By Kevin B. Knowles, DO, Medical Director, Community Medical Associates

September is Prostate Cancer Awareness Month, making it an important time to talk about a disease that affects thousands of men and their families every year.

Prostate cancer is one of the most common cancers among men in the United States. While some prostate cancers grow slowly and may never cause serious health problems, others can be aggressive and spread beyond the prostate. The challenge is that prostate cancer often causes no symptoms in its early stages.

That is why I encourage men, particularly as they get older, to have a conversation with their healthcare provider about their individual risk and whether prostate cancer screening is appropriate for them.

What is the prostate?

The prostate is a small gland that is part of the male reproductive system. It is located below the bladder and surrounds part of the urethra, the tube that carries urine out of the body.

The prostate commonly grows larger as a man ages. An enlarged prostate is not the same thing as prostate cancer, but because both conditions can affect urination, it is important not to assume that urinary changes are simply a normal part of getting older.

Prostate cancer may not cause symptoms

One of the most important things for men to understand is that you cannot rely on symptoms alone to tell you whether there is a problem.

Many men with prostate cancer, particularly in its early stages, have no symptoms at all. When symptoms do occur, they can also be caused by noncancerous conditions such as an enlarged prostate or infection.

Symptoms that should be discussed with your healthcare provider include:

• Difficulty starting urination or a weak or interrupted urine stream
• Needing to urinate more frequently, especially at night
• Difficulty emptying the bladder completely
• Pain or burning with urination
• Blood in the urine or semen
• Persistent pain in the back, hips or pelvis
• Painful ejaculation

Having one of these symptoms does not mean you have prostate cancer. But persistent or unexplained symptoms deserve medical attention.

What is a PSA test?

One of the tools we use to screen for prostate cancer is the PSA, or prostate-specific antigen, blood test.

PSA is a substance produced by the prostate. The test measures the amount of PSA in the blood. An elevated PSA level can sometimes be associated with prostate cancer, but an elevated result does not automatically mean cancer is present.

PSA can also be elevated because of an enlarged prostate, inflammation or infection of the prostate, certain medications and other factors. That is why a PSA result should be evaluated in the context of a man’s age, medical history, previous PSA results, family history and other risk factors.

If a PSA result is elevated or changes significantly over time, additional evaluation may be recommended. Depending upon the circumstances, that may include repeat testing, referral to a urologist, additional testing or imaging, and sometimes a prostate biopsy.

When should men begin talking about PSA screening?

There isn’t one screening schedule that is right for every man.

The American Cancer Society recommends that men at average risk have a discussion with their healthcare provider about prostate cancer screening beginning at age 50. Men at higher risk, including African American men and men whose father or brother was diagnosed with prostate cancer before age 65, should have that conversation beginning at age 45.

For men at even higher risk, including those with more than one close relative who developed prostate cancer at an early age, that discussion may begin at age 40.

Other organizations have somewhat different recommendations, which is another reason I encourage men to talk with their healthcare provider rather than simply choosing an age and assuming everyone should be screened the same way.

The decision should take into consideration your age, overall health, family history, personal risk factors and the potential benefits and limitations of screening.

Know your family history

Family history matters.

Men who have a father, brother or son who has had prostate cancer have an increased risk, particularly when the cancer was diagnosed at a younger age. Certain inherited genetic changes can also increase risk. A family history of other cancers, including breast, ovarian and pancreatic cancer, can sometimes be important when evaluating inherited cancer risk.

This is why knowing your family’s health history and sharing it with your healthcare provider is valuable.

African American men also face a higher risk of developing prostate cancer and are more likely to die from the disease than men in other racial groups.

An abnormal PSA doesn’t necessarily mean cancer

I think this is an important point because men sometimes hesitate to have a PSA test because they are afraid of what the number might mean.

A PSA test is a screening tool, not a diagnosis of cancer.

An elevated PSA tells us that we may need to look more closely. It does not tell us by itself that a man has prostate cancer. Likewise, screening can sometimes identify slow-growing cancers that may never have caused health problems during a man’s lifetime. These are among the reasons patients and providers should discuss both the benefits and limitations of screening.

If cancer is ultimately diagnosed, treatment is also not automatically the same for every patient. Depending upon the type and stage of the cancer and the patient’s overall health, options can range from careful active surveillance to surgery, radiation or other treatments.

Don’t wait for symptoms to think about your prostate health

Men are often very good about taking care of their families, their farms, their businesses and everything else that needs attention. Their own health can sometimes end up farther down the list.

Prostate Cancer Awareness Month is a good reminder to change that.

If you are experiencing urinary changes or other concerning symptoms, don’t ignore them. And if you feel perfectly healthy, that doesn’t necessarily mean you should wait until symptoms develop before talking about prostate cancer.

Ask your healthcare provider a simple question: “Is it time for me to have a PSA test?”

That conversation gives us an opportunity to look at your age, family history, previous PSA results and overall health and decide together what makes sense for you.

Early detection can make a difference, and a simple conversation is a good place to start.

Talk With Your Healthcare Provider

If you have questions about prostate cancer, PSA testing or your individual risk, contact your healthcare provider.

Community Medical Associates (CMA)
📞 660-258-1050

Meadville Medical Clinic (MMC)
📞 660-938-4213

When additional evaluation is needed, Pershing Health System can also help connect patients with urology services, helping patients receive more of their care close to home.