As with many medical issues, men are always shy to talk about prostate problems. It carries the stigma that implies he is getting old. Actually, the definition of getting old has changed over the last decade due to the fact that expected life for both sexes are increasing but still in the favor of females. Taboos about Men’s Health still prevent men to talk freely about their symptoms, diseases, and problems. With the proper screening of prostate cancer, mortality has decreased 25% over the last decade and is expected to decrease more with the advent of new technologies.

First, we need to clarify some misbeliefs and understandings about the prostate.

Prostate is not a disease: Whenever somebody talks about prostate it refers to symptoms of urination. Actually, the prostate is not a disease but an organ, just like our liver, kidneys, heart. Its’ main job is to produce the liquid part of the semen. Like any other organ prostate also has different diseases.

I have no symptoms, why should I bother for prostate diseases? Another mistake among people is that prostate diseases only appear with symptoms. Prostate cancer, which is the most common form of cancer in men in the world, does not give any symptoms until too late. It is crucial and life-saving if cancer can be found early in the stage before any symptoms; it is almost 100% curable.  

I had prostate surgery for prostate enlargement, I am free from the risk of cancer development: In benign prostate, enlargement prostate is not removed totally. Only the portion that causes obstruction is removed and the capsule is left behind. Guess what! Cancer develops in most cases from the capsule of the prostate. Therefore, even if you already went through a prostate surgery for benign prostate enlargement, you need to continue the annual check-ups for possible cancer.

I had a PSA test that was normal 1 year ago I don’t need to do it again? PSA control should be done every year to find subtle, suspicious rises to diagnose early-stage cancer. That is the reason we need to follow up annually.

Prostate control starts with the evaluation of any symptoms you might have with a detailed questionnaire. We then do a digital rectal examination. Some blood is drawn to test for PSA (prostate-specific antigen). You do not need to be fasting or need to prepare for the test, but you will be asked about recent sexual activity over the last 24 hours, recent colonoscopy or any rectal manipulations that might affect PSA levels. Together with PSA levels and the digital rectal examination your initial screening is completed.  If there are any suspicious findings in the digital rectal examination or the blood test further investigations are warranted.

What can be wrong in the PSA test?

  1. Total PSA levels may be higher than 2.5 ng/dL in men between the ages of 45-55 years and higher than 5 ng/dL in men over 55
  2. Free/total PSA ratio is lower than 20%
  3. There is more than 0.75 ng/dL increase in PSA levels compared to last year’s measurements.

If there is any one of the above PSA problems or a suspicious examination, e few steps are taken according to the patient’s personal situation. A multiparametric prostate MR imaging has almost been the gold standard to evaluate the tissue characteristics. MRI findings indicative of cancer will require a targeted prostate biopsy for a definitive diagnosis. This is done by a special technique of combining the MRI images and the ultrasound images to overlap and guide directly to the suspicious target area. These new techniques have improved cancer detection but also decreased to a great degree the necessity of biopsies in benign cases.

We have tried to summarize the steps of prostate cancer screening and diagnosis in this blog. In our next blog, we will try to explain how prostate cancer is dealt with once diagnosed.