Treatments May Have Side Effects
The treatment options for early-stage prostate cancer fall into three broad categories: surgery, radiation therapy, and active surveillance. Your doctor will make a treatment recommendation based on your numbers as well as a mathematical tool known as a nomogram, which can help you and your doctor better assess how extensive your cancer is likely to be and whether it is likely to become active in the future.
Yet clinical studies have not provided any evidence that one treatment is better than another or that any treatment at all actually prolongs life: The average 5-, 10-, and 15-year survival rates are virtually the same for all treatment options in early-stage prostate cancer, including active surveillance. Its also important to understand that no mathematical model is foolproof, and some men diagnosed with early-stage, locally confined disease will later find out that their cancer was more extensive than originally believed.
If you are diagnosed with early-stage prostate cancer, you have a number of treatments to choose from. A brief comparison is listed in Table 2.
Went In For A Prostate Exam
I asked the doctor where I should put my pants. “Right over there with mine”…
After my recent Prostate Exam – one of the most thorough examinations I’ve ever had the Doctor left the room and the nurse came in.After she shut the door, she asked me a question I didn’t want to hear….She said….”Who was that guy?”
What To Expect During A Prostate Exam
The prostate exam, or digital rectal exam , along with prostate-specific antigen testing, is sometimes part of the prostate cancer screening process. Recent research suggests that the DRE may be ineffective in prostate cancer screening. Current screening recommendations vary depending on age and other factors. Men aged 5569 should talk with their healthcare providers regarding their risks and benefits of prostate cancer screening. African Americans and men with a family history of prostate cancer may need early screening.
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What Happens During A Male Physical Exam
Physical exams assess all systems of the body to determine your overall health. Gender-specific tests are also performed to evaluate the health of your reproductive system. For males, this includes examination of the penis and testicles, to screen for conditions that affect these areas.
If you are experiencing serious medical symptoms, seek emergency treatment immediately.
Give You An Exam Each Year
You may not look forward to your annual doctor’s visit, but the yearly exam can play a crucial part in your ongoing health. Your doctor knows this, and uses that time to check for any symptoms or signs of health problemsand catch them while there’s still time to do something about them.
Yearly physical examinations can help spot high blood pressure, STIs including HIV/AIDS, and high cholesterol. They’re good ways to remember your immunization schedule, too. But perhaps the most important job of the yearly doctor’s visit is to screen for a variety of cancers, many of which are more easily treatedwith better survival oddsif they are found early.
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What Are The Symptoms Of Prostate Problems
The symptoms of prostate problems may include
- urinary retentionthe inability to empty the bladder completely
- urinary frequencyurination eight or more times a day
- urinary urgencythe inability to delay urination
- urinary incontinencethe accidental loss of urine
- nocturiafrequent urination at night
- trouble beginning a urine stream
- weak or interrupted urine stream
- blockage of urine
- urine that has an unusual color or odor
- pain after ejaculation or during urination
Different prostate problems may have similar symptoms. For example, one man with prostatitis and another with BPH may both experience urinary urgency. Sometimes symptoms for the same prostate problem differ among individuals. For example, one man with BPH may have trouble beginning a urine stream, while another may experience nocturia. A man in the early stages of prostate cancer may have no symptoms at all. Because of this confusing array of symptoms, a thorough medical exam and testing are vital.
What Happens During A Dre
The DRE will take place in a private exam room at your doctor’s office. The test only takes a few minutes. You will need to take off any clothes below your waist. You will be given a gown to wear or a cloth to wrap around your body.
For men. The doctor will ask you to stand and bend forward at the waist or they will ask you to lie on your side on an exam table with knees pulled up to your chest. As they start the DRE, the doctor may ask you to relax and take a deep breath. Then they will gently insert a lubricated, gloved finger into your rectum. The doctor will feel the size of your prostate gland. They will also feel for bumps, soft or hard spots, or other abnormal areas. The doctor will also examine the wall of your lower colon and rectum.
For women. The doctor will usually ask you to lie on your back on an exam table. Your feet will be in raised stirrups. The doctor may ask you to relax and take a deep breath as they start the DRE. Then they will gently insert a lubricated, gloved finger into your rectum. The goal is to feel your reproductive organs and the bowel. The doctor may also feel for problems in your internal organs. They do this by pressing on your lower abdomen or pelvic area with their other hand.
A DRE usually does not hurt, but you may be uncomfortable. You may also feel the need to urinate. If a man’s prostate is enlarged, there may be some discomfort or mild pain during the exam.
