runs through the prostate. By producing a fluid called prostatic fluid that makes up around 15-30 percent of the total volume of semen, the prostate plays a significant role in the function and viability of sperm cells and is critical for a man’s fertility.

Prostatic fluid contains citric acid, zinc, spermine and prostate-specific antigen (PSA), which protect and enrich sperm and reduces acidity of the vaginal canal. Muscles of the prostate usually press into the urethra during ejaculation, helping sperm to move through the urethra.

What is prostate enlargement?

While the prostate is usually a small gland, it typically grows bigger with age. In fact, from birth to early 20s, the prostate grows by around 8 times its initial size. Then from around the age of 25 to early 50s the prostate doubles in size and continues to grow gradually. It is this second phase of growth of the gland which, in later years, results in a non-cancerous condition called benign prostatic enlargement (BPE) or benign prostatic hyperplasia (BPH).

As the prostate grows larger, it causes the muscles at the base of the bladder to become thicker and pressures the urethra to become narrower. By squeezing the urethra more tightly, the enlarged prostate makes it difficult to urinate. The bladder also may become more sensitive, causing a need to pass urine more frequently and suddenly. In some cases, prostate enlargement may cause a blockage that triggers repeated urinary tract infections, bladder or kidney damage, and acute urinary retention (sudden inability to pass urine).

How common is prostate enlargement?

Although prostate growth continues almost throughout a man’s life, the resulting enlargement does not usually cause serious problems until late in life. An enlarged prostate hardly causes symptoms before the age of 40, but some symptoms occur in half of men in their 60s and in up to 90 percent of men in their 70s and 80s. In the United States, as many as 14 million men experience lower urinary tract problems related to benign prostatic hyperplasia while at least 400,000 annual hospital stays involve a diagnosis of prostate enlargement.

You are more likely to have BPH if:

  • You are 40 or older.
  • You have a family history of BPH.
  • You lack physical exercise.
  • You have erectile dysfunction.
  • You have medical conditions like type-II diabetes, obesity, circulatory and heart disease.


Common symptoms of prostate enlargement include:

  • Urinating 8 or more times a day (urine frequency).
  • Inability to delay urination (urine urgency).
  • Trouble starting to urinate.
  • A weak or interrupted urine stream.
  • Inability to empty your bladder completely (urine retention).
  • Dribbling at the end of urination.
  • Accidental leakage of urine (urinary incontinence).
  • Pain during urination or after ejaculation.
  • Unusual color or smell of urine.
  • Blood in urine.

Most of these symptoms are not specific to benign prostatic enlargement and may be caused by bladder problems, prostatitis, urinary tract infections (UTIs), or a more serious problem such as prostate cancer. Therefore, men with such symptoms should seek immediate medical attention.

Diagnosis and treatment of prostate enlargement

When you visit a GP or a specialist such as urologist, various steps will be taken to determine the cause of your symptoms. The doctor will take your medical, personal and family history, ask questions about the symptoms and their effect on your life and conduct a physical examination to check the size, feel and shape of your prostate. The urologist also may request tests such as prostate-specific antigen (PSA) and ultrasound scan to rule out any serious complications.

There are many treatment options for BPH. For instance, the doctor may recommend lifestyle changes, bladder training exercises or medications (such as muscle relaxants and hormone blockers). The doctor also may perform surgery to correct the problem.

At St. Pete Urology, we have a highly skilled team of urologists with a great deal of experience diagnosing and treating BPH and other urinary problems. We fix these issues quickly, safely and effectively, helping you to resume your normal life and activities. For more information on treatment of benign prostatic hyperplasia, visit the site, St Pete Urology.

When Should You Get A PSA Test?

When should you take the Prostate-Specific Antigen (PSA) test? The question of screening is typically a personal and complex issue that requires a consultation with a urologist. Currently, the medical community does not share a unanimous opinion regarding the benefits of prostate cancer screening.

Most physician-led groups, like the American Urological Association and the American Society of Clinical Oncology, insist that PSA screening ought to be considered within the context of a man’s life expectancy and level of risk given other prior or existing medical conditions. Other groups have advised that PSA screening for healthy men under 40 comes with a risk of harm that may outweigh the benefits depending on the patient’s medical history.

