What you need to know—from screening to the treatments that work best
It’s National Prostate Health Month. And while wearing blue to raise awareness for prostate health this September isn’t as widely practiced as wearing pink for breast cancer, seize this opportunity to learn more about how to keep your prostate healthy.
The prostate, which is about the size of a walnut and located below the bladder, is vital to men’s health in many ways. If it doesn’t function properly, men have trouble with urination and their reproductive and sexual health.
If you’re a man over 40, you might already have had a prostate check (and if not, schedule one with your urologist). It involves having a prostate specific antigen blood test and a digital rectal exam. “While a rectal exam might not be the most pleasant experience, it can be an important way to check the prostate for swelling," says Daniel Kellner, MD, a Yale Medicine urologist. Abnormal findings from the rectal exam or blood test could alert your urologist to one of two conditions: benign prostatic hyperplasia (BPH), which is an enlarged prostate, or prostate cancer, he says.
Detecting a swollen prostate
Having an enlarged prostate is very common—in fact, if affects about half of all men by age 50. By age 80, more than 80 percent of men have this condition. The good news is that BPH is, well, benign; it’s not cancerous.
Men with BPH have several treatment options. Your urologist can help you decide which is right for you, taking into consideration the severity of your prostate swelling and other lifestyle considerations. Options include medication, surgery (transurethral resection of the prostate surgery, or TURP) and the GreenLight laser treatment.
Now Yale Medicine also offers new, minimally invasive treatments. Prostatic Artery Embolization—an interventional radiology procedure performed by Raj Ayyagari, MD—and the UroLift procedure, which is performed by Dr. Kellner. Both are out-patient options you might want to learn more about.
The leading cancer for men
Regular prostate screenings are key to detecting prostate cancer—it’s the leading non-skin related cancer that affects men, according to the Centers for Disease Control and Prevention (CDC). In fact, 1 in 6 men are diagnosed with prostate cancer, which usually occurs in men over 65. Early detection is important, yet because prostate cancers grow so slowly, some men do better when treatment is not started immediately. At Yale Medicine, we take a unique approach to low-grade prostate cancer called active surveillance.
The “active surveillance” approach combines advanced radiological imaging and fusion technology to perform targeted biopsies. This approach allows urologists to better evaluate a man’s prostate cancer and identify men with low-grade disease who may benefit from active surveillance. "Active surveillance does not mean no treatment but rather following a man’s disease to identify if and when the cancer progresses so that we can intervene at an appropriate time with treatment," says urologist Peter Schulam, MD, chair of Yale Medicine's Department of Urology.
Leading technology ensures that prostate removal happens when absolutely necessary to help men avoid possible side effects such as incontinence and impotence. “We tend to over-treat prostate cancer in the United States,” says Dr. Schulam, who is also a professor of urology at Yale School of Medicine. "Each year in the U.S., an estimated 100,000 to 120,000 men have a radical prostatectomy surgery to remove the prostate gland, but this may be unnecessary for some men."
Radiologists monitor the emergence and growth of prostate cancers, using high-tech tools such as a combination 3-D imaging and magnetic resonance imaging (MRI) tool called the Artemis Device. “Skilled and experienced radiologists are rare for this relatively new technique,” says Preston Sprenkle, MD, a Yale Medicine urologist. “At Yale Medicine, we are fortunate to have some of the world leaders in prostate MRI.”
Treatment options for prostate cancer depend on the stage of the cancer and can include active surveillance, surgery, targeted or focal ablation therapies and radiation therapy. Radiation oncologists treat prostate cancer and tumors, including ones that have
advanced to organs near the prostate, explains James Yu, MD, director of the Prostate & Genitourinary Radiotherapy Program at Yale Medicine. To make sure
radiation is delivered precisely, “we have a large physics staff that is
essential to designing and verifying our radiation treatment plans,” Dr. Yu says.
What you can do for your prostate
Tell your urologist if you notice any of these symptoms, which could be warning signs of a prostate condition. Symptoms can include:
- Difficulty starting urination
- Frequent urination
- A weak urine stream
- Blood in the urine or semen
Of course, some men have no symptoms at all, which is where prostate screening comes into play. Our physicians discuss the timeframe for screening with each man individually. We recommend that men should have a baseline prostate-specific antigen (PSA) screening in their 40s.
At age 55, routine screening for prostate cancer is advised every two years for men who are at average risk (and annually for people at greater-than-average risk, including black men and men who have a family history of the disease). For men over 69, screenings are recommended on an individual basis.
“When it comes to your prostate, the bottom line is that you should care as much about your prostate health as society does about breast health," says Dr. Kellner.