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September 17, 2008 > What You May Not Know About Prostate Health

What You May Not Know About Prostate Health

Urologist Stresses the Importance of Awareness, Screenings

In a discussion about men's health, the subject of the prostate is never far off. A gland positioned in the pelvis, under the pubic bone, and just beyond what urologists refer to as the "bladder neck," the prostate is involved in the production of fluid that is released during ejaculation, explains Washington Township Medical Group urologist Mark Saleh, M.D.

"The prostate is involved in fertility and we believe the fluid produced by the prostate supports and enables the sperm after it leaves the body," according to Dr. Saleh. "What many people don't realize is that the prostate is not really necessary after having children."

During the course of a man's lifetime, the prostate has a tendency to grow in size but really serves no biological function after a man has had children, he explains. Furthermore, prostate enlargement, known as benign prostatic hyperplasia (BPH), will happen to just about every man as he ages, Dr. Saleh adds.

Growth of the prostate does not necessarily correlate to prostate cancer and benign enlargement is much more common than prostate cancer, according to Dr. Saleh. Similarly, symptoms of enlargement are rarely indicative of cancer.

These symptoms may include:
* Difficulty starting a urine stream (hesitancy and straining).
* Decreased strength of the urine stream (weak flow).
* Dribbling after urination.
* Feeling that the bladder is not completely empty.
* An urge to urinate again soon after urinating.
* Pain during urination (dysuria).
* Waking at night to urinate (nocturia).
* Frequent urination.
* A sudden, uncontrollable urge to urinate.

"Most times, cancer of the prostate is not symptomatic," he says. "Now that we do screening, we tend to diagnose cases before any symptoms occur."

Comparatively to some other types of cancer, Dr. Saleh remarks that prostate cancer tends to be slow-growing, but this can vary because there exists a wide spectrum of factors involved in its rate of growth, including degrees of aggressiveness, grade of cancer, when it is diagnosed, as well as family history (genetic predisposition).

Since the advent of early screening techniques, including the prostate-specific antigen (PSA) test, the medical community has conducted numerous clinical studies on the effectiveness of screening and treatment methods.

According to Dr. Saleh, long-term studies suggest that screening for prostate cancer does indeed identify clinically significant cancers. Additionally, early treatment for the right patient does improve chances of survival, studies show.

"Most cancer societies and the American Urological Association (AUA) recommend regular prostate screening," Dr. Saleh says. "Most specialists agree that treatment for prostate cancer in an otherwise healthy young man is important because of the long life-expectancy and the possibility that the cancer can spread and cause death. When we talk about slow-growing cancers, it's a relative term compared to lung cancer, testicular cancer and other aggressive forms of cancer.

For somebody who is 50 or 60 and has 20 or 30 years to live, prostate cancer can certainly cause trouble down the road. Again, it is a variable cancer."

Generally, all men, beginning at age 50, should receive regular screening exams including the PSA test and an annual digital rectal exam (DRE), in which the physician physically examines the prostate for growths or changes.

"Neither test is perfect by itself," Dr. Saleh notes. "In combination, you're much more likely to catch something. You can have abnormal results for one test and normal results from the other. If we suspect cancer from either test, a biopsy can be ordered. And that's the ultimate indication of cancer."

Some populations, including men with a strong family history - a father or close relative who developed prostate cancer at a younger age - should start screening at age 40. The African American male population also tends to have more aggressive cancers and should start screening at age 40, Dr. Saleh says, adding that all men are at some degree of risk for developing prostate cancer.

"Urologists have a saying that the main two risk factors for prostate cancer are being male and getting older," Dr. Saleh says of the risk.

He adds that prostate cancer seems to be so common that in examining the prostate of autopsy specimens many tend to exhibit microscopic findings of prostate cancer. Fortunately, more often most men will deal with a benign form of prostate issues.

Free Men's Health Fair: Saturday, October 4

During the upcoming Men's Health Fair at Washington Hospital on Saturday, October 4, Dr. Saleh will address a range of topics about the prostate, urinary health and other issues. Dr. Saleh will be joined by a panel of Washington Hospital experts who will discuss a wide range of men's health issues and answer your questions.

Open to all men and women. (See the Men's Health Fair ad on the opposite page for more information.)

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