“Because they need prostate examinations.” If that is the answer what might be the question?
Why do men hate seeing their doctors? Why do men have rectal examinations? Why do men die of prostate cancer?
This, essentially, is all too hard for men, and so they just go on dying of prostate cancer in greater numbers than necessary.
But, for once, it is not actually the men’s fault. The situation is made worse by the fact that men do not see their doctors often enough, but prostate cancer is still difficult to detect early, and treat without complications.
We still argue over whether more men are helped by early treatment compared to those damaged by surgery or radiotherapy that might not have been necessary.
Despite all this, I think the tide has turned. Probably, now, we help more men than we harm. It is time, men, to see your doctor for the prostate check.
Even though we do better than before, the situation is still complicated.
Prostate disease comes in two main types: benign (non-cancer) prostatic enlargement, and prostate cancer.
As men get older, the prostate gets bigger. It is situated around the outflow tract (urethra) from the bladder to the penis, like a doughnut, so as it gets bigger it makes the hole for the urine to get out smaller (that is, the hole in the doughnut gets smaller).
Prostate enlargement is a natural part of the ageing process. By the time a man got to be 100 years old, he would almost certainly have had his ability to urinate strangled by his enlarged prostate.
The problem is that urinary retention is painful, and needs to be fixed. Left untreated it is fatal.
The operation done now is a TURP. Also known as a “rebore”, the trans urethral resection of the prostate is done by an instrument being put into the end of the penis and cutting away the prostate from the inside (making the donut hole bigger).
The good thing here is that no external cut is needed. The problem is that the valves that help hold the urine in the bladder can be damaged.
Not usually a problem is occasional leaking urine (incontinence) as a consequence of this surgery. Still, better than a permanent catheter, the TURP is considered a good, quick and satisfactory outcome from the benign prostate enlargement.
Prostate cancer is the growth of a cancer from somewhere inside the prostate (doughnut). Because the prostate is an internal organ, it is – unlike a woman’s breast for cancer – not easily examined. And, on a visit to the doctor, most men look forward least to the prostate examination.
A doctor can feel a patient’s prostate by inserting his or her finger through the rectum. Problematic is that the doctor can feel only part of the prostate (being a doughnut) in such an examination.
If the cancer is big enough, the doctor can feel it and start treatment. If the cancer is small or in the wrong position, he or she cannot feel it.
The blood test becomes the next check. The trouble with this is that prostate-specific antigen (PSA) is a normal protein of the prostate.
A blood test can easily detect PSA, but anything that damages the prostate will make the PSA leak into the bloodstream.
A blood test with a high PSA only tells if the prostate has been damaged – it does not tell if cancer exists. A high PSA might mean an infection so, to see if there is a cancer, needle biopsies may have to be done.
Usually, 18 needles are stuck into the prostate through the rectum to biopsy the doughnut of the prostate. Still cancer can be missed or, alternatively, a very small cancer can be detected.
If prostate cancer is found, the next thing is to take out the prostate or give it a blast of radiotherapy. Because of the position of the prostate (the doughnut around the bottom of the bladder), any surgery will be complicated by the risk of damaging the bladder, the valves, the erection mechanism of the penis and other tissue in the pelvis (muscles and bowel).
New surgical methods might decrease the side effects. But, for a very small cancer, major surgery with many complications has raised concern that such surgery is too aggressive for the possible minor cancer.
The other thought is that an operation on a curable cancer is worth many years of incontinence, impotence and other bladder problems.
So complicated is the whole scenario that the only way to proceed is to talk to a doctor about your particular situation. There are so many possibilities – the one you face might actually be simple.
Also, new advances give more options, and some of them are better. We now, in the last two years, have a new form of radiotherapy that has revolutionized treatment and highlights the ongoing changes that make this a complicated topic.
Not complicated, however, is seeing your doctor. But this remains the rate-limiting step. It is better at least to consider and reject a treatment option than to be told that, had you seen a doctor, your cancer could have been cured.
