Welcome to another edition of the Doctor’s Note, where we talk about what’s on our minds when it comes to your health. This week, we are continuing our series on Men’s Health by talking about prostate cancer and prostate health.
First things first: Every man should be concerned about his prostate. It’s the #2 killer of cancer deaths in men behind lung cancer.
The most troublesome thing for men is when their prostate gets larger, and they start having symptoms of BPH (Benign Prostatic Hyperplasia). It’s a bothersome thing that can be treated.
There’s a lot of misinformation on how to screen for prostate cancer, and what to do for it. I do a lot of hormonal evaluations for middle aged men, and this comes up all the time. One topic that comes up a lot is prostate cancer and testosterone.
Testosterone itself doesn’t cause cancer, and if you have cancer testosterone doesn’t make it worse. You’re not putting “fuel on the fire” as many people think.
In fact, being on testosterone replacement therapy is a good opportunity to screen for cancer.
There are two big controversial subjects surrounding prostate cancer:
- The PSA
- MRI Versus Biopsy
Let me start off by saying you do need to get your PSA checked. You need a PSA and your prostate checked every year starting at age 40.
But the PSA test isn’t great because it’s not 100% accurate by any means. For example, if you have an elevated PSA it can mean you just have an enlarged prostate or a recent infection (Prostatitis).
A PSA of anything under 4 is usually termed “normal”, but what I look at is the velocity of your PSA. If it was 1 last year and this year it’s 3, then I perk my ears up.
Your PSA usually goes up as you age, as your prostate gets bigger. A lot of men freak out because of this and they just don’t go to the doctor. If your PSA jumps up, it needs to be noted. You don’t need to be freaked out about it though.
1 in 7 men are going to be found with prostate cancer in their life. But only 1 in 35 will die from it. I’m not trying to downplay it, but most of the time it’s not going to kill you.
What you need to do is watch your prostate and make sure it doesn’t grow too large or develop cancer.
Biopsy versus MRI: What I Would Do
Here’s the way I learned how to treat it. If my PSA was climbing or if I was worried about it, I would most likely go for an MRI instead of going straight for a biopsy. It’s not invasive and it’s directly visualizing the prostate. You’re not just guessing on a blind biopsy with 14-16 large needles like you would have by most Urologists. Although some will use ultrasound, which is legitimate.
If you’re in the MRI machine and they’re fairly certain they visualize a cancer, they can directly needle it while in the MRI with 2 much smaller needles. It’s less invasive, less painful, and less chance of infection from the procedure.
This situation is kind of a turf battle between Urologists and expert Radiologists, and it’s controversial. The problem is that there’s not a lot of doctors who can perform the MRI biopsies expertly. I predict there will be.
A prostate biopsy can be effective, but in my opinion some of the biopsies done are CYB (cover your butt) for doctors. Sometimes, watching the PSA and obtaining an MRI is maybe the best way to go. The problem is the MRI isn’t available in many smaller cities yet.
Remember, what you’re trying to find is the aggressive prostate cancers. I’ve seen PSA’s as high as 18 with negative biopsies, and PSA’s as low as 2 with prostate cancer. So, the PSA isn’t the end all test. But it is useful.
Again, I don’t want to down play anything. These guys are experts, and in our area especially there’s some great Urologists. But always remember that specialists tend to follow their own expertise.
Here are some of the options that can be good if you have prostate cancer:
- Do nothing (Watchful waiting)
- Proton Therapy
- Robotic Prostatectomy
- Laser Ablation (least invasive)
Preventative Measures You Can Take:
- Have lots of sex.
- Eat a great diet. Eat plenty of vegetables and avoid a lot of red meat. Like any type of cancer prevention, stay away from sugar and stress.
- Exercise and stay lean.
- There are some prescription medications that can shrink your prostate and alleviate some symptoms of an enlarged prostate. They can have side effects, and to be honest you need to talk to me or another expert about it.
Vitamins you can take:
- Vitamin D
- Omega 3’s
- Vitamin C
- Stinging Nettle
- Saw Palmetto
- Pumpkin Seed