Health
Inaccurate results and less
than fool-proof detection
has lead many health professionals
to eschew prostate
specifi c antigen tests as an indicator
of prostate cancer. A
draft recommendation from
the U.S. government said tests
should no longer be part of
routine screening for men.
Why? According to the U.S.
Preventative Services Task
Force, evidence indicates
there is little, if any, reduction
of prostate cancer-related
deaths from the tests. Further
research has indicated
that tests actually may turn a
man’s life upside down by unnecessary
stress and surgery
for false-positive readings.
But there are proponents of
the test that say it is still vital
in early detection of prostate
cancer and enables men to get
treatment earlier.
A prostate-specifi c antigen
test measures a protein in the
COURIER L 28 IFE, SEPT. 6-12, 2019
blood, which has a tendency to
spike when prostate cancer is
present. People who support
the test say that it is one of the
best practices for male health
screenings and that fatalities
have dropped 40 percent due
to prostate cancer since these
tests were introduced 20 years
ago.
Opponents say the tests often
deliver fl awed results. This
has frequently led to overtreatment,
stress and anxiety.
Furthermore, the test may indicate
cancer, or it could be detecting
something much more
benign, like an infection or recent
sexual intercourse. Also,
a positive test reading can require
a biopsy that takes place
through the rectum, which
can lead to a number of uncomfortable
side effects.
One of the biggest arguments
against tests is that
they don’t really lower a
man’s risk. Prostate cancer
Some people still believe that prostate-specifi c antigen tests are a good choice in prostate cancer detection.
Others say they can lead to false positives and unnecessary surgery.
is a slow-growing cancer for
many men, which may not actually
impair a man’s health
in his natural lifetime, especially
since prostate cancer
is largely a disease of men in
their 60s and older.
The American Cancer Society
has not taken sides on
the matter. The Canadian
Cancer Society has said that
the test cannot diagnose cancer.
If your tests are high,
more tests are usually needed
to determine if you have prostate
cancer. They also say
some types of prostate cancer
grow slowly, may never cause
problems, and don’t need to be
treated. Finding this type of
cancer may lead to unnecessary
treatment that can have
side effects.
Whether to undergo a test
or not is largely the decision
for a man and his doctor. Some
believe it to be invaluable in
the fi ght against cancer, while
others are no longer so sure
about a test’s effi cacy.
The prostate
test controversy
HE PROSTATE — the
small gland sitting just
below the bladder that
supplies an essential ingredient
of semen — may provide
a variety of clues that
something is wrong. Use this
primer about three common
prostate conditions to get to
know the signs that you need
to see your doctor.
1. PROSTATE CANCER
The most common nonskin
cancer, prostate cancer
shows no symptoms in
the early stages. However, in
later stages, prostate cancer
can cause many of the same
symptoms as other prostaterelated
conditions, especially
BPH. These symptoms include
frequent and sudden
urges to urinate, difficulty
initiating urination, weak
or erratic urine flow, trouble
emptying the bladder and
painful urination.
Treatment for prostate
cancer depends on a variety of
factors, including the stage of
the disease and the patient’s
overall health. For men with
early, low-grade disease, we
may simply need to monitor
the cancer over time. Others
may need surgery to remove
the prostate or other treatments
to kill cancer cells or
inhibit their growth, such
as radiation therapy, chemotherapy,
hormone therapy or
immunotherapy.
2. PROSTATITIS
Prostatitis — inflammation
of the prostate — occurs
in two main forms, bacterial
and nonbacterial. Prostatitis
can make urination difficult,
painful or more frequent. It
can also cause fever, low-back
pain, discomfort in the penis
and testicles, and blood in the
urine.
Bacterial prostatitis is
treated with antibiotics, but
the length of time depends on
whether the patient has acute
or chronic prostatitis. Someone
with chronic bacterial
prostatitis may need to take
antibiotics for an extended
period, whereas someone
with the acute form may only
need antibiotics for a week or
two.
In the case of nonbacterial
prostatitis, doctors may also
prescribe antibiotics to help
treat an underlying bacterial
infection but will likely use a
variety of other medications,
too, such as nonsteroidal antiinflammatory
drugs.
3. BENIGN PROSTATIC
HYPERPLASIA
The prostate grows for
most of a man’s life, but if
it becomes too large, it can
squeeze the urethra, making
urination difficult. That
abnormal enlargement of the
prostate is called benign prostatic
hyperplasia (BPH). The
oversized prostate may also
contribute to weakening of
the bladder, which prevents it
from emptying completely.
If you have BPH, you may
feel the need to urinate much
more often than normal, especially
at night, and with
an abnormal urgency. You
may have trouble initiating
a urine stream, and when
you do, it may be weak or intermittent.
After urinating,
your bladder may still feel
full because it is not emptying
completely. At the extreme
end of the spectrum,
kidney damage may occur.
Fortunately, doctors can
prescribe a variety of treatments
for BPH, including
long-term monitoring, medications,
minimally invasive
surgeries — procedures
that shrink or lift the prostate
out of the way — and laser
surgery to remove part of
the prostate causing blockage.
Open surgery for BPH is
rarely necessary.
If you are experiencing
any of these symptoms, or
have questions about prostate
health, make an appointment
with a NewYork-Presbyterian
Brooklyn Methodist
Hospital urologist by calling
718.499.2273.