When should you start screening?

The decision on when to start screening should depend on your overall health, level of risk, life expectancy, and desire for treatment should you be diagnosed with prostate cancer. While the time to start screening depends on individual factors, the age of 40 years is a reasonable time to begin, particularly for those with genetic predispositions or a family history of cancer. Likewise, for healthy men at high risk, such as African American men with a family history of prostate cancer, starting at age 40 is advisable.

For men at average risk, a urologist may recommend the initial DRE or PSA test at age 40 or 45, while some urologists may recommend starting at age 50. In general, most men have discussed PSA testing with their doctor by the time they reach age 50. This means that men above 40 years should consider discussing PSA screening with their urologist to determine if and when the test is right for them. All men should develop a proactive prostate health plan based on their family history and lifestyle.

When should you visit a urologist?

The above recommendations are specific to prostate cancer screening for healthy men showing no symptoms. If you are diagnosed with prostate cancer and a confirmation is made using a biopsy, your urologist may recommend routine PSA testing for risk assessment and post-treatment monitoring.

The right time to start PSA screening is an individual decision that depends on your risk level and family history. Visit your urologist to discuss the timing of this important medical test for men. For more information on the screening and treatment of prostate cancer, visit St Pete Urology in St Petersburg, Florida.

Promising New Procedure for Men With Enlarged Prostates

A minimally invasive procedure designed to shrink prostate tissue with a series of nine-second blasts of steam offers men a new treatment for urinary symptoms commonly associated with enlarged prostates.

The procedure, called Rezūm (pronounced “resume”) and developed by NxThera Inc. of Maple Grove, Minn., became widely available in the U.S. in the second half of 2016. Thermal energy in the form of steam is applied to the prostate with a needle. As it cools it releases heat energy into the tissue, killing cells and shrinking the prostate overall by about a third, says Bob Paulson, NxThera’s chief executive.

Some 50% of men over the age of 50 have enlarged prostates, which can produce symptoms such as increased urgency to urinate during the day and frequent urination, which disrupts sleep at night. Sufferers often must choose between surgery or medication, both of which have side effects, including sexual dysfunction.

The NxThera therapy is the second major innovation in recent years for men with enlarged prostates. The other, an implanted device called UroLift, was introduced in the U.S. in 2013 by NeoTract Inc. of Pleasanton, Calif.

After years of little improvement in the minimally invasive treatment of enlarged prostates, men now have two new options “that leave your sexual function intact,” says Claus G. Roehrborn, a professor and chairman of the department of urology at the University of Texas Southwestern Medical Center in Dallas and a co-author of published studies on both treatments.

Middle ground

Physicians say Rezūm can be used on a wider range of prostate anatomies than the UroLift implant. The procedure, which costs about $2,000 and generally is covered by insurance, can be done in a doctor’s office in just a few minutes. To dull pain, lidocaine may be injected into the prostate, and most doctors will offer a sedative for patients who want one. After the procedure, most patients need to wear a catheter for two or three days but can return to daily activities immediately.

While the results of a two-year clinical trial published by Dr. Roehrborn and colleagues show that Rezūm provides significant relief from symptoms, it isn’t clear how long the improvement will last.

“The durability issue is what’s going to sink or swim this procedure,” says study co-author Kevin T. McVary, chairman and professor of urology at Southern Illinois University School of Medicine, in Springfield, Ill. Both minimally invasive options are likely less effective than surgery, Dr. Roehrborn says, because surgery removes the most tissue.

Still, for many men, the steam treatment offers an appealing middle ground between the risk of surgery and the hassle and side effects of taking daily medication, which can cause dizziness and fatigue.

“I tried Flomax for about two years but the side effects were too annoying,” says Stephen Gooding, a 60-year-old utility supervisor from Grayson, Ga., who says the drug made him dizzy and constipated. He had the Rezūm procedure in October, and now “I feel like I did 30 years ago.”

