WELLNEWS
Victor
Romulo Gallardo Dumaguing, MD
June is Men’s Health
Awareness month. Just as women are scared of breast cancer, so are men
terrified of having prostate cancer. Admittedly, the fear, anxiety, the worry
are perfectly warranted and understandable. Except for the gender, breast
cancer and prostate cancer have some disturbing similarities; both are
hormone-dependent or rather hormone-sensitive e.g. estrogen and testosterone,
and while debate is still raging as to whether they are
genetically-predisposed, the yes has more votes. Add to that the increasing
evidence that dyslipidemias- cholesterol and triglyceride - is a common finding
in the clinical profile of victims of breast and prostate cancer.
At this
juncture, it must be clarified that prostate problems do not necessarily start
with middle age of men. Adolescents or young adults who are sexually-active may
suffer from prostatitis, that is, infection of the prostate by microbes like
streptococcus, staphylococcus or by Neisseria gonorrhea in which pus cells come
out thru the urethra, with painful urination, fever and pain at the
groin, buttocks and the lower back. In these cases, a regimen of antibiotic
therapy is needed.
Changes in
the size and shape of the prostate usually occurs in men who are 45 years
old due to changes in hormone levels that occur with aging. In time the
flow of urine is obstructed. As a result, the muscles of the urinary bladder
becomes larger and stronger in order to push the urine through.
However,
when the man urinates, the bladder does not empty completely and as a result
the urine stagnates and becomes a culture medium for infection, which if not
attended to immediately would later lead to stone formation and kidney
problems. Most men complain of hesitancy or difficulty in initiating urination,
others notice they now urinate more frequently but with smaller amounts.
Moreover,
there is the disturbing nocturnal- need to urinate several times at night
disrupting a restful sleep. Of course, members of the household would tell the
man, in the nicest way they can so as not to hurt his feelings, that his pants
or his pajamas has the acrid smell of urine and this is due to terminal
dribbling or the flow of small amount of urine as the man zips up his pants
because he thought the urination is over.
With some
men, because of the incomplete evacuation of the bladder, it may sson overflow,
this time leading into urinary incontinence- an urgent need to look for a
restroom to urinate immediately otherwise, he would wet his pants, a truly
embarrassing situation.
Most doctors
and family physicians advise the head of the family- husbands, unless otherwise
agreed upon by the couple - to undergo DRE or digital rectal examination done
by urologist or surgeons. With a lubricated gloved , the forefinger is gently
inserted into the anus of the man to evaluate the consistency of the prostate-
soft, firm- hard- tender or painful, presence of nodules or other masses. Based
on this, and of course, with a detailed medical history and a thorough physical
exam, the urologist may suggest a blood test, PSA or prostate specific antigen.
It must be
stressed that a high PSA level is not a death sentence confirming prostate
cancer. There are false positives, i.e., elevated PSA but it's not cancer.
In the same manner, a Normal PSA does not rule out prostate cancer either. So,
it is he call of the urologist to do other tests like biopsy of the nodule to
examine the cells in the mass.
For those
diagnosed to have prostate cancer, although it is known to grow slowly, there
is always the fear that it would metastasize or spread to other organs like
lungs, liver and brain, although the most common site is the skeleton- ribs,
pelvis and vertebral column. Thus, another test might be needed, blood levels
of the enzyme acid phosphatase indicate active bone erosion and destruction.
Gentlemen,
let us find consolation in the fact that most enlarged prostate is benign thus,
with a mindset, we have to contend with the inconveniences it brings into our
lives like difficulty in initiating urination, weak and reduced stream of urine
which at times wet our pants and feet, many trips to the toilet at night.
Another
positive development is the availability of medicines that could alleviate the
signs and symptoms. For the few men who are diagnosed with prostate cancer,
surgery is the ultimate and definitive management, but not without some
complications and sequelae like urinary incontinence and some erectile
dysfunction. Castration or removal of both testicle is also an option, and mind
you, it takes a real man, sure of his manhood to take that choice. After
all, there would be more happy fulfilling years to enjoy life to its
fullest. Cheers to manhood!
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