1 in 9 American men will be diagnosed with prostate cancer at some point in their lifetime however early detection promises hopeful statistics in surviving prostate cancer.

Recent numbers show that there has been a steady decline in the number of people who have died through cause of cancer since 1991. The figures state that in 2018, there was projected to be a total of 1,753,350 new cancer cases with a corresponding 609,640 deaths.

The drop in cancer deaths has largely been attributed to the more initiatives to raise awareness around risk factors such as smoking tobacco, a poor diet, sedentary lifestyle and excessive alcohol consumption.

More screening and therefore early detection is a key player in ensuring fewer deaths by cause of cancer.

However, all cancers still pose a threat to life. The American Cancer Society report that 1 in 41 men will die by cause of prostate cancer.

LetsGetChecked want you to know everything you can this Cancer Prevention Awareness Month so we are speaking with our U.S. Medical Director Dr. Robert Mordkin who is Chief Urologist and Director of Robotic Surgery in Virginia Hospital Center. We are also joined by Michael J. Russer who a TEDX speaker, writer for The Good Men Project, Intimacy expert and prostate cancer survivor.


Contents




Prostate Cancer | Quick Facts


  • Prostate cancer is a cancer of the prostate gland, which sits within the male reproductive system.

  • Often, signs and symptoms of prostate cancer often will not become apparent until the cancer is advanced.

  • 57% of prostate cancer cases are diagnosed in men over the age of 65, however it can affect you at any age.

  • Prostate cancer is the second most common cancer in men after skin cancer.

  • 1 in 41 men will die by cause of prostate cancer.


What Is Prostate Cancer?


Prostate cancer affects the prostate gland. The prostate gland a small walnut shaped gland that makes up part of the male reproductive system. The prostate gland is responsible for producing seminal fluid that nourishes and transports sperm.

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Prostate cancer is the second most common cancer in men. It may