Urologist Daniel Simon, MD, answers your questions
As a urologist, what is the biggest health concern for men? Why?
Men are most often concerned with prostate health. Prostate disease, specifically prostate cancer and prostate enlargement (benign prostatic hyperplasia or BPH), are such common conditions that most men are either personally affected, or know men close to them who are. Despite this, the prostate remains largely a mystery to most people. Until they come face to face with the anatomy diagrams in the exam room of a urologist, the majority of patients do not know where the prostate is located or what its normal function is.
What are the risk factors and symptoms?
The biggest risk factors for prostate cancer are age, family history and race. Prostate cancer is more common in older men, especially in men over 65 years old. Men with a first degree relative (brother or father) with prostate cancer have over a twofold increased risk of developing prostate cancer. Also, African Americans traditionally have higher rates of prostate cancer. Most patients with prostate cancer do not have any symptoms, though in advanced cases, prostate cancer can cause blood in the urine, urinary obstruction or bone pain. On the other hand, prostate enlargement (BPH) commonly shows symptoms, including increased urinary frequency both during the day and nighttime, straining to urinate, decreased force of urination and dribbling. The only clear risk factor for BPH is age.
Are there any new treatments or new information about this concern?
In May of 2012, the U.S. Preventive Services Task Force recommended against screening for prostate cancer using a blood test that measures prostate-specific antigen, or PSA, because it can identify cancers that are so slow growing that they might never be harmful. We, along with the American Urologic Association and many others, feel this recommendation does men a great disservice because not screening guarantees missing many dangerous cancers. It is true that the PSA test is not a perfect test: there is no PSA level that guarantees the absence of cancer, and most men with an elevated PSA do not have cancer. However, PSA remains the only widely available test to help identify men with prostate cancer before symptoms develop. We know that most cases of prostate cancer are not fatal. We are increasingly able to determine which men should be treated aggressively, and which can be closely observed in order to safely avoid any negative effects of treatment. It is always worthwhile to consult a urologist, who can evaluate your particular situation.
What are the screening recommendations by age?
The optimum age to begin and end screening has not been established. We recommend that PSA screening be considered in men with risk factors for prostate cancer starting at age 40. For men without risk factors, we recommend screening be considered starting at age 55. After that, screening should be individualized to each patient. If significant risk factors such as a strong family history, African American race or an abnormal baseline PSA are present, then screening should be considered on a regular basis after that. In general, we believe that prostate cancer screening should end at age 70, or earlier, in cases where life expectancy is less than 10 years.
What message would you want to send the women who are reading this about the health of the men in their lives?
Without generalizing too much, women tend to be more proactive about their health and routine screening, while men can stick their head in the sand, only to emerge once symptoms drive them to the doctor’s office. It is natural for men to have concerns about screening. I encourage women to open a dialogue with the men in their lives about screening, and to help them seek the answers to allow them to make the most educated and informed decisions about their health.