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| What a Better Time of the Year to Get Your Prostate Checked |
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Take it from this prostate cancer survivor: if I hadn’t gone to my regular doctor for an annual checkup, I may have been dead right now, or at least have cancer that had spread beyond the gland and into the lymph nodes. Luckily, my cancer was confined to the prostate, but hugging the wall of the gland through which it would have busted eventually. The doctors found no cancer in the surrounding lymph nodes. Because I caught the cancer very early, my cure rate is 90 percent over my lifetime. Why am I bugging you about prostate checks? Second most common form of cancer After skin cancer, prostate cancer is the second most common cancer in men and is second only to lung cancer as a cause of cancer deaths. In 2006, about 230,000 men were diagnosed with prostate cancer, and about 30,000 died of the disease. The good news is that reliable diagnostic tests and numerous treatment options are available, and death rates from prostate cancer are on the decline, according to urologists at Johns Hopkins University’s medical school. At your doctor’s office, the testing involves a “digital rectal exam,” in which the doctor inserts a gloved and lubricated finger where the light don’t shine to feel for any lumps, swelling, etc., in the prostate. In case you don’t know, and you really should, the prostate rests just the other side of the rectal wall, underneath the bladder. However, the doctor can’t feel your entire prostate. A tumor—like mine—could lurk far back in the shadows. That’s where the PSA blood test comes in. The importance of 'velocity' The PSA blood test is controversial because doctors disagree on whether all men should undergo the procedure. The best reason for the PSA test, which came about in the late 1980s, is it can help doctors catch prostate cancer very early, like mine. My space is limited to go into the controversy of PSA testing. I’ll let you research that issue. But using your PSA reading, doctors can lay odds as to whether it's cancer or some other affliction causing your prostate to act up. Which brings us to PSA “velocity,” the measure of how quickly a man's prostate-specific antigen level rises from one year to the next. A rapid rise in PSA—a “high” velocity— strongly suggests cancer, Johns Hopkins researchers say. For instance, my PSA rose from 2.6 to 3.9 in a period of about three years. Over six months, it rose to 4.5. Over the next six months, it shot up to 7. “Normal” is considered anything below 4. So don’t get hung up on whether your PSA is “normal,” but pay close attention to your “velocity.” Urologists say I had prostate cancer, despite my PSA being within the normal range, but my velocity was from 2.6 to 3.9—not good. Detection many years in advance Meanwhile, Johns Hopkins researchers say that PSA velocity can predict prostate cancer many years in advance when it is more curable. A study from Johns Hopkins and the federal government’s National Institute on Aging found that a PSA increase of more than 0.75 per year was an early predictor of prostate cancer in men with PSA levels between 4 and 10. The only way to diagnose prostate cancer is through a biopsy. In addition, PSA velocity is especially helpful in laying odds of early cancer in men with mildly elevated PSA levels and a normal digital rectal exam. It is most useful in predicting the presence of cancer when changes in PSA are evaluated over at least one to two years, the researchers say, in the latest Journal of the National Cancer Institute. In The New England Journal of Medicine, scientists say a rapid rise in PSA level—more than 2—in the year before prostate cancer diagnosis and surgical treatment predicted a higher likelihood that a man would die of his cancer over the next seven years. So during Prostate Cancer Awareness Month, think early detection. 'Required reading?' But keep in mind that other things may cause your prostate to act kooky. For instance, many men 50 and over have prostate enlargement, called benign prostatic hyperplasia, which can make your PSA rise. In addition, a prostate infection also can spike your PSA. Here’s the kicker: the symptoms of each are the same symptoms of prostate cancer. So now you see why I’m urging men to see their doctors, even if they don’t have tell-tale signs. Like many malignancies, prostate cancer can lurk for many years without showing symptoms. By the way, Johns Hopkins is the home of Dr. Patrick Walsh, the famous urologist who wrote Guide to Surviving Prostate Cancer and The Prostate: A Guide for Men and the Women Who Love Them. Walsh is heralded as being the lead researcher on development of “nerve-sparing” prostate surgery that seeks to protect the nerves that control urinary and sexual function. The technique seeks to reduce the chances of impotency and incontinence, two of the major side effects of prostate surgery. For men in their 40s and 50s, these two books should be required reading, since many men will encounter prostate problems. They're definitely on my bookshelf, right beside Gay Talese and James Joyce.
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September is Prostate Cancer Awareness Month, and I urge all men 40 and over to get to their doctors during this special time for prostate exams.
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