Prostate disease is one of the most common health concerns for men age 50 and older. While cancer is most concerning, other types of prostate trouble often develop with age.
“Almost all men will develop some element of an enlarged prostate after the age of 50, and this will be associated with worsening of the urinary stream. This is quite treatable with either medicines or surgery,” says Dr. Gerald Andriole, chief of the division of urologic surgery and director of the Men's Health Center with Washington University Physicians. “Prostate cancer also is very common. It is estimated that one in six men in the U.S. will be diagnosed with prostate cancer.”
Men typically notice a need to urinate more frequently as they age, often having to get up during the night several times. “The most common prostate disease in older men is just the benign enlargement of the prostate that occurs with middle age,” says SLUCare urologist Dr. Michael Chehval, who also is director of urology at Saint Louis University School of Medicine. “As the prostate enlarges, it can produce obstruction to the outflow of urine and difficulties in that regard. There have been medications that have modified that enlargement of the prostate and slowed it down—or even in some cases, reversed it slightly.” Minor surgical procedures, sometimes performed with minimally invasive techniques, also may reduce the size of the prostate and help restore more normal function.
Difficulty emptying the bladder, which results in frequent urination, may be more than simply annoying, Chehval adds. In some cases, kidney damage may result. “Occasionally, the enlargement can be very slow and insidious and can place pressure on the kidneys and cause difficulties with renal function,” he says. While this can occur without obvious symptoms, most men do notice increasing frequency of urination, a slowing of the urine stream, or the sensation that the bladder is not empty following urination.
Preventive screening exams for prostate disease are common for men beginning in middle age. “Annual digital rectal exams should begin at about age 40,” says Dr. Angela Alt, a St. Luke’s Hospital urologist. This simple exam typically is performed by a primary-care physician to check for prostate enlargement. “A PSA blood screening for prostate cancer should be considered for men 40 years and older who have at least a 10-year life expectancy,” she adds.
Like mammograms for women, the PSA (prostate specific antigen) test has come under scrutiny from the U.S. Preventive Services Task Force, an independent panel of non-federal experts in prevention and evidence-based medicine, composed of primary care providers.
“Convincing evidence demonstrates that the PSA test often produces false-positive results,” the panel states. “There is adequate evidence that false-positive PSA test results are associated with negative psychological effects, including persistent worry about prostate cancer. Men who have a false-positive test result are more likely to have additional testing, including one or more biopsies, in the following year than those who have a negative test result...New evidence from a randomized trial of treatment of screen-detected cancer indicates that roughly one-third of men who have prostate biopsy experience pain, fever, bleeding, infection, transient urinary difficulties or other issues requiring clinician follow-up that the men consider a moderate or major problem.”
Physicians emphasize that the decision regarding prostate cancer screening should be based on individual patient-physician discussions, including factors such as family history, age and general health. And new technologies may soon offer additional screening options.
“The most exciting advancement in the diagnosis and treatment of prostate cancer has been the use of 3-TESLA MRI scanning of the prostate,” Andriole says. “This approach may be likened to use of a mammogram to look for breast cancer in women. It often allows us to perform more accurate biopsies of the prostate and to use ablation procedures to completely destroy small prostate cancers that are within the prostate.”
Men should not be embarrassed or afraid to discuss prostate concerns, Andriole adds. “Our treatments for prostate cancer have improved substantially in the last several years and patients should not be fearful of the side effects of these treatments, as experienced urologists can often successfully eradicate the cancer with minimal long-term side effects.”