The San Quentin News “Health and Wellness Corner” column runs every month. A University of California, San Francisco, health professional student will answer questions that you submit about health issues. Inquiries will be answered in the next month’s paper. Feel free to ask us questions about any medical concern that you have, and it may be answered so that everyone can benefit. If you have a question, put it in a U-Save-Em envelope addressed to:
Health and Wellness Corner, UCSF Doctors (Dr. Shira Shavit) – Medical Box. If you include your name and number, they will be kept confidential. Note that this column is for general medical questions.
This edition, we will address the following question:
Should I Be Screened for Prostate Cancer?
What is prostate cancer?
The prostate is a small organ that sits between the bladder and the penis. The prostate gland has a minor role in making a fluid that mixes with sperm and other fluids during ejaculation. Prostate cancer is uncontrolled growth of the cells in your prostate. When prostate cancer cells grow in an uncontrolled way, they can spread throughout your body.
My doctor t old me I have a large prostate. Does this mean I have cancer?
No! The prostate gland grows over time in all men. Some older men have large prostate glands. This larger gland pushes on your bladder and your urethra, which is the tube that carries urine from your bladder to your penis. When this happens, you may have to urinate more often, and it may take you longer to start urinating. If you are bothered by these symptoms, talk to a doctor about medications that can shrink your prostate. This enlargement of the gland is not dangerous, and it does not increase your risk for cancer.
What is a PSA test?
PSA (Prostate Specific Antigen) is a protein produced by the cells of the prostate gland. The PSA test measures the level of this protein in the blood. It is normal for your PSA protein level to be low.
What if my PSA protein level is high?
If your PSA level is high, it can mean one of two things. First, it can mean nothing is wrong, only that you have a large prostate gland. Second, it can suggest you have prostate cancer. The important thing is that a high PSA level does NOT mean you have prostate cancer. But your doctor will want to do more tests. The next test is usually a prostate biopsy, which involves sticking needles into the prostate so doctors can examine the cells for cancer.
Should I have a PSA Test for Prostate Cancer?
This is a very complex question, and there is no right answer. Experts recommend talking with your doctor about the pros and cons of getting screened for prostate cancer. For example, if you are African-American, or if your dad or brother had prostate cancer, then you are more likely to get the cancer. You are also more likely to benefit from the test, when you are in your 50s and 60s. In fact, experts recommend that you not have a PSA test if you are younger than 40 or over age 75.
Prostate cancer screening may not be helpful because the cancer grows very slowly, so most patients with prostate cancer die from something else, like heart problems, before the cancer becomes a problem. Also, surgical treatment for the cancer can cause problems, like trouble having an erection or difficulty holding urine.
It is up to you and your doctor to talk about these issues to decide if a PSA test is right for you.
David Kaufman, UCSF Medical Student