One of the concerns that many men encounter as they age is prostate health.
The prostate is a gland found only in males that sits below the bladder, in front of the rectum and wraps around the urethra. Simply put, four things can happen to a prostate over time in the aging male: nothing, inflammation, enlargement of the prostate or prostate cancer.
Enlargement of the prostate, or Benign Prostatic Hyperplasia (BPH), can begin as early as age 40 in some men. By age 55, as many as 25 percent of men may have signs of BPH, and that number increases to 50 percent by age 75. As the prostate grows, it obstructs the bladder, which can lead to various voiding symptoms.
Those symptoms might include decreased urinary flow, sudden urgency to urinate, greater frequency of urination at night, post-void dribbling, the sensation of not completely emptying the bladder after urination or the inability to void at all, known as urinary retention.
The treatment for enlarged prostate usually begins with a physical exam, and a urologist might recommend one of many appropriate medications that either shrink, relax or dilate the prostate and bladder. Should medications not improve the symptoms, there are also office procedures and surgical options your urologist might discuss as an effective step in your care.
Nearly 192,000 cases of prostate cancer are diagnosed in the United States each year. It is the most common cancer diagnosed in men except for skin cancer and is also the second leading cause of cancer death among men, according to the American Cancer Society. It is estimated that 33,330 deaths from this disease will occur this year. However, the death rate has dropped by more than half from 1993 to 2017 as a result of screening and treatment advances.
The American Cancer Society (ACS) recommends that men have a chance to make an informed decision with their health care provider about whether to be screened for prostate cancer. ACS adds that the discussion about screening should take place at:
» Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
» Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father or brother) diagnosed with prostate cancer at an early age (younger than age 65).
» Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).
Prostate cancer can often be detected using a simple blood test called a prostate-specific antigen (PSA) test and a physical exam. Most men without prostate cancer have PSA levels under 4 nanograms per milliliter (ng/mL) of blood. When prostate cancer develops, the level usually goes above 4, but a level below 4 does not guarantee that a man does not have cancer. If your PSA level is high, and/or your prostate exam is normal, a doctor may advise repeating the test or performing a prostate biopsy to find out if cancer is present. Factors such as your age, race and family history might affect this decision. Should the test results indicate cancer, most treatment plans include either radiation therapy, surgical removal or a combination of both.
If surgery is appropriate, a urologist can help you decide the best course of treatment for your specific diagnosis. With the help of genetic testing of a patient’s particular cancer, many patients’ condition can be monitored closely and not require initial active treatment.
One of the most advanced treatment options for prostate cancer is robotic urologic surgery. Also known as robotic prostatectomy, this minimally-invasive surgery is performed using a robotic interface. The surgeon controls the robot’s every move while seated at a console in the operating room. The surgeon’s hand, wrist and finger movements guide the robot as it becomes an extension of the physician’s hands. The surgeon views the operating area though High-Definition, 3-D imagery that provides greater magnification and improved visualization and precision than traditional surgical techniques. For the patient, the robotic approach provides less pain, smaller blood loss and a quicker recovery time.
The evolution of technology that has led to robotic urology surgery is exciting for both physicians and patients, but it might not be the best option for everyone. The most important factor in the success of any type of surgery is the surgeon’s experience and skill. A highly trained and skilled robotic surgeon can provide robotic surgery as a safe and effective option for patients whose diagnosis is appropriate for the procedure.
The key feature in deciding on the best treatment option, in all patients with prostate cancer, is early detection and diagnosis. Each person is unique, and it is important to talk to a health care provider about the uncertainties, risks and potential benefits of prostate cancer screening before deciding whether to be tested.