Prostate cancer - an easy discussion

Ok, I’m a sixty-ish man and I’ve decided to buck-up and see my doctor for a prostate cancer examination. I have been, like so many men, procrastinating. I don’t think it is fear that precluded me from testing for prostate cancer (ok, ok, maybe a little -- there, I said it) but there always seems to be something else I should be doing. Life gets in the way of prostate exams.

My friend has prostate cancer. It’s not good. Over the past 1-2 years I’ve watched him undergo harsh radiation treatments. He was one of those men that did not benefit from early detection. His regular blood work tests are showing his “numbers” are doubling -- in the wrong direction. This can be a nasty disease, and it can take your life, especially if left undetected early.

This successful treatment, like so many cancers, is directly related to early detection. Early is better. Early is better. Early...

So, I found myself on my doctor’s examination table, with his rubber-gloved hand, saying, “lay on your side, face the wall, and bring your knees towards your chest”. Sounded simple enough. So, the exam only lasted a moment, as the doctor used his finger (hence, the “digital” exam) to feel the prostate.

“Your prostate is a little enlarged, but otherwise the shape feels fine. No nodules or anything.”

Whew.

But since it is a little enlarged, (I repeat, this does NOT necessarily mean prostate cancer), he ordered a PSA, blood test. Now, neither the digital (gloved finger) exam nor the PSA (blood test) will offer conclusive results, but if both of them are suspicious, it’s time to look further and launch more tests. See below for details.

• Intravenous Urography
An injection is given directly into the bloodstream, then an x-ray shows a visualization of the bladder and kidneys.

• Urine Flow Test
This one’s easy. You urinate into a special container and it measures the strength of the flow. This will help to indicate the amount of blockage.

• Cystoscopy
This instrument, a cystoscope, is a small instrument, equipped with a light that is used to view the inside of the urethra and bladder and prostate.

• Blood test
Other related lab work is a blood test to check your kidneys. This is not a prostate cancer check in itself, but part of the overall test series.

• Urodynamics
Urodynamics is a series of tests your doctor will give to show how well, or not well, your bladder is working. It is offered as an indicator of prostate cancer, but also to check other symptoms such as urinary incontinence. A catheter (thin tube) is inserted through the urethra into the bladder. This procedure may cause short term discomfort with some men.

Other tests along the road to prostate cancer detection, and using Urodynamics testing series may include:

i) Urine Flow Test -- mentioned above, this test measures the strength of the urine flow.

ii)Bladder Filling Cystometry –this test measures how much urine your bladder can hold, and the pressure within the bladder as it holds the urine.

iii)Residual Urine Measurement – This measures the amount of urine remaining in your bladder after you have finished urinating. You will be asked to pee before the test, and then a catheter (thin tube) will be inserted through the urethra into the bladder to empty the remaining urine. The amount of remaining pee is measured.

Again, these Urodymanic tests are used for detection of other issues, not just the detection of prostate cancer, and are simple, quick and informative.

Do you need treatment for BPH (enlarged prostate)?

Surgical intervention is only required if the tests reveal kidney damage, or if you are completely unable to empty your bladder. Otherwise, your symptoms, along with your doctor’s advice, may suggest that “watchful waiting” is the best course of treatment. The situation may not worsen for you, and your doctor may be able to predict your future situation based upon the size of your prostate and your PSA (blood) results. There is always a requirement to monitor your symptoms in case it develops into future prostate cancer, so ongoing monitoring is require (but we know that, right men?).

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