Understanding Prostate Cancer: A Conversation with Nathan

Talk to Nathan about prostate cancer screening. Hey, I'm Nathan. Maybe you've heard about prostate cancer and wondered, "What do I need to know?" Or, "Do I really need to get checked out?" Well, I can talk you through it, answer some questions. I'm no doctor, just a retired truck driver, but I've been getting screened for a while now. Talked to my provider about it a lot. Your provider is your main medical professional, like a doctor, nurse practitioner, or physician's assistant. >> You know, I actually had a false alarm at one point where it looked like I might have had prostate cancer. So now I know more about this stuff than I ever thought I would. >> What does the prostate do? Your prostate's about the size of a walnut and it sits between your rectum, bladder, penis, and well, all the other stuff down there. It makes some of the fluid for semen, and it controls the flow of pee and semen. It's like the stoplight of your downstairs. What happens if the prostate has problems besides cancer? Well, almost everyone's prostate gets bigger as they age, and that can get in the way when you're trying to pee. It's the difference between a strong stream and a kind of drip drip, if you know what I mean. If pee gets stuck too long, it could get infected. That could make it hurt to pee or it could cause pain in your groin. What problems does prostate cancer cause? A lot of prostate cancers are small and grow slowly. Might be a long time before they cause problems or they might never cause problems. When it does, there could be trouble peeing, blood in your pee, trouble getting an erection or pain in your back, hips, ribs, or other bones. But if you have anything like that, could be a lot of things besides prostate cancer. Talk to your provider about it. >> How common is prostate cancer? >> It's the most common cancer for men. About one in nine men will be diagnosed at some point in his life. It's even more likely for African-Amean men and men with a family history, too. Now, it doesn't always cause problems, but when it does, these days we have some good options to treat prostate cancer. Most men who catch it early and get it treated have a normal lifespan. >> Do I need to get screened? You know, that's one question I can't answer for you. It's up to you, your family, and your provider to decide because screening can have some benefits, but it could also have some harms. There are some different recommendations about when to start considering screening for prostate cancer, but all experts agree you should start talking to your provider in middle age. Some experts recommend you talk to your provider earlier if you're at higher risk of having prostate cancer. Men at higher risk include African-Amean men and men with a family history of prostate cancer. There comes an age when it stops making sense to get regular screenings. You can talk to your provider about that, too. What kinds of screenings can I get? So, right now, the only screening experts think is worth considering is a blood test. It checks if there's too much prostate specific antigen or PSA. Isn't there a test where the doctor puts a finger up your rectum? So, in medical ease, that's called a digital rectal exam or DRE. And yep, it is what it sounds like. It usually takes about 10 seconds, and it's an exam where your provider is trying to feel if there's a tumor on your prostate. Some providers think it can help find cancer, others don't. >> What are the benefits of screening? The benefit of the blood test is it can help find problems with your prostate, like if it's enlarged or has an infection or has cancer. But catching cancer early can make treatment easier. And it can lower the chances the cancer will spread and cause problems or lead to death. Some prostate cancers won't spread. They won't cause any problems or lead to death. Even then, knowing you have it might help you make choices about your health. And hey, if the test doesn't find anything, that could be a relief. >> What are the harms of screening? >> So, screening has three possible harms. First, the test isn't always accurate. You could have a low PSA but still have cancer, or your PSA could be high for some other reason. It could take a while to figure out if it's high from cancer or something else. For a lot of men, that's a stressful time. I know when I got tested and found out my PSA was high, I had to hit the books, get up to speed, did a lot of late night reading, lost sleep, wondering, "Do I have cancer in me right now?" It was weeks of that when turns out it wasn't that serious. My prostate was just enlarged. Second, a high PSA usually leads to more tests, like a biopsy. That's when they use a needle to take out small parts of the prostate. It can be uncomfortable and it can have side effects and complications like infection. And third, some prostate cancers will grow fast and cause problems, but some never will. And it's really hard to tell which is which. So if tests find cancer, it can lead to men getting treatments they don't need. And treatments often have side effects like erection problems. What happens if screening finds something? Oo boy. You mean besides breaking out in a cold sweat? The good news is a high PSA doesn't always mean cancer. So when mine was high, I just waited a few weeks to get another test. And yep, that one was high, too. So my doc sent me to a urologist to look into it. He did an MRI, which is like an X-ray. Then he did a biopsy, and that's how I learned I didn't have cancer. I had an enlarged prostate. What does treatment for prostate cancer look like? >> Well, for most prostate cancers, there are two aggressive treatments, surgery and radiation, and one less aggressive one, active surveillance. Surgery removes the prostate. Radiation kills cancer cells in and around the prostate. Now, for active surveillance, a lot of prostate cancers won't never cause problems or might not for a long time. So, the idea is you and your doc keep an eye on it. You don't start an aggressive treatment until you definitely need it, maybe never. What are the common side effects of prostate cancer treatment? Here are the most common ones. >> The most common side effects of treatment are trouble with bladder control, erections, and bowel movements. Not everyone has these, and there are ways to treat them. How can I tell if screening is right for me? Well, there isn't one decision that's right for everyone. So, what you want, what you prefer matters a lot. For example, you know what? Let me ask you a couple of questions. We talked about how not all prostate cancers need to be found. To you, how important is it to know more about your prostate health, even when that could cause unnecessary stress? How do I talk to my provider about screening? Here are three ways you could start the conversation. Ways to start the conversation about screening. I want to talk about prostate cancer. Should I be concerned? What do I need to know to decide if screening is right for me? I heard about PSA and DR screening. What are some reasons I should or shouldn't get screened? It can help to write down questions you want to ask. What other questions can I ask my doctor? Here are a few ideas, >> questions you can ask about screening. Am I at greater risk for prostate cancer than most men my age? At what age should I start to think about screening for prostate cancer? Where will the test be done? How and when will I get the results? Who will explain them to me? Is the test and follow-up covered by my insurance? If not, how can I try to get this covered by my insurance? What will happen if my test comes back high? How often are PSA tests repeated? What will happen if I do have prostate cancer? It can help to write down questions you want to ask. To learn more, visit cdc.gov/prostate-cancer.