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Two Guys Sitting In A Doctor’s Office Waiting Room
First guy says to second guy:”I …I…I…I’m hhhhh… hear ….fffffff…for my stttut…stutttering ppp,ppp, problem. Yyyy, you?”Second guy says:”I’m here because I have a swollen prostate, gonna get it checked”First guy says:”wwwww, what hhhhh, hhhappens wwwheeen y, yoour, ppppp, pprostate swelll, swells?Second guys says:”well, basically, I pee like you talk”
How To Get Proper Screening
Proper screening consists of two tests: the digital rectal exam and the PSA blood test.
Most people are aware of the rectal exam because a lot of men find it uncomfortable and embarrassing, and it makes for an easy premise in a comedy movie or television show. But it only takes 10 seconds, and 10 seconds of mild discomfort is much better than letting cancer go unchecked, which can lead to serious consequences, including death. ;Delaying diagnosis of prostate cancer can lead to the need for hormone therapy, which Dr. Harris said turns the testicles off, or can require the removal of the testicles altogether.
Basically, early detection prevents major damage, Dr. Harris said.
The blood test checks for the presence of prostate specific antigen . Its typically only found in the blood if something is wrong with the structure of the prostate, allowing the antigen to leak into the blood stream.
If you have an elevated or rising amount of PSA in your blood, its a sign something might be wrong in the prostate, and cancer could be one of those things, Dr. Harris said.
Both exams are necessary because one can turn up an issue that the other might miss, Dr. Harris said. During a rectal exam, your doctor could find a suspicious nodule, while the blood test appears normal. Likewise, the blood test could reveal the presence of PSA in your blood, while the rectal exam fails to turn up anything.
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Track Your Heart Rate
How fast your heart beats can reveal a lot about your health. And tracking it over time can help your doctor anticipate future problems.
A normal resting heart rate is 60 to 100 beats per minute . This can vary depending on a lot of things, like how much caffeine you’ve had recently, how active you’ve been in the last two hours, and whether or not you’re anxious or stressed.
Usually a low resting heart rate suggests good physical fitness. But that’s not always the case. A heart rate that is at the very low end of the range or below can signify something is wrong with the way your heart is transmitting electrical signals. This is more likely if you also notice fatigue and occasional dizziness.
If your heartbeat is regularly at our above the high end of this range, you may be at a higher risk of heart disease. It can even signify you’re more likely to die at a younger age than average. All those heartbeats take their toll. Exercise helps reduce your resting heart rate, though, as does maintaining a healthy cholesterol level.
What Does The Psa Test Involve
The PSA test involves taking a blood sample and sending it to a laboratory for analysis. The results indicate:
Normal levels: Most healthy adult males have PSA levels below 4 nanograms per milliliter .
Borderline levels: PSA levels of 4â10 ng/ml are borderline. There is a 1 in 4 chance that cancer is present.
High levels: If PSA levels are over 10 ng/ml, there is a 50% chance that the person has prostate cancer. The specialist will likely recommend more testing, including a prostate biopsy.
It is important to note that PSA levels can naturally vary from person to person. A person with high levels may not have prostate cancer. On the other hand, about 15% of people who test positive for prostate cancer after a biopsy have PSA levels below 4 ng/ml.
Prostate cancer is not the only cause of high PSA levels. Find out more about the other causes here.
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Talking With Your Doctor
Different kinds of doctors and other health care professionals manage prostate health. They can help you find the best care, answer your questions, and address your concerns. These health care professionals include:
- Family doctors and internists
- Physician assistants and nurse practitioners
- Urologists, who are experts in diseases of the urinary tract system and the male reproductive system
- Urologic oncologists, who are experts in treating cancers of the urinary system and the male reproductive system
- Radiation oncologists, who use radiation therapy to treat cancer
- Medical oncologists, who treat cancer with medications such as hormone treatments and chemotherapy
- Pathologists, who identify diseases by studying cells and tissues under a microscope
View these professionals as your partnersâexpert advisors and helpers in your health care. Talking openly with your doctors can help you learn more about your prostate changes and the tests to expect.
Questions To Ask Your Health Care Team
Before having a DRE, you may want to ask these questions:
Why do you recommend that I have a DRE?
What happens during the DRE?
Who will do the DRE?
How long will the DRE take?
Will it hurt?
Can a DRE find cancer?
When and how will I get my test results?
Who will explain them to me?
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Table 1 Why A Low Psa Does Not Mean You Are Cancer
The Prostate Cancer Prevention Trial included a provision that men randomized to receive placebo undergo a prostate biopsy at the end of the study, even if they had normal PSA levels and digital rectal exams. To their surprise, investigators found that many of these men had prostate cancer in some cases, high-grade prostate cancer.
PSA level 13 *Note: A PSA level over 4.0 ng/ml traditionally triggers a biopsy. Adapted with permission from I.M. Thompson, et al. Prevalence of Prostate Cancer Among Men with a Prostate-Specific Antigen Level 4.0 ng per Milliliter. New England Journal of Medicine, May 27, 2004, Table 2.
