If you find yourself in an elevator with five older men, chances are good one of them is dealing with a disease or condition affecting his prostate, a tiny gland found below the bladder, surrounding the upper part of the urethra.

About the size of a walnut, the prostate gland aids in the production of seminal fluid. It is not vital; men can get along without one. As a man ages, his prostate can become enlarged, inflamed or cancerous. Prostate cancer generally attacks older men.

Prostate exams may be a key reason men avoid doctors. They fear the “gloved hand.” This is a digital rectal exam, one of two tests that help determine the likelihood of prostate cancer. The other diagnostic tool is the PSA blood test. Known as prostate-specific antigen, PSA is a protein made only by the prostate gland. According to UrologyHealth.org, “High levels of PSA in the blood may be a sign of prostate cancer.” As a man approaches middle age, he needs to discuss prostate issues with his doctor. African American men are at greater risk of prostate cancer as are men who have a family history of the disease. Cancer is a powerful incentive for men to stop procrastinating. Getting these prostate tests at regular intervals help men catch cancer in its early stages, when it’s confined to the prostate. This is when prostate cancer can be cured.

Dr. Sheldon Marks, author of “Prostate and Cancer,” says more men are becoming aware of prostate health thanks to public figures sharing their cancer stories and media exposure to medications such as Avodart and Flomax. Even so, Marks says, “there are still a lot of men who either don’t want to talk about it or don’t understand it, so they kind of just choose to avoid it.”

A man, according to Marks, should first approach his doctor if he has disturbing or alarming urinary symptoms, such as dribbling, urgency and frequency. If you are healthy and not experiencing symptoms, “it’s probably a good idea to get a baseline exam and PSA starting about age 40 to 45, absolutely at a minimum age 50, then annually thereafter.” Those at greater risk of prostate cancer need to start tests at 40.

Marks says the PSA test is “far and away the most sensitive test for detecting prostate cancer. It’s far more sensitive than a mammogram, than a pap smear, than almost any other screening test on the market.” The tricky part of the prostate puzzle is that the PSA blood test is not prostate cancer specific. Marks says if the PSA is elevated or going up, it raises a question that needs to be answered. “It may be, gee, it was the recent infection you had, or maybe it’s because you just had orthopedic surgery and you had a catheter in for three days…or something else.” An abnormal PSA, says Marks, is like the “idiot light” in your car. “It tells you something may be wrong and needs further evaluation.”

It’s important to have both a PSA test and a digital rectal exam. Marks says the exam is not as effective and sensitive as the PSA, but on occasion, “there’s a guy who will have a nodule or asymmetry, one side being fuller than the other, but the PSA is normal, and it turns out there is a cancer.”

While some prostate cancers are found at an advanced stage (typically spreading to the bones), the prognosis is much better with early stage disease. Marks says, “That’s one of the things that’s so exciting about this. If we catch it early, it’s totally curable.” Depending on the stage of the cancer, treatments include prostate removal, radiation and hormonal therapy.

Despite growing publicity about prostate health, men continue to drag their feet. Marks says it remains an issue, observing, “Men are stubborn about their own health. They’ll go and they’ll get their lawnmower fixed, they’ll take their car in every 3,000 miles for an oil change, but when you say you’re age 50, it’s time for your PSA and colonoscopy, they flatly refuse.”