American Medical Association Family Medical Guide - American Medical Association [557]
• Avoid caffeine, alcohol, and spicy foods. They can irritate the prostate and increase the need for nighttime urination.
• Monitor your medications. Some drugs—including oral bronchodilators, diuretics, tranquilizers, antidepressants, and over-the-counter medications such as antihistamines and decongestants—can worsen urinary problems. Check with your pharmacist.
Prostate Cancer
Prostate cancer is a common form of cancer in American men. Each year in the United States, doctors diagnose about 200,000 new cases of prostate cancer and more than 30,000 men die of the disease. Prostate cancer is the third leading cause of cancer death in American men, after lung cancer and colon cancer. The risk of prostate cancer increases significantly after age 50, especially in African American men. Your risk of developing prostate cancer is increased if a close relative (such as your father or brother) has the disease, which indicates a genetic component.
Some prostate cancers grow slowly, and are not detected for several years. Some prostate cancers never threaten health because they develop later in life; many older men who have prostate cancer die of another cause. However, in a significant number of cases, the cancer is more aggressive and grows and spreads rapidly.
Symptoms
Prostate cancer usually causes no noticeable symptoms in the early stages. In some men, the cancer grows so slowly that it never causes symptoms. Rarely, in the late stages of the disease, symptoms can develop, including weight loss, weakness, decreased appetite, a weak or interrupted flow of urine, inability to urinate, difficulty starting the flow of urine, and frequent urination (especially at night). Other possible symptoms include blood in the urine, pain or burning during urination, or persistent pain in the lower back, pelvis, or upper thighs.
Diagnosis
Doctors usually detect prostate cancer in one of three ways—during a digital rectal examination, from a prostate-specific antigen (PSA) blood test (see right), or during a surgical procedure called transurethral resection of the prostate (TURP; see previous page), performed to treat an enlarged prostate. Annual digital rectal examinations are recommended starting at age 50 for white men who have no family history of prostate cancer, and at age 45 for all African American men and for white men who have a family history of prostate cancer. If you have any symptoms of prostate cancer, see your doctor right away.
The PSA Test
The prostate-specific antigen (PSA) test measures the amount of prostate-specific antigen, a protein that circulates in your bloodstream and is produced mainly by the prostate gland. Normally, very little PSA is in the blood. Elevated PSA levels can be a sign of prostate cancer, but usually indicate other, less serious, prostate problems, such as benign prostatic hypertrophy (see page 832), infection or inflammation of the prostate, or a minor injury, such as bruising caused by a long bike ride. For this reason, additional tests, such as a biopsy (in which a doctor removes a small sample of tissue from the prostate gland for examination under a microscope), are performed to rule out prostate cancer.
Doctors disagree about whether all men should have routine PSA testing after age 50. The PSA test is not designed to diagnose prostate cancer, so some men who have low PSA levels may still have prostate cancer. Conversely, most men who have elevated PSA levels do not have prostate cancer. Uncertain test results can cause anxiety and may lead to unnecessary procedures, such as a biopsy or surgery. Any kind of prostate cancer surgery poses the risk of problems such as urinary incontinence (leaking of urine) or erection problems (see page 486). However, although the PSA test is imperfect, when combined with a digital rectal examination, many doctors consider it to be dependable for detecting prostate cancer in the early stages, when it is more