This study inadvertently provided evidence not only that prostate cancer occurs more often than once believed, but also that PSA levels may not be a reliable indicator of which cancers are most aggressive. Both findings add weight to the growing consensus that many prostate tumors currently being detected may not need to have been diagnosed or treated in the first place.
What To Expect During The Digital Rectal Exam
Your doctor may examine you either standing or lying down.
- If standing, you will be asked to stand facing the examination bed, with feet apart, body bent forward and your arms or elbows on the bed. Feel free to ask your doctor to give you a heads up before making any sudden movements.
- Wearing surgical gloves, the doctor will coat a finger in lubricant.
- The finger will be inserted into your rectum in a downwards angle. You may feel a little pressure or slight discomfort, but it shouldn’t hurt. It is important to relax and take deep breaths and let the doctor know immediately if there is pain.
- Your doctor may have to wait a few seconds for your external sphincter muscle to relax, and may ask you to bear down as if you are having a bowel movement.
- The doctor moves the finger in a circular motion in order to identify the lobes and groove of the;prostate gland.;The doctor checks for:Lumps on or around the prostate
- Hard spots or bumps;;
- Abnormalities on the prostate
- A normal prostate is usually around 2-4 cm long and has a triangular shape, with a firm and rubbery texture
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Ontogenesis Of Postural And Sphincter Anticipatory Adjustments
The control of body position in space develops with different intensity during life span . As an example, Zaino and McCoy showed that young healthy children exhibit much higher variability of posture control than older healthy children . It is also reported that the age 79 years is an important period of their life in which children master postural control . Moreover, Schmitz et al. showed that children 34 years old develop APA, although they show coexistence of both adult-like and immature patterns, concluding that this anticipatory activities are being set up and that children are progressively mastering them.
Changes in brain structure are continuous throughout life . By the age 2, the brain has reached 75% of its adult weight and the processes of synaptic pruning and cell death are most active during these early years . During the school-age years, strong signs of brain maturation are appreciable, especially in its connectivity . MRI measures of the structure in fibers tracts correlate with behavioral indices that also change in this period . Later changes involve the associative neocortex, which continues to develop well into the third decade , and the corpus callosum, which connects all major subdivisions of the cerebrum .
Risks And Benefits Of Prostate Cancer Screening
There are two main benefits of prostate cancer screening.;
One is potentially preventing death from prostate cancer. Many men have prostate cancer without experiencing symptoms, so screening can potentially identify prostate cancer early on when it can be treated more easily.;
Another benefit of screening and early detection is potentially catching prostate cancer in its early stages, allowing for more effective treatment. Earlier treatment can help prevent prostate cancer from spreading beyond the prostate , which can cause several symptoms.
Unfortunately, there are drawbacks to prostate cancer screening. The DRE is not very sensitive or specific. This means that people who have prostate cancer can still have a normal DRE, while patients with an abnormal DRE may not have prostate cancer. For these reasons, healthcare providers are no longer performing DRE alone for routine prostate cancer screening and relying instead on the PSA test .;;
PSA testing also has limitations in screening for prostate cancer. Elevated PSA levels do not only occur in prostate cancer. Prostatitis or an enlarged prostate can also cause PSA levels outside the normal range. Abnormal test results can ultimately lead to undue anxiety and further testing that may prove unnecessary .;
Another problem with the PSA test is the potential for overdiagnosis and overtreatment. Screening uncovers patients with prostate cancer who would otherwise never have had any issues resulting from the disease.;
Why Does The Doctor Say: Turn Your Head And Cough
The short;answer is that the doctor is checking for hernias. Hernias are due to a weak area in the abdominal wall that allows your abdominal contents like fat to slip down into your scrotum area or groin where don’t belong. What the doctor is doing is holding your scrotum to see if he or she feels anything slipping into the scrotum when you’re coughing. The reason they have you turn your head, is so that you’re not coughing in their face.
A few doctors will tell you to cover your mouth in lieu of telling you to turn your head and cough. Often, this is much safer as the germs from a cough can actually permeate the air and the doctor may still inadvertently breathe them in.
The doctor may do this as part of a routine checkup, especially if you’re older or if you have ever had a history of hernias. If you present yourself with some pain or other classic hernia symptoms your doctor may also wish to check you for a hernia. Hernias can occur in your belly button as well as the testicles in men. Eventually every man will have to have this type of exam. Try not to be embarrassed about it, every man has to go through it and for your doctor, it’s very routine. So when you hear the doc say: please turn your head and cough, just do as he says.
He may also check for testicular cancer as well, especially if you have a family history of testicular cancer or if you have any complaints about swelling or hardening in your testicle area.