A Guy’s Guide to Prostate Health

“Let’s talk about your prostate,” isn’t exactly the icebreaker most guys want to hear. But maybe it should be, because this tiny gland plays an important role in men’s health.

Actually, no, it doesn’t—at least not directly.

“The prostate has essentially two functions,” says Kenneth Goldberg, MD, an associate professor of urology in Lewisville, Texas. “The first is to create part of the fluids that come out in ejaculation, and the second is to keep your urologist busy. That’s it. Men can live without their prostate.”

So why all the fuss about prostate health? While it doesn’t serve any truly essential functions—especially if you’re not trying to have kids—a troublesome prostate can cause an oversized number of health issues. Here’s what you need to know to keep your prostate gland from wreaking havoc.

Bigger Isn’t Better

“Two parts of the body [tend to] get bigger as a man gets older,” says Dr. Goldberg. “One is the belly; the other is the prostate.” And it’s the latter that kicks off a chain of events that can cause problems.

“There’s a channel that runs through the prostate which carries urine during urination and semen during ejaculation,” says Petar Bajic, MD, a board-certified urologist and specialist in men’s sexual and urinary dysfunction in Cleveland. “The prostate can become enlarged with age, and it can become harder for the urine to pass through. Symptoms [of an enlarged prostate] can include weak urinary stream, night-time urination, dribbling after urination, and a stream that stops and goes.”

While it does not serve any truly essential functions, a troublesome prostate can cause an oversized number of health issues.

These may seem like more of an annoyance than anything else, but they can bring on more serious issues, including the inability to fully empty your bladder which, says Dr. Goldberg, “can lead to infections, backup in the kidneys, or bladder stones.”

That’s not the worst of it, of course—guys also have to be concerned about the big C. “Prostate cancer can be life-threatening,” says Dr. Bajic. “If detected early, [prostate cancer] is very curable, but early prostate cancer may not have any symptoms.”

History Matters

If prostate cancer doesn’t present any symptoms, how’s a guy supposed to detect it when it’s still early—rather than too late? The answer is a combination of age and family history.

“Prostate issues typically affect men over 50,” says Dr. Bajic. “It’s very rare to have prostate issues before age 40.” The older a guy gets, the greater his chances of having problems become. “I’d say that 20 to 30 percent of men in their 50s have an enlarged prostate,” says Dr. Goldberg. “By the time they get up to their 80s, about 80 percent of men do.”

“If detected early, [prostate cancer] is very curable, but early prostate cancer may not have any symptoms.”

So, it’s something only older guys have to worry about, right? Not so fast. “Sometimes men with a strong family history of prostate enlargement or prostate cancer develop issues earlier in life,” says Dr. Bajic. “A strong family history means screening should start in a man’s 40s.”

Dr. Goldberg agrees:[Knowing your] family history is important for men in their 40s, 50s, or maybe early 60s. If you have prostate cancer in your 70s or 80s, that’s not genetics. That’s just age. The key is to find the men who really need treatment. The man in his 80s who may have prostate cancer isn’t necessarily going to die from cancer, and the treatments are probably worse for him than the disease. But men with a family history of it—and African-American men—should start screening at age 40.”

That last piece of advice is critical, because, according to the Prostate Cancer Foundation (PCF), “men of African descent are about 75 percent more likely to develop prostate cancer compared with white men, and over twice as likely to die from the disease.”

It’s best to test

Depending on genetics, men should start screening for prostate issues in their 40s or 50s. The two most common diagnostic methods are performed by a blood test (pretty easy) and a finger (pretty awkward and uncomfortable).

“We check for prostate cancer using a test called a PSA, or Prostate Specific Antigen,” says Dr. Bajic. “PSA is a substance naturally secreted from the prostate. It converts semen from a viscous gel-like substance to a more liquid consistency. With prostate cancer, there can be an overproduction of PSA, which is detected by a blood test.”

Dr. Goldberg strongly recommends an annual PSA test in your 40s if you’re African-American or have a family history of prostate cancer, and in your 50s if you don’t fall into either category. If there’s an increase of more than two points in a year, he advises repeating the test to make sure it’s accurate. If the elevated PSA checks out again, your doctor may recommend other tests or a biopsy to examine the tissue more closely. In other words, the PSA is not an end-all-be-all screening. “It’s a fair test, but nothing is absolute,” says Dr. Goldberg. “A PSA test can be high due to cancer, prostate enlargement, or just an infection.

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One of the “other tests” would likely be the traditional method doctors use to check the prostate—you know the one. “The digital rectal exam can help us feel for nodules in the prostate that might represent cancer,” says Dr. Bajic. “There are some prostate cancers that do not produce PSA and can only be detected by a rectal exam. The PSA is considered the gold standard test and is the most widely used, but many urologists also recommend an annual rectal exam starting at age 50.”

There is, however, some disagreement among urologists about whether you need an annual “finger test.” And there are newer screening options, such as ultrasounds, available as well. Talk to your doctor about which might be best for you and your situation.

“I don’t know that we need [the digital rectal exam] every year anymore, but in cases with elevated PSA, it should definitely be done,” says Dr. Goldberg. “Ultimately, an ultrasound is a better test than PSAs, finger tests, or biopsies. You can’t judge whether a man has a 100- or 200-gram prostate without doing an ultrasound.”

If you’re interested in going the ultrasound route, keep in mind that it will likely be considerably more expensive than a PSA or digital rectal exam and will involve the same entry point as the latter, although a small probe or transducer will take the place of a finger.

Early Detection Leads to Great Outcomes

Regardless of the tests you and your doctor decide upon, the goal is early detection, as the cure rate for prostate cancer that’s found in a lower stage is very high. In fact, according to the PCF“The 5-year survival rate in the United States for men diagnosed with early-stage prostate cancer is greater than 99%.”

If you’re African-American or have a family history of prostate cancer, get annual screenings starting in your 40s. Otherwise, annual exams can start at 50.

If the prostate cancer isn’t detected before it progresses, Dr. Bajic warns, “it can spread to other areas of the body and, at that point, is no longer curable.” According to Dr. Goldberg, “there are different degrees of aggressiveness with prostate cancer. Some don’t need to be treated right away, but aggressive cancers need to be treated quickly.”

Those treatments run the range of what you might expect. “Surgery, radiation, or just monitoring are options, with different treatments appropriate for different types of prostate cancer,” says Dr. Goldberg. As with screening, consult your doctor on how best to treat your particular situation.

You Can Practice Prevention—Sort Of

Of course, it’s better to avoid prostate problems altogether. What can younger guys do now to ensure they have a healthy prostate in the future? Unfortunately, the answer is “not much.”

“Prostate enlargement and prostate cancer will affect all men if they live long enough,” says Dr. Bajic. “There’s nothing that can be done diet-wise to prevent prostate issues. However, eating a mostly plant-based diet and exercising has been suggested to prevent cancers in general.” As for foods to avoid, Dr. Goldberg notes that “spicy foods, alcohol, and caffeine all cause irritation in the prostate and bladder.”

Here’s one final piece of prostate advice: “In theory,” says Dr. Goldberg, “frequent ejaculation would be a benefit because you’re clearing out the secretions that the prostate makes. Certainly, that’s a good line to tell your significant other.”

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