After scouring the Web for information on prostate cancer and related topics, you’re bound to become overwhelmed, confused and maybe even a little terrified. Many of my patients are often left feeling unsure about the tests they need to have done, the results they should listen to and the steps they should take moving forward after a cancer diagnosis. Although our society has certainly come to rely on the World Wide Web as a universal answer-key, when it comes to prostate cancer, the Web doesn’t have all the answers needed to help men navigate a diagnosis and the various treatment options. Only a doctor who knows the correct answers, given a specific patient’s situation, does.
I spend a great deal of time educating my patients on their condition and individual options, so I know how important it is for a patient to get an answer to every one of his questions. I’ve had many patients come in, terrified from the results of their online search and afraid to ask the questions on their minds, since many of them are sensitive about this topic and embarrassed to ask the important questions. As a result, I’ve decided to address the top 5 questions men are afraid to ask their doctors about their prostates, but to which they need to know the answer. I urge patients to discuss these difficult questions with their physicians to make sure they have all the information they need to comfortably make the right treatment choices.
How often do I need to get tested, and what does the test involve?
Screening for prostate cancer involves a digital rectal examination (DRE) to feel the prostate, as well as a blood test to check for PSA (prostate-specific antigens) once a year, starting at the age of 50. However, African American men and men who have a family history of prostate cancer are strongly recommended to take a proactive approach and begin testing at the age of 40, as they are considered to be at higher risk for the disease.
What really are my risk factors?
There are a number of factors to consider, when understanding your overall risk for developing prostate cancer:
- Age - As men age, they are at a greater risk of developing prostate cancer.
Over 65% of men diagnosed with prostate cancer are over the age of 65.
- Race - African American men are 60% more likely to develop prostate cancer when compared with Caucasian men. They are also more likely to develop an aggressive form of the disease.
- Family history – Risk increases significantly for men who have a first degree relative (i.e. a father or brother) who has been diagnosed with prostate cancer, especially if the relative was diagnosed at a young age, or if they have multiple first degree relatives with prostate cancer.
- Diet – Obesity and a high fat diet both increase a man’s risk of not only
developing prostate cancer, but of developing a more aggressive form of the
What symptoms should I be most worried about?
Prostate cancer often does not cause symptoms, except in its advanced stages when it can cause difficulty with urination, blood in the urine, or bone pain due to spread of cancer to the bones. However, common symptoms related to the prostate gland, which include frequent or nighttime urination, difficulty starting the urinary stream, slowing of the urinary stream, and having to rush to urinate, can signal problems that warrant further evaluation from a physician. Prostate cancer can sometimes be found during evaluation of some of these symptoms.
What are the differences between traditional surgery methods and robotic surgery for prostate cancer?
As opposed to traditional surgery, where a large open incision is made in the lower abdomen and the prostate is removed using the surgeon’s hands, the robotic approach uses the advantages of minimally invasive techniques using small incisions and the insertion of a stereoscopic camera and robotic instruments to facilitate prostate removal. The high resolution, magnified 3-D view inside the patient’s body, combined with the enhanced instruments that have a range of motion greater than the human hand allows, enables the surgeon to perform a very precise and meticulous surgery that significantly reduces the risk of bleeding. The smaller incisions give patients the added advantages of a shorter hospital stay, significantly reduced pain, and a faster return to work and daily activities, compared with open surgery.
What are the real side effects from having my prostate removed?
There are a number of side effects that can accompany having the prostate removed, but significant advancements have been made to reduce any effects that can follow surgery:
- Urinary incontinence – Though leakage of urine is common immediately after surgery, 95% of patients will regain full urinary control upon recovery.
- Erectile Dysfunction – Men may experience a decrease in erectile function following surgery due to damage to critical nerves and/or blood vessels around the prostate which contribute to erectile function. Risk of dysfunction depends on numerous factors, including age, baseline function, and whether nerve preservation was performed during surgery. Aproximately 50-70% of potent men undergoing nerve preservation at the time of prostate removal can expect to see return of erectile function following surgery.
- Loss of fertility – After prostate removal, men will not be able to father a
child using conventional methods. If a man is interested in still having children after surgery, it is recommended that he carries out sperm banking
prior to the surgery.
I'm Dr. Dhiren Dave, the first fellowship-trained robotic surgeon at Somerset Medical Center in the Somerville, N.J. borough. For more information, please visit http://www.somersetmedicalcenter.com/prostate-cancer-institute.