Prostate Health – Prostate Exams and What to Expect

Prostate cancer is cancer of the prostate, a walnut-sized gland located between the bladder and the penis. The prostate is responsible for part of the seminal fluid essential to reproduction. Prostate cancer occurs as other cancers do when the gland cells begin to grow out of control. More than 99 percent of prostate cancers are adenocarcinomas, which are cancers that form in the glands.

Next to skin cancer, prostate cancer is the most common cancer in men. One in six men will be diagnosed with prostate cancer in his lifetime. The American Cancer Society (ACS) predicts that in 2017, there will be 161,360 new cases of the disease. Fortunately, due to advancements in screening, diagnosis, and treatment methods, 85 percent of prostate cancer in American men is found during the early stages.

While there is no sure way to prevent prostate cancer, there are measures that may lower the risk. These include lifestyle changes, such as eating a healthy diet, maintaining a healthy weight, and exercising regularly. Above all, men should get into the habit of getting screened for prostate cancer routinely to detect the disease in its early stages.

Current research supports that prostate cancer screening may reduce prostate cancer-related deaths. In a recent article by Tsodikov et al., they found that prostate cancer screening may reduce the risk of death from prostate cancer by 25%-32%.

At What Age Should You Have a Prostate Exam?

The topic of prostate cancer screening remains controversial. Since recommendations differ, the bottom line advice from both the United States Preventive Services Task Force and the American Cancer Society (ACS) is that when and if to undergo prostate screening should be based on an informed decision made with a healthcare provider. The ACS age guidelines for that discussion are:

• Age 50 for men who are at average risk of prostate cancer and are expected to live at least ten more years.
• Age 45 for men at high risk of developing prostate cancer. This includes African-Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).
• Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).

What to Expect During a Prostate Exam

Prostate screening begins with an introductory discussion with one’s doctor. This is to explore any prostate symptoms (problems urinating, blood in urine or semen, erectile dysfunction), and should also include a family history–specifically, whether an immediate relative (father or brother) has/had prostate cancer.

Digital Rectal Exam (DRE)

This is a relatively simple test in which a doctor can feel for any abnormalities in the size or shape of the prostate. In this exam, the doctor inserts a gloved and lubricated finger into the rectum. This may cause momentary discomfort, and the urge to urinate may occur, particularly if the prostate is enlarged or inflamed.

PSA Blood Test

The PSA (prostate-specific antigen) is a protein produced by the prostate. PSA can travel through the blood by itself or attach to other proteins. A rise in PSA levels can be caused by several factors:

• An enlarged prostate
• An infected or inflamed prostate
• Some forms of prostate cancer

An abnormal PSA blood test result, while not an absolute indication of cancer, can lead your doctor to order additional testing (In fact, most tests that reveal high PSA levels are not of men with cancer). If the medical history, DRE, or PSA are abnormal, other potential tests may include:

Transrectal Ultrasound (TRUS)

This is a short (15-minute), usually pain-free procedure in which an ultrasound probe (called an ultrasound transducer) is inserted into the rectum. The sound waves create an image of the prostate gland and surrounding tissue to help determine any cancerous changes. However, since a transrectal ultrasound often does not discover anything significantly different than a DRE or PSA test does, its use is often indicated mainly as a guide for a prostate biopsy to help pinpoint suspicious areas.

Prostate Biopsy

This is the only definitive test to diagnose prostate cancer. Combined with TRUS to guide the doctor to the suspected site of cancer, samples of prostate gland tissue are extracted and then examined under a microscope. The tissue is checked for abnormal cells.

Surgical Options for Prostate Cancer

While there are various potential treatments for prostate cancer, whether or not someone is a candidate for surgery is determined by various factors. These include the type and location of the tumor, as well as its size and stage. Also taken into consideration is the general health of the patient. Surgery is often combined with other treatments for cancer, such as chemotherapy, radiation, or hormone therapy, to help prevent the spread or recurrence of the disease.

The most common surgery for prostate cancer is a radical prostatectomy. This surgery entails removing the prostate gland and its surrounding tissues. Done under general anesthesia, this surgery can be performed in several ways.

Open prostatectomy

This is the traditional approach, done through an incision made in the lower abdomen.

Laparoscopic prostatectomy

This is a minimally invasive approach involving several small incisions and special tools to remove the prostate.

Robot-assisted laparoscopic prostatectomy

This is a minimally invasive laparoscopic surgery but done with the assistance of a special robotic machine which is a computer-assisted mechanical device.

Potential Side Effects of Prostate Cancer Surgery

Surgery for prostate cancer, as well as other types of prostate cancer treatment, contains a risk of side effects. These include urinary incontinence (inability to control urine) and erectile dysfunction (impotence; problems with getting or maintaining erections).

Erections are controlled by two small nerve bundles located on either side of the prostate. A radical prostatectomy can entail the removal of some or all of these nerves that are responsible for erections. If one or part of those nerves is removed, there is an increased chance that a patient will experience erectile dysfunction following their surgery.

At the Institute for Advanced Reconstruction, we provide options to preserve erectile function at the time of surgery, as well as restore erectile function after surgery.

Our expert reconstructive surgeons perform penile nerve reconstruction that allows men to retain normal erectile function. Our physicians, working in conjunction with a team of skilled urologists, have perfected this procedure. This preventative procedure is performed immediately after a prostatectomy, takes minimal time (adding only 20 to 30 minutes to the prostatectomy surgery), and does not involve any additional risk.

We also offer a genitofemoral to cavernous nerve transfer procedure to restore erectile function. This procedure may be an option for men who experience a loss of erectile function after prostatectomy, prostate radiation, pelvic surgery, trauma, or being diagnosed with diabetes. Following the procedure, nerve regeneration is expected at around 6 to 9 months before the desired erection is possible.

If you are about to undergo radical prostatectomy or suffer from erectile dysfunction following your prostate cancer treatment, Contact us to explore your options!