Making Informed Decisions:

Collaborating with Your Physician to Improve Prostate Health

Some say it’s “superman syndrome.” Others say they prefer living in denial. Whatever it is, the stereotypes are generally true—men don’t like going to the doctor. Unfortunately, this reluctance to seek medical advice is particularly accurate for sensitive issues related to men’s health. According to the American Cancer Society, 1 in 7 men will be diagnosed with prostate cancer in their lifetime, making it the third leading cause of cancer death for American men. Prostate cancer begins when cells in the prostate, the small gland responsible for making some of the fluid that is part of semen, begin growing uncontrollably and crowding out healthy tissues, causing problematic symptoms like changes in urination or erectile dysfunction.

Although early detection strategies are typically recommended for mitigating cancer risk, the methods used to screen for prostate cancer have come under scrutiny from various medical groups who disagree about their necessity, validity, and dangers. To determine if prostate cancer screening is right for you, it’s important to understand your personal health risk and collaborate with your physician to make an informed decision.

Understanding risk and screening options

Because prostate cancer most frequently affects older men, the American Cancer Society suggests that men begin assessing their screening needs around age 50; however, this process may begin as early as ages 40-45 for men who are at a higher risk for developing the disease. Those at higher risk include African American men and men who had a father, brother, or son diagnosed before the age of 65; risk increases based on the number of close relatives diagnosed. Risk is more than just a numbers game though; your health history can also be a contributing factor when considering early screening.

Prostate cancer screening isn’t a perfect science. Some of the early screening options can yield under or over diagnoses of the disease. One of the most common and less invasive early screening options for prostate cancer is the prostate-specific antigen (PSA) blood test, which uses the amount of antigen in the blood as a barometer for risk. PSA levels at or above 4 nanograms per milliliter (ng/ml) signify the potential of prostate cancer; however, the results for this particular test can sometimes yield false positives due to other health factors. Physicians are also able to check for early signs of prostate cancer by preforming a digital rectal exam (DRE). During these exams, a physician inserts a gloved, lubricated finger into the rectum to feel for abnormalities in the prostate gland. Physicians may also call for a Prostate Cancer Gene 3 (PCA RNA) test that measures the PCA3 in urine if they believe this is necessary post-DRE test. If levels are higher than normal, physicians will typically suggest a biopsy of the prostate to diagnose. More effective screening options might still be on the horizon. According to a recent article in STAT, researchers are actively exploring new approaches to screening that could more accurately detect prostate cancer and drive down over-diagnosis.

Even if the screening options accurately detect the presence of prostate cancer, the decision of whether or not to treat the disease is complex as treatment sometimes offers more risk than reward. Most physicians prefer to adopt a watch-and-wait or active monitoring approach with a prostate cancer diagnosis due to the detrimental side effects of treatment, such as urinary, bowel, and/or sexual dysfunction, that can affect quality of life. In many cases, prostate cancer is slow-growing, and men who are older or are in poor health are more likely to die from causes other than the prostate cancer.

Collaborating with your physician

Your physician can be an invaluable resource for helping you determine if early screening and/or treatment are right for you. Developing an open, trusting relationship with your physician is important for your health, but that dialogue can sometimes be difficult to initiate, especially if your visits are short or infrequent. The most important strategy for preparing for an upcoming appointment is to be informed. Research and preparation will allow you to make the most of your visit, better participate in the conversation, and reduce stress about the experience. CancerCare and National Institute of Health (NIH) both offer some general tips for improving communication with your physician which include keeping a health journal, preparing questions in advance, and taking notes on your physician’s responses. Applicable for both routine and need-based appointments, these tips can help you take a more active role in your health care. The Center for Disease Control (CDC) provides a list of questions you can ask your physician that will help you decide if prostate cancer screening is right for you.

If you are diagnosed with prostate cancer, you will be referred to a urologist who will help you assess the need for treatment based on the aggressiveness of the cancer and your personal health history. The decision to undergo treatment, however, is ultimately yours. Talk candidly with your urologist about your treatment concerns to ensure that their philosophy of care is in line with your own. If it isn’t, interview different urologists until you find the right fit for you.

It’s important to make your health decisions in collaboration with your physician and to consult him/her before taking any supplements that promise to improve prostate health. Not only are supplements an ineffective treatment of the condition, many can interfere with medications or cause other health problems. Your physician is always your greatest ally in helping you navigate screening and treatment options.

Resources

American Cancer Society—What Tests Can Detect Prostate Cancer Early?

CancerCare—“Doctor, Can We Talk?”: Tips for Communicating With Your Health Care Team

Center for Disease Control—Health Tips for men about prostate cancer: What you can do

National Institute of Health—Clear Communication: Talking to Your Doctor

STAT—Thousands of men with prostate cancer get risky treatment they don’t need. New approaches could curb that