In the two-year study of 197 men, funded by NxThera and published online in the Journal of Urology in December, patients who had the Rezūm procedure showed a significantly greater improvement in symptoms at three months compared with patients who had a sham procedure. At the end of two years, patients treated with Rezūm showed a 51% reduction in urinary symptoms (as measured by a seven-question survey), compared with the beginning of the study.

Over the two years, about 4% of the patients who underwent Rezūm had to have a repeat procedure or surgery to treat their condition. Early in the trial, physicians were new at performing the procedure and didn’t always remove enough tissue, says Cindy Ogden, vice president, clinical affairs at NxThera.

So far, Rezūm appears to spare men sexual side effects. In the surgical procedure known as transurethral resection, 70% to 80% of men generally get a condition called retrograde ejaculation, also called dry orgasm, says Dr. McVary.

In the Rezūm study, about 3% of the patients who underwent the procedure experienced no ejaculatory volume afterward, and 5.3% experienced a decrease in ejaculatory volume, according to data provided by NxThera. Ejaculatory volume can fluctuate over time in men with enlarged prostates, so it isn’t clear the reductions were caused by the procedure, Dr. McVary says. Overall in the study, there was no average change in ejaculatory volume, he adds.

Larger prostates

A major advantage of Rezūm is that it can be done on most types of anatomies. UroLift isn’t approved by the Food and Drug Administration to treat the median, or middle lobe of the prostate, which contributes to symptoms in about 10% to 30% of patients, Dr. Roehrborn says.

The FDA hasn’t cleared Rezūm or UroLift for prostates weighing more than 80 grams. So NxThera can’t market its procedure for larger prostates, though doctors can legally use it on such patients if they choose.

Early results in clinical practice on large prostates appear “promising” and a study on prostates up to 150 grams is expected to begin later this year, says Ricardo Gonzalez, a urologist at Texas Medical Center in Houston, who will be a principal investigator on the research. About a quarter of men seeking treatment for prostate-related urinary symptoms have prostates greater than 80 grams, he says.

Business executive Jim Bracke, 69, says that, with just a Tylenol and the lidocaine shot, discomfort from Rezūm’s steam blasts felt no more intense than “warm water spilled on the groin.” He drove himself home after the procedure, and says he’s thrilled that he no longer needs to check out a bathroom the moment he arrives at a restaurant. And as long as he doesn’t overdo it, he adds, “I can have beer, and coffee and chocolate and still sleep through the night.”

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Should You Take Medicine for Treating Enlarged Prostate?

As a man ages, his prostate may become larger, a disorder known as Benign Prostatic Hypertrophy (BPH). While an enlarged prostate is neither a serious nor a life-threatening condition, it can cause urinating problems in men aged 50 years and older. Men with urinary problems should immediately see their doctor for a prompt and accurate diagnosis because symptoms of BPH are similar to those of prostate cancer. A patient should also see a doctor immediately when experiencing fever, chills, back pain, side pain, abdominal pain, bloody or cloudy urine, or pain when urinating.

Treatment of Enlarged Prostate

After a diagnosis of prostate enlargement, the urologist evaluates the severity of symptoms before recommending treatment. You are expected to participate in the decision making process to ensure you get the best treatment possible. Generally, no medications are prescribed for enlarged prostate unless the symptoms are severe, bothersome or accompanied by problems such as bladder stones or bladder infection. In fact, around 4 out of 10 men usually have no symptoms or have their symptoms improve without medications or surgery and only require lifestyle changes to manage BPH. Conversely, 1 in 4 men in their late 50s, 1 in 3 men in their late 60s, and 1 in 2 men in their late 70s and beyond can expect to have bothersome symptoms that require medications or even surgery.

Watchful Waiting

Should you take medications for treating enlarged prostate? After the diagnosis of BPH, you will have to choose either watchful waiting or medicine as your primary treatment, though surgery is sometimes necessary for serious symptoms. The best treatment option for men with minimal and less bothersome symptoms is watchful waiting. It involves combining lifestyle measures that prevent or relieve symptoms of BPH with visits to the urologist at least once a year for physical examination, testing and symptom status review.

