Dr. John Powell, a radiation oncologist at Cayuga Medical Center (Photo: Dede Hatch)
As men age, concern over prostate health should take priority. It is a topic many men prefer not to think about, but the implications for health and longevity make it a subject well worth understanding.
Dr. John Powell, a radiation oncologist at Cayuga Medical Center, is on hand to explain what you need to know about prostate health.
Risk and Age
“The prostate is a small gland located in the pelvis. It’s located just in front of the rectum and just below the bladder,” explains Dr. Powell. A part of the sexual and reproductive system, the prostate produces seminal fluid. That is its job. “As we age, there’s commonly benign swelling of the prostate, referred to as BPH or benign prostate hypertrophy.”
Dr. Powell says that BPH is not cancer in and of itself, but it is where most of the symptoms men associate with the prostate tend to come from. For example, slower urinary stream, more frequent urination, having to go more during the night, or not emptying the bladder completely.
Prostate cancer risk increases with age. “It’s generally a disease that is detected in men over age 50,” verifies Dr. Powell. The highest incidence of prostate cancer is found in men around age 65, and some research reveals that many—if not most—men over the age of 80 or 90 have abnormal prostate cells that would be classified as cancer.
Screening Guidelines
The guidelines in the United States suggest men should consider some kind of prostate screening at age 45. One screening method is a blood test that checks for prostate-specific antigen or PSA.
“One thing that is unique about prostate cancer is the wide spectrum of disease,” states Dr. Powell. “Our ability to find the cancer means that we can detect many, many prostate cancers that fall into an extremely low-risk spectrum. There are very dangerous prostate cancer situations that can be life-threatening, and PSA gives us the ability to detect all of them.”
That ability to detect low-risk cancers makes PSA screening controversial. There is some concern over the harm that may be done in men who are given a course of cancer treatment, with all the side effects that entails, for a non-life-threatening condition.
Evaluation and Surveillance
Fortunately, there are tools available to help determine the path a specific cancer may take. In addition to the PSA level, a biopsy may be performed. From this, a pathologist can evaluate the cells and determine how aggressive the prostate cancer’s pattern of growth appears to be.
Taking the biopsy results and PSA level into consideration, along with the size of the prostate, and the man’s age and overall health, a plan can be put in place. Research recently completed in the United Kingdom studied an approach referred to as “active surveillance,” a strategy of initial monitoring rather than initial treatment of prostate cancer.
“They found that with good follow-up, many of the men who chose active surveillance wouldn’t need treatment,” notes Dr. Powell. Eventually, more than half the men being surveilled did go on to prostate cancer treatment. Active surveillance helps determine who really needs that treatment, and who doesn’t.
The important takeaway is to get screened when it is appropriate, and work with your healthcare provider to determine the correct course of action, based on your PSA levels.
Dr. Powell is board certified in radiation oncology and is medical director of radiation therapy at Cayuga Medical Center. He serves on the medical staffs of Roswell Park Cancer Institute and Cayuga Medical Center.
