How to understand prostate health

I'm Lisa Birnbach for howdini.com. At a certain age, nearly every man needs to start thinking about his prostate health. What do you need to know? With us is Dr. Brent Ridge of Mount Sinai Hospital.

What is the age at which your prostate becomes a top concern?

Really, at the age of 50, men should start having screenings for prostate cancer.

How is that accomplished?

Two ways, predominantly. One is with the digital rectal exam, and that's the dreaded exam from the doctor where he inserts his finger into the rectum to get a feel of the prostate. And what he does when he does that is he feels how smooth the prostate is, if it's enlarged, and if he can feel any nodules there. That's very important. The second test is something called prostate-specific antigen, which is a blood test, the PSA test. There is some controversy around it, whether we should make it a part of regular screening or not. I typically recommend that men do get it. It's an adequate screening test, and followed over time it can really give the doctor some valuable information.

Now are there things that men can do to prevent prostate cancer?

Not really. What you really have to do is be fastidious about detecting symptoms. The symptoms that you need to be aware of are any changes, really, in the way in which you urinate. If your urinary habits become more frequent, if there's hesitancy-- which means you're standing at the urinal and you're really having to push or strain to get the urine flow started-- or if the flow stops and starts, or if there's dribbling at the end of the urination, those are things that are not normal and could be indicative of an enlarged prostate or prostate cancer.

Are those always signs of prostate cancer, or could those be signs of something else as well?

Yes, they could be signs of just an enlarged prostate, but sometimes they're the first signs. And sometimes you can have prostate cancer and have none of those symptoms. That's why getting a regular screening, at least a digital rectal exam, by your doctor is very important.

Some men have their prostate glands removed, and some can have other kinds of treatment. How do you know which one you should try?

Well again, it depends on the diagnosis. If you have a diagnosis of prostate cancer, there's several different treatment modalities. You could wait, because prostate cancer is a very slow growing disease. And most of the time, men with prostate cancer are going to die from something else before they die from the prostate cancer. If you're a younger man, radiation may be recommended. And most the time now, the type of radiation used is called brachytherapy, which is where they go in and insert tiny little seeds of radiation throughout the prostate, so you're helping control wherever the cancer is located in the prostate. And then there's also hormone therapy. What potentiates the growth of prostate cancer is testosterone in the body. And so you can give anti-testosterone hormones, which help shrink the size of the cancer.

But then you're dealing with a reduced amount of testosterone in the body, so your libido may shrink and depression may result.

Depression may result. You may get gynecomastia, which is enlargement of the breast tissue in men. So all of those things, while concerning, certainly not as concerning as having cancer.

But can a man have an erection and ejaculate without a prostate gland?

Yes. The problem is this. If you have surgery to remove the prostate, oftentimes in the process of that surgery there can be nerve damage because it's a very tight area. And oftentimes, the removal of the prostate can damage those nerves and then that can cause erectile dysfunction.

So it's very complicated, plus I would imagine men get very nervous about it because of the side effects because of the risk to sexual performance.

Actually, what I have found is that most men are more nervous about getting the digital rectal exam than the diagnosis of the cancer.

Really?

Is it because it's uncomfortable or embarrassing?

Exactly. And it shouldn't be. It's a necessary part of maintaining good health, and the best thing to do is to detect it early, to treat it early, and go on with your life.

Thank you so much, Dr. Ridge. For howdini.com, I'm Lisa Birnbach.