Men managing BPH through watchful waiting must limit the amount of fluid they consume at any given time, avoid drinking fluids after 7 p.m., avoid beverages containing caffeine, avoid delaying urination, cut back on salty or spicy foods, limit alcohol intake, engage in regular physical activity and Kegel exercises, avoid cold weather and keep themselves warm, control their weight, control their blood sugar level, eat diets rich in vegetables, and avoid over-the-counter antihistamines (decongestants).

You should opt for watchful waiting if:

  • (a) You experience mild and less bothersome BPH symptoms.
  • (b) The side effects of the medicine may bother you more than the mild symptoms of BPH.
  • (c) You can attend regular medical checkups (at least once a year).
  • (d) You can effectively use special bathroom techniques, cut back on your fluid intake and change your lifestyle.

Medicines

If your symptoms are severe or worsen during watchful waiting, you should consider taking BPH medications. The three types of drugs commonly used for treating enlarged prostate are alpha-blockers, 5-alpha reductase inhibitors and phosphodiesterase-5 inhibitors. Alpha-blockers are fast-acting drugs that relax prostate muscles and relieve urination problems within a few days or weeks. They include terazosin (Hytrin), doxazosin (Cardura), prazosin (Minipress), silodosin (Rapaflo), Alfuzosin (UroXatral) and tamsulosin (Flomax). Drugs called 5-alpha reductase inhibitors such as dutasteride (Avodart) and finasteride (Proscar) cause shrinkage of the prostate and improve symptoms, albeit after several months. Phosphodiesterase-5 inhibitor called tadalafil (Cialis for daily use) has also been approved for use in treating BPH.

When using a prescription for managing enlarged prostate, you will take the pills every day for life, have regular medical checkups, and use special bathroom techniques such as relaxation and double voiding. The medicines will reduce the risk of urinary retention, relieve symptoms and minimize risks of future surgery. However, prescriptions are often expensive and come with certain side effects such as trouble getting an erection, diminished sex drive, tiredness, dizziness, and stuffy nose.

Conclusion

When you have problems urinating, you should immediately see a doctor as you may have an enlarged prostate. At the urology clinic, the doctor will perform a physical exam and run a few tests to find out if you have BPH. If BPH is confirmed, the urologist will explain to you the treatment options available, such as watchful waiting, medications and or surgery for serious cases. The treatment option chosen will depend on the severity of symptoms and your desire to improve the quality of your life. You should consider watchful waiting if you have mild symptoms and want to avoid the adverse effects of drugs. However, in case of severe BPH symptoms, you should take medications to relieve symptoms and possibly prevent the need for surgery in the future. For more information on treating an enlarged prostate, visit St Pete Urology in St Petersburg, Florida.

The Prostate Cancer Test That Saved My Life

“So, yeah, it’s cancer.”My urologist segued from talking about how inconvenient it was picking his daughter up at school that morning to dropping a cancer diagnosis on me without missing a beat. Two weeks earlier, I didn’t even have an urologist.

“Yeah,” he said, in a slightly nonplussed way, gazing at the results, “I was surprised myself.”

As my new, world-altering doctor spoke about cell cores and Gleason scores, probabilities of survival, incontinence and impotence, why surgery would be good and what kind would make the most sense, his voice literally faded out like every movie or TV show about a guy being told he had cancer… a classic Walter White moment, except I was me, and no one was filming anything at all.

I got diagnosed with prostate cancer Friday, June 13th, 2014. On September 17th of that year I got a test back telling me I was cancer free. The three months in between were a crazy roller coaster ride with which about 180,000 men a year in America can identify.

Right after I got the news, still trying to process the key words echoing dimly in my head (probability of survival–vival-vival-val…” “incontinence-nence-nence-ence …), I promptly got on my computer and Googled “Men who had prostate cancer.” I had no idea what to do and needed to see some proof this was not the end of the world.
John Kerry… Joe Torre… excellent, both still going strong. Mandy Patinkin… Robert DeNiro. They’re vital. OK great. Feeling relatively optimistic, I then of course had to do one more search, going dark and quickly tapping in “died of” in place of “had” in the search window.

As I learned more about my disease (one of the key learnings is not to Google “people who died of prostate cancer” immediately after being diagnosed with prostate cancer), I was able to wrap my head around the fact that I was incredibly fortunate. Fortunate because my cancer was detected early enough to treat. And also because my internist gave me a test he didn’t have to.

