The Most Important Number for Keeping a Healthy Prostate

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When it comes to staying on top of your health, doctors often tell you how important it is to “know your numbers.” Blood pressure, cholesterol, and body mass index can tell you a lot about your heart health, but if you’re a man, you need to know one more: your PSA, or prostate-specific antigen.

Doctors use the PSA test to check for any abnormalities within the prostate, a male reproductive gland located between the bladder and the penis. An elevated level of PSA in the blood can be a sign of non-cancerous, as well as cancerous, prostate issues.

“In most cases, prostate cancer does not present with any signs or symptoms,” says Aria Olumi, MD, chief of Urologic Surgery at Beth Israel Deaconess Medical Center (BIDMC). “That’s why we recommend that men have a conversation with their physician and decide whether prostate cancer screening is appropriate for them. Most urinary symptoms are due to non-cancerous prostate issues, or other parts of the urinary system.”

Symptoms to look out for:

• A weak or slow urinary stream
• A feeling of incomplete bladder emptying
• Difficulty starting urination
• Frequent urination
• Blood in the urine or semen (specific to prostate cancer)
• Urgency to urinate
• Getting up frequently at night to urinate
• A urinary stream that starts and stops
• Straining to urinate
• Continued dribbling of urine
• Returning to urinate again minutes after finishing
• Erectile dysfunction

If you or your male partner has experienced any of the above symptoms, it could be a result of prostate disease. The three most common forms of prostate disease are prostate cancer, benign prostatic hyperplasia, or BPH (non-cancerous enlargement of the prostate), and prostatitis (inflammation of the prostate).

Prostate Cancer

Prostate cancer is the second most common cancer found in men, following skin cancer. It affects nearly 175,000 men in the U.S. each year and 60 percent of those cases are found in men over 65-years-old. Currently, as many as 20 percent of men will get prostate cancer in their lifetime, and with the aging population, the percentage is expected to rise. But thanks to screenings and a variety of treatment options, men are living longer with the disease than in years past.

Some prostate cancers can be slow growing, which means men have many treatment options to choose from.

“At BIDMC, we take a ‘watch and wait’ approach, or ‘active surveillance,’ with our patients who have these slow-growing tumors,” says Dr. Olumi. “Of the more common cancers, prostate cancer is the only one in which so many patients have a slow-growing tumor that does not need to be immediately or aggressively treated.”

But for other types of prostate cancer, treatment options range from hormone therapy to radiation to surgery.

“BIDMC is a national leader in robotic surgery for prostate cancer,” said Dr. Olumi. “We perform a very large number of these procedures and studies have shown that hospitals that perform a high volume produce the best surgical results.”

BIDMC also offers various types of radiation therapy, including a radioactive “seed” that gets placed directly into the prostate, and CyberKnife®, which contrary to its name, is a non-surgical system that delivers a very narrow radiation beam to the tumor precisely, without harming surrounding tissue.

“A one-size-fits-all approach does not work when it comes to prostate health,” says Irving Kaplan, MD, a radiation oncologist and CyberKnife expert at BIDMC. “Every patient is different, and our job is to customize treatment options that work best for our patients and allow for the best possible quality of life.”

Benign Prostatic Hyperplasia

Non-cancerous enlargement of the prostate, or benign prostatic hyperplasia (BPH), is common in men as they get older. It is not life threatening, but can significantly affect the quality of life.

In many cases, medications can reduce or resolve symptoms and are usually the first treatment offered by your doctor. When medications don’t work, or produce too many side effects, surgery may be necessary.

Prostatitis

While prostatitis can affect men of any age, it is more common in younger men, between 30 and 50 years old. Prostatitis can be caused by a bacterial infection or can be non-bacterial.

“Non-bacterial prostatitis is the most common form of prostatitis and is more difficult to manage,” says Dr. Olumi. “Symptoms vary and there is no single test to diagnose it, so your doctor will need to rule out other possible causes of your symptoms before making a diagnosis.”

Learn more about the Genitourinary Cancer Program at BIDMC, which consists of a multidisciplinary team of specialists with expertise in the areas of prostate, kidney, bladder, and testicular disease.