Throughout September, The People’s Tribune will place a strong focus on prostate cancer as part of Prostate Cancer Awareness Month, with a series aimed at encouraging men in St. Maarten to learn more about their prostate health, understand their risks and become more comfortable having conversations about testing and early detection.
Prostate cancer deserves more than an occasional reminder for men to “get checked.” Throughout the month, we will examine the warning signs, PSA testing, risk factors, what happens when a PSA result is elevated, how prostate cancer is diagnosed, treatment options and some of the fears and misconceptions that cause men to delay speaking with a doctor. We begin with perhaps the most basic question: What are the possible signs of prostate cancer, and what should a man do if he wants to know for sure?
The first thing every man should know about prostate cancer is that you do not necessarily have to feel sick to have it. Early prostate cancer often causes no noticeable symptoms, which means waiting until something feels wrong is not a reliable way of protecting yourself. In many cases, prostate cancer is discovered through testing before a man experiences any obvious problem.
The prostate is a small gland located below the bladder. It surrounds part of the urethra, the tube through which urine leaves the body. Because of its location, changes involving the prostate can sometimes affect urination, although urinary problems are much more commonly caused by conditions other than cancer.
Possible warning signs include difficulty starting to urinate, a weak or interrupted urine stream, needing to urinate more frequently, particularly during the night, and feeling as though the bladder has not emptied completely. Pain or burning while urinating, blood in the urine or semen and painful ejaculation can also occur.
None of these symptoms automatically means prostate cancer. An enlarged prostate, known medically as benign prostatic hyperplasia or BPH, becomes increasingly common as men get older and can produce several of the same urinary problems. Infections and inflammation of the prostate can also cause symptoms and can even affect prostate-specific antigen, or PSA, levels.
More advanced prostate cancer may produce symptoms elsewhere in the body. Persistent pain in the back, hips or pelvis can be a warning sign, particularly when cancer has spread to the bones. Other symptoms can include unexplained weight loss and fatigue. Any persistent or unexplained symptoms should be discussed with a healthcare professional rather than self-diagnosed.
But what if you have no symptoms?
This is where the conversation about testing becomes important. Screening means looking for cancer before symptoms develop, and one of the main tools doctors use when assessing prostate cancer risk is the PSA blood test.
PSA is a protein produced by cells in the prostate. A small amount normally circulates in the blood. Higher PSA levels can sometimes be associated with prostate cancer, but there is an important point men should understand: a high PSA does not automatically mean you have cancer.
An enlarged prostate, prostate inflammation, infection, certain medical procedures and some medications can affect PSA levels. Even ejaculation and vigorous exercise such as cycling can temporarily influence the result. A doctor therefore looks at the number together with factors such as your age, medical history, previous PSA results and personal risk.
A doctor may also perform a digital rectal examination, or DRE, during an evaluation. This involves feeling the prostate through the rectum to check for unusual hardness, lumps or other abnormalities. A DRE by itself cannot determine whether cancer is present.
What happens if something looks suspicious?
An abnormal PSA result is not an immediate cancer diagnosis. Depending on the circumstances, a doctor may first repeat the PSA test. Additional blood or urine tests may also be considered, and increasingly an MRI of the prostate can be used to identify suspicious areas and help determine whether a biopsy is necessary.
The test that can determine for sure whether prostate cancer cells are present is a prostate biopsy. During a biopsy, small samples of prostate tissue are removed and examined under a microscope by a pathologist. If cancer is found, further information from the biopsy helps doctors assess how aggressive it appears to be and decide what should happen next.
Men should also remember that prostate cancer risk is not the same for everyone. Age, family history and ancestry can affect risk. Black men have a higher risk of developing and dying from prostate cancer, while having close relatives who developed prostate cancer can also increase a man’s risk.
The most important message is therefore not to wait for pain or urinary problems before thinking about your prostate. Speak with your doctor about your age, family history and individual risk, and ask whether PSA testing is appropriate for you.
Having a prostate problem does not mean you have cancer, and an elevated PSA does not mean you have cancer. But if you want to know what is happening, the conversation has to start somewhere. For many men, it starts with a simple discussion with their doctor and, when appropriate, a blood test.
Next we will dive into:“Your PSA Number: What Is Normal, What Is High and When Should You Worry?”
