Please Mind Your Prostate Health
Words by Daniel Hirsch
For those of a certain age, prostate cancer is an unfortunate commonality. According to the American Cancer Society, one in eight people born with a prostate will be diagnosed with the disease in their lifetime. But like all things connected to sexual health, open discussion of the prostate does not always stack up to its importance and potential vulnerability to cancerous growth.
To shed light on the walnut-sized gland responsible for the production of seminal fluid, I spoke with DAP Health Co-Directors of Adult Medicine Dr. Frederick Afari and Dr. Damoun Rezai.
Because prostate cancer is so common, many people think it’s no big deal. Is that a misconception?
Dr. Afari: There was once this concept: you die with prostate cancer, not from prostate cancer. But there are aggressive forms. So, getting diagnosed early and getting it managed is the best option for everybody who has a prostate — especially after age 50.
Dr. Rezai: Untreated, it’s highly likely it will continue to develop, potentially spreading throughout the whole body.
How do you know if you have prostate cancer? How is it diagnosed?
Dr. Afari: Some patients come in with pain in the pelvic area. Sometimes it feels like a low back pain. It can cause a blockage or an obstruction of the urethra, so some patients can come in with trouble urinating.
If the patient is routinely visiting a provider, especially after age 50, most providers will screen for prostate cancer. We are either doing a blood test for a prostate specific antigen (PSA) and/or doing a digital rectal exam to push on the prostate and see if there are irregularities. And if there are, that usually triggers further workup and evaluation.
How does a PSA test work?
Dr. Afari: The test measures the levels of an enzyme that comes out of the prostate — the prostate specific antigen. On average, there is a certain range (or score) of this protein produced.
Dr. Rezai: Normal PSA is generally below 4. Once you hit 4.5, 5, or 6, we must find out why. There are many things that can cause it to elevate, such as benign prostate hypertrophy, an infection of the prostate that can result from a sexual encounter. If the PSA is elevated, this is when the urologist gets involved. They perform an ultrasound-guided biopsy to see if it’s normal cellular activity or abnormal.
What does the treatment look like for prostate cancer?
Dr. Rezai: If growth is abnormal, then we talk about radiation or surgery. There are different risks and benefits from both. Chemotherapy is there for when the cancer has spread — or metastasized — throughout the body, but that’s almost like a shotgun or nuke approach.
What are the risks factors? How can someone lower their risk of getting prostate cancer?
Dr. Afari: The main risk factor for prostate cancer is to have a prostate. If you have a prostate, you should get checked. Once you turn 50, the incidence goes up significantly. There are other things that come into play: family history, people who have a high-fat diet have been shown to have a higher propensity, non-Hispanic Black men have been diagnosed more with prostate cancer. But the advice and the recommendation for any of my patients born with a prostate: get tested. [The recommendation for those at higher risk is to start discussions with their doctor as early as age 40 or 45.]
It will likely differ patient to patient, but generally, are there complications to recovery after treatment of prostate cancer?
Dr. Rezai: What you typically encounter — for either surgery or radiation treatment — is you’re not going to be able to urinate like you normally do [temporary or permanent incontinence]. Possibly, you might have [temporary or permanent] erectile dysfunction.
Dr. Afari: In terms of choosing a treatment option, most of the time your doctors try and minimize side effects as much as possible, and try to optimize recovery time. But the mainstay is getting the cancer — especially if it’s aggressive — under control, and to prevent it from moving to other places and causing more damage.
Are there any misconceptions about prostate cancer you’d like to clear up?
Dr. Afari: A lot of people are apprehensive about getting a digital rectal exam. But the exam itself is usually less than a minute, and it’s handled by people who have been trained and have experience in navigating through it. If you have apprehension getting a digital rectal exam, the PSA blood test is also pretty sensitive. That allows us to identify if there’s anything off, and then it can help us get a workup started for you.
Dr. Rezai: If you have a concern or a question, definitely bring it up to your doctor because it’s an easy test to do.
For Trans Women
Yes, trans women can develop prostate cancer. The prostate gland is present in all individuals assigned male at birth, including trans women, unless it has been surgically removed during gender-affirming surgery (which is uncommon).
Even though hormone therapy (such as estrogen) that trans women may take can reduce prostate size and lower testosterone levels, the risk of developing prostate cancer still exists, though it may be lower than for cisgender men. The risk tends to increase with age, and screening considerations for trans women should be discussed with health care providers who can tailor recommendations based on individual health history, hormone use, and other factors.
To discuss your prostate health, or to schedule a DRE or PSA test, please make an appointment with your DAP Health primary care physician. If you are not yet a DAP Health primary care patient, and would like to become one, click here.