Taking the PSA test saved my life. Literally. That’s why I am writing this now. There has been a lot of controversy over the test in the last few years. Articles and op-eds on whether it is safe, studies that seem to be interpreted in many different ways, and debates about whether men should take it all. I am not offering a scientific point of view here, just a personal one, based on my experience. The bottom line for me: I was lucky enough to have a doctor who gave me what they call a “baseline” PSA test when I was about 46. I have no history of prostate cancer in my family and I am not in the high-risk group, being neither — to the best of my knowledge — of African or Scandinavian ancestry. I had no symptoms.

What I had — and I’m healthy today because of it — was a thoughtful internist who felt like I was around the age to start checking my PSA level, and discussed it with me.

If he had waited, as the American Cancer Society recommends, until I was 50, I would not have known I had a growing tumor until two years after I got treated. If he had followed the US Preventive Services Task Force guidelines, I would have never gotten tested at all, and not have known I had cancer until it was way too late to treat successfully.

Now, in my case, my doctor, Bernard Kruger, watched my PSA tests rise for over a year and a half, testing me every six months. As the numbers continued to rise, he sent me to the urologist, who gave me a slightly invasive physical check in his office using a gloved finger. This took all of 10 seconds. While I don’t recommend it for fun, amazingly some don’t recommend it at all. After this exam, and looking at my rising PSA numbers, he suggested an MRI to get a roadmap of my prostate.
It’s a non-invasive procedure like the one athletes get to check for torn ACLs. Loud, but painless. Only after studying the MRI results did my doctor recommend a not-fun-at-all biopsy. Unlike the MRI, the biopsy was as invasive as it gets: long needles in sensitive places and more small talk about kids and school pick ups while it was all going down.

Then the biopsy came back positive. Of course “positive” for medical tests is usually not so positive. I had a Gleason score of 7 (3+4), which is categorized “mid-range aggressive cancer.” Surgery was recommended. At this point I decided to go out and get a few different opinions. All the doctors I talked to concurred that the tumor needed to be taken out.

Ultimately, I found a wonderful surgeon named Edward Schaeffer who I felt comfortable with. He performed a robotic assisted laparoscopic radical prostatectomy. Due to a lot of skill and a little beneficence from some higher power, he got all the cancer. As of this writing I am two years cancer free and extremely grateful.
So. What is the deal with this PSA test and why the controversy?

It is a simple, painless blood test. It is not dangerous in itself in any way. If the PSA (Prostate Specific Antigen) value is elevated in the blood, or levels rise sharply over time, it could indicate the presence of prostate cancer. It is definitely not foolproof.

The criticism of the test is that depending on how they interpret the data, doctors can send patients for further tests like the MRI and the more invasive biopsy, when not needed. Physicians can find low-risk cancers that are not life threatening, especially to older patients. In some cases, men with this type of cancer get “over-treatment” like radiation or surgery, resulting in side effects such as impotence or incontinence. Obviously this is not good; however it’s all in the purview of the doctor treating the patient.

But without this PSA test itself, or any screening procedure at all, how are doctors going to detect asymptomatic cases like mine, before the cancer has spread and metastasized throughout one’s body rendering it incurable? Or what about the men who are most at risk, those of African ancestry, and men who have a history of prostate cancer in their family? Should we, as the USPSTF suggests, not screen them at all? There is growing evidence that these guidelines have led to increased cases of prostate cancers that get detected too late for the patient to survive the disease.

Five years after their initial recommendation to stop PSA testing, the USPSTF is presently, per their website, “updating their recommendations.” I think men over the age of 40 should have the opportunity to discuss the test with their doctor and learn about it, so they can have the chance to be screened. After that an informed patient can make responsible choices as to how to proceed.

I count my blessings that I had a doctor who presented me with these options. After I chose to take the test, he directed me to doctors who worked at centers of excellence in this field to determine the next steps. This is a complicated issue, and an evolving one. But in this imperfect world, I believe the best way to determine a course of action for the most treatable, yet deadly cancer, is to detect it early.