Prostate Cancer

“Is it my prostate, doc?” Dave asks me at the golf course as he rushes to the washroom for the fifth time.

As a travelling salesman, Dave finds it difficult to make many washrooms stops. He makes an appointment to see me.

Dave is 40. His father has had prostate cancer. Dave wants to know what are his risks and what can he do for prevention and early detection.

The prostate is a small gland, usually weighing about 20 grams. It surrounds the urethra where it joins the bladder. Enlargement of the gland causes voiding problems and may cause bleeding in the urine which may or may not be visible.

Prostate cancer is, after lung cancer, the most common cause of cancer-related death in men. The risk of developing prostate cancer increases with age. At 40, the probability of prostate cancer occurring within five years is 0.01 per cent. At 80, it is eight per cent.

Although the risk is only eight percent, it is important to note that 80 per cent of men at 80 will have prostate cancer. But this will not affect life or life expectancy.

“What’s up doc?” Dave greets me as I enter the examination room.

We discuss symptoms. In a physical examination we find his prostate is slightly enlarged, smooth but quite firm.

There are no hard lumps to cause alarm at this stage.

Although most prostate cancers are diagnosed at 70, they can occur at a younger age. Since Dave has a family history and his prostate is enlarged and firm, he is referred to Urologist for further investigation.

Dave has a blood test – prostate-specific antigen (PSA). This is slightly abnormal. Therefore he has rectal ultrasound and a needle biopsy. This is reported as normal.

“Doc, how often should I have checkups for my prostate?” Dave asks.

His Urologist indicates Dave should have a repeat antigen test in three to six months.

If this is abnormal then he may need a repeat prostate biopsy.

Screening is recommended for men 50 and over. Half the men in this age group develop prostate problems. This may or may not be due to cancer.

Digital rectal examination and antigen tests are recommended for screening high risk patients like Dave. Although neither tests are hundred percent accurate for early diagnoses, they are accepted as part of routine medical checkups.

Dave is happy there is no cancer and his anxiety level improves. He feels reassured about his health.

He is ready to hit the road for another few days of good salesmanship.

(This series of articles explore the health problems of Dave and his family. They are composite characters of a typical family with health problems)

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