Ask the Specialist: Urology
SHELDON MARKS, MD, IS A TUCSON, ARIZONA UROLOGIST AND AUTHOR OF “PROSTATE AND CANCER: A FAMILY GUIDE TO DIAGNOSIS, TREATMENT, AND SURVIVAL.” DR. MARKS IS ALSO THE INTEGRATIVE UROLOGIST FOR DRWEIL.COM AND THE MEN’S HEALTH AND MALE FERTILITY EXPERT FOR WEBMD.
Men and Health: It’s a Guy Thing provided the following questions to Dr. Marks:
1. What is the function of the prostate? The prostate secretes proteins to assist with reproduction. Most of the semen is fluid from the prostate.
2. At what age does the prostate start to affect health? Men in their 50s and older classically start to note signs of blockage from their prostate — frequent urination, getting up at night to urinate, weak stream, dribbling, urgency to urinate.
3. At what age should men start talking with their doctors about the prostate? It is smart to get a baseline prostate exam and PSA starting at age 40, and then regularly thereafter depending on the results, family history and risk fact0rs.
4. Does prostate cancer only strike elderly men? Though it is commonly thought of as an “old man’s disease,” prostate cancer is diagnosed regularly in men in their 50s. I have seen a number of men in their late 30s and early 40s diagnosed with significant cancers as well, so you are not safe just because you are not 50.
5. Describe people at “high risk” of developing prostate cancer? African-American men are at higher risk as are men with a family history — those who have brothers, fathers, uncles or grandfathers with prostate cancer. The more family members with cancer, and the younger they are diagnosed, the more the concern.
6. Does prostate cancer usually grow slowly? If it spreads, where does it go? Usually prostate cancer is a slow-growing cancer, but for some it can grow rapidly and be potentially deadly. There is no way to know for sure which category you have. If prostate cancer spreads, it usually goes to the bones of the spine, ribs, hips and pelvis.
7. When is prostate cancer curable? If it spreads, can the cancer be slowed down…and for how long? Prostate cancer can be cured when found early and while still confined to the prostate gland. If it has spread, we have very effective treatments, including hormone therapy, that can keep the cancer in check for years and even decades.
8. Describe the digital rectal exam and the PSA test? Why is it good to have both? The digital rectal exam involves a several-second examination of the back wall of the prostate by inserting a gloved, lubricated finger into the rectum. The exam tells us if the prostate is soft, smooth and without areas of firmness or asymmetry, which are suspicious for cancer. The PSA blood test looks for elevated levels of a normally occurring substance, PSA, which, when elevated, can also suggest prostate cancer or other problems.
9.Is a prostate biopsy the “gold standard” in finding out if there is a cancer? Yes, all other tests are only suggestive. To know if there is a cancer, and the potential aggressiveness, you need to analyze tiny hair-like slivers of prostate tissue, which can only be obtained by biopsy.
10. What is the Gleason score? The Gleason score is the best way to grade how aggressive a prostate cancer is. The higher the number, the more aggressive the cancer can behave.
11. Generally, does the newly diagnosed patient with localized, low-grade cancer have time to decide on a treatment? Yes, there is rarely any urgency to rush into a treatment. You should take the time to do your research so you can make an intelligent and informed decision about your care.
12. Describe the various treatment options? You can choose to have the prostate surgically removed or the cancer killed by radiation, if the cancer is believed to be confined to the prostate. If the cancer is felt to have spread, then there are effective hormone treatments.
13. Describe other prostate conditions, such as enlarged prostate and prostatitis? The prostate can grow in size and the muscles within the prostate can squeeze down, causing compression and symptoms of blockage. These symptoms are effectively treated for most men with medications.
14. Is active surveillance an option? Even for some younger men with localized, low-grade cancer? It can be, but there is always a worry that a significant cancer could be given more time to grow. It is best for older men with very small, low-grade cancers. Young men will have so many decades of life ahead of them that active surveillance is probably not a smart option for most.
Note: “Prostate and Cancer: A Family Guide to Diagnosis, Treatment, and Survival” has been recommended by TIME magazine. Dr. Marks has been quoted in Men’s Health, Woman’s Day, Cosmo (17 times), Ebony, and BottomLine. He is interviewed regularly on XM/Sirius Doctor Radio and has been a speaker in hundreds of cities, stretching from Portland, Maine to Honolulu, Hawaii.
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