What To Look For During Prostate Cancer Month

By Paul Mittelstadt, MD

As the male population ages, the concerns about prostate cancer risks, diagnosis and treatments become more important. In the male homosexual population, treatment options are a significant concern as our population wishes to continue with long term sexual activity and intimacy.

The major risks for prostate cancer are age, being racially black, certain hereditary factors such as the LYNCH syndrome and having first degree relatives that were diagnosed at an age younger than 65. It appears anal sexual activity is not a risk factor.

Actual testing for prostate cancer has changed over the years. In the past, a digital rectal examination was standard evaluation but found not accurate especially in early cases. The current standard is a yearly blood test called PSA. These are highly accurate but can be falsely elevated by any sexual activity or unusual prolonged pressure on the rectal area such as biking activity within the previous 4 days before the PSA blood test is drawn. Also, false elevations of PSA can occur secondarily to a chronically enlarged prostate or prostate infection.

Actual diagnosis of prostate cancer is done by doing a biopsy of the prostate in which a very fine needle is placed in multiple places in the prostate. Typically, multiple biopsies are done at the same time to locate the extent and size of the cancer. These biopsies are done through the rectum. In the past these biopsies were done with no anesthesia. This process has now changed as many urologists now give a “local” anesthetist which consists of two injections to the nerves in the rectal area. This results in an essentially painless biopsy with most biopsies done by ultrasound – a radiology process -which gives off no radiation. Rarely, after the biopsy, the patient may have blood in the urine or hematospermia with ejaculations. This is normal and generally is a one time event.

Once the diagnosis of prostate cancer is made emotionally dealing with this diagnosis is variable depending on the personality of the patient. Counseling and family support are highly recommended especially in gay male community where impotence, male erections, and sexual satisfaction are of concern.

Treatment choices are multiple depending on the age, overall health, extent of any spread, and expected life expectancy of the patient. Treatment options vary from surgical removal of the prostate, radiation, and chemotherapy. All these treatment options have potential side effects such as impotence, incontinence of urine and stool, colon spasms or bladder spasms. Any decision about treatment should be made with all options discussed with the primary urologist and oncologist. Also be aware that treatment of prostate cancer is an evolving science with treatments changing significantly within the last decade. For men, we live in an era where treatment options are improving and more variable and thus individualized.