- Annual Check-up
- What is known about Prostate Cancer?
- What are the benefits of the annual check-up?
- What are the risks of the annual check-up?
Prostate Cancer is the most common type of male cancer and the second cause of cancer-related death in men after lung cancer. Unfortunately, it manifests NO SYMPTOMS in early stages. Today it can be treated effectively if diagnosed early. Although the exact etiology of prostate cancer is not known, there are preventive measures that have to do mainly with nutrition and the annual check-up.
- Avoid excessive consumption of red meat and animal fat.
- Nutrition should contain plenty of fish (rich in ω-3 fats), vegetables, fruit, soya, greent tea and wholegrain cereals. Also, tomatoes, watermelon and pink grapefruit may be very beneficial because they all contain an antioxidant called lucopene.
- If you are overweight, lose weight. BMI above 30 increases the risk for prostate cancer.
Prostate Cancer is the most common type of male cancer and the second cause of cancer-related death in men. About 1 out of 30 men with prostate cancer above 50 years old will die of prostate cancer.
The annual prostate check-up was established decades ago. It aims at reducing prostate cancer mortality. It includes two (2) screening tests: a) PSA-Test, measuring the Prostate-Specific Antigen, which is a protein produced in the prostate gland, and b) Digital Rectal Examination (DRE). In DRE, the Urologist examines the prostate gland by gently inserting a gloved and lubricated finger through the anus. As the prostate is located right above the large intestine (bowel), the Urologist can palpate any potentially occuring induration in the gland. Such a palpable induration is a suspicious finding (positive digital examination).
The PSA value cannot determine whether one suffers from prostate cancer or not; however, the higher the value, the higher the chances of having cancer. Unfortunately, there are no normal values, for the PSA value depends on the size of the gland and the presence or absence of inflammation. Probably the most determining factor to evaluate the condition is whether the annual PSA elevation is small (usually below 0,20) or high. High increase within only a small period of time (e.g. twofold elevation within 3 months) is a potent cancer marker.
As long as PSA is not high or DRE is not normal, the Urologist will recommend prostatic biopsy. Biopsy is the only examination for setting the diagnosis of cancer.
During the last years, there has been a great debate among Urologists about whether the annual check-up is necessary in all men above the age of 50. In 2008, the US Preventive Services Task Force (USPSTF) considered that PSA examination is not recommended to men above 75 years old. Recently, though, in an article published in Annals of Internal Medicine (May 2012), the very same Task Force provided evidence against the routine performance of annual check-up for prostate cancer in healthy men of every age. According to USPSTF, "the benefits of PSA-based screening for prostate cancer do not outweigh the harm".
This decision has triggered many discussions and debates in the scientific community and certainly raised high concerns in men who had either already started having an annual check-up as a routine test or had been seriously thinking of starting it.
Surely this is not a question to be easily answered, for prostate cancer is characterized by 3 (three) main features:
- It is very slow in its progression.
- It usually occurs at advanced ages.
- All avaialble treatments are accompained with frequent complications, mainly related to sexual life and more rarely with urinary control.
Thus, a man is likely to discover a cancer he will never die of, but there is no doubt that in his effort to treat this cancer, the quality of his life will significantly be reduced.
What is known about Prostate Cancer?
- The risk for prostate cancer increases with age. Thus, 30% of men will develop prostate cancer below 50 years old and 80% above the age of 80.
- Men who have a first-degree blood relative (father, uncle or brother) with prostate cancer are 2,4 times more likely to develop the disease compared to other men. And, furthermore, if cancer was diagnosed to the the relative at a relatively young age (e.g. in his 50s), the odds for the man to develop prostate cancer double.
- About 1 out of 5 men who have an annual check-up will be sent for biopsy.
- Prostate cancer is traced in about 1 out of 4 men undergoing biopsy. This means that about 75% of those having the biopsy will have experienced an unnecessary invasive examination, which may be painful and/or cause also other additional side effects (e.g. rectal hemorrhage -which is easily treated- or infection or blood in the semen for a period of 2-6 weeks). In some cases, when the biopsy results indicate proneoplasmatic lesions or the PSA keeps increasing after the biopsy, the examination has to be repeated once or, more rarely, even more times.
- It has been shown that old people with health problems and life expectancy up to 10 years are very unlikely to gain any benefit from the annual prostate cancer test.
- For every 1.000 men aged 55-69 years old who have the annual check-up, 1 man will be saved from death within the next decade, while 24 men will have been submitted to therapy without ultimately living any longer.
- 30-50% of men undergoing therapy will develop erectile dysfunction and 5-10% a urinary control problem (e.g. incontinence).
- Prostate cancer manifests NO SYMPTOM in early stages; this means that if the annual prostate test is not done, the diagnosis will be set only from metastatic symptoms (e.g. pain due to metastasis in bones).
What are the benefits of the annual check-up?
- The annual check-up minimizes the probability of your life being threatened by prostate cancer, as long as prostate cancer is much more easy to treat if identified in an early stage and before cancerous cells spreading also to other parts of the body (metastases).
- DRE and PSA test are the best available ways to identify prostate cancer in an early stage and treat it in order to minimize the chances of any further bad outcome.
What are the risks of the annual check-up?
- Most prostate cancer cases progress slowly and do not require therapy because they do not cause impairment. Thus, most men of advanced aged with prostate cancer die of some other cause and not of cancer itself.
- Many men having a check-up may be sent for biopsy or even therapy that is unnecessary because the cancer they potentially have is not life-threatening. This becomes even more serious if we consider the potential complications that may arise from the therapies, which have already been mentioned above.
Discuss with your Urologist and do not hesitate to pose any questions. Seek answers to all your queries, express your concerns and do not forget that the final decision is ALWAYS YOURS!
For further information, go to Prostate Cancer.