Men's Health Update — Prostate

A Better Treatment for Enlarged Prostate

Men with an enlarged prostate who would have faced surgery before have a new option now: a laser treatment with much faster recovery.

Enlarged prostate (benign prostatic hyperplasia) affects 1 in 3 men. “As men age, the prostate grows and presses against the bladder and urethra, the tube that carries urine from the bladder,” says urologist Brian Murphy, M.D., of Lehigh Valley Hospital and Health Network. This causes difficulty starting the urine stream, a strong urge to urinate, a feeling as though you’re never relieved, or the need to urinate often overnight.

Medication resolves the problem in 80 percent of men, but when it doesn’t, surgery to remove excess tissue is the traditional alternative. The new GreenLight laser—which vaporizes the tissue—makes treatment much easier. In an outpatient procedure that takes about 45 minutes, a laser fiber is threaded into the urethra to deliver the energy. Afterward, a catheter is inserted to help remove urine for 1-2 days. “Laser surgery reduces bleeding and allows for a quicker recovery,” Murphy says. The procedure has no effect on sexual health, and nearly all patients go home the same day.

Do You Need a PSA Test?

The goal in cancer detection is to find it at the earliest, most treatable stage,” says urologic oncologist Joseph Trapasso, M.D., of Lehigh Valley Hospital and Health Network. For prostate cancer, the tools to achieve that goal are a yearly doctor’s exam and a test that measures the amount of prostate-specific antigen (PSA) in your blood.

The value of PSA testing remains somewhat unclear, and researchers won’t have definitive answers for a few more years. The American Cancer Society and other professional organizations recommend the test (see chart); bodies such as the U.S. Preventive Services Task Force only recommend a yearly discussion with your doctor.

What should you do? It depends partly on your prostate cancer risk (which is higher if you’re African-American or have a family history of prostate cancer), and also on you and your doctor.

Here are the facts about PSA. “Most men have a PSA level under 4,” Trapasso says.“When prostate cancer develops, the PSA level most often rises above 4, though not always. Therefore, it is also important to assess the rate at which it rises over time, called PSA velocity.”

PSA testing typically begins at age 50 (age 40 for men at higher risk), though some doctors advocate an earlier baseline test. It’s important to discuss the results with your doctor. “Because PSA levels normally rise with age, a level near 4 might be worrisome for a 50-year-old but less so for a 70- or 80-year-old,” Trapasso says.

The concern and lack of consensus over PSA testing stems from the number of false positive results, and the fact that some prostate cancers are non-aggressive and won’t affect the quality or length of your life. Treating them can create needless side effects.

The bottom line: talk to your doctor regularly about the pros and cons of prostate screening and the latest findings. While the PSA test isn’t foolproof, it is the best blood test for prostate cancer. And don’t forget a yearly doctor’s exam—it’s the other component to prostate health after age 50.

Aggressive Cancer Treatment May Be Best

For years, the thinking has been that “watchful waiting” was the safest option for older men with early prostate cancer. However, a recent study found that men age 65-80 who chose to aggressively treat their prostate cancer with surgery or radiation were about 30 percent less likely to die from that cancer than those who waited. “You have to weigh the pros and cons,” Trapasso says. “In very elderly or ill patients, the effects of aggressive cancer treatment may do more harm than good.”

Want to Know More? Lehigh Valley Hospital’s urologic cancer second opinion service helps patients make good treatment decisions. For information on this and general prostate health, call 610-402-CARE.

Published from Health You Magazine, May-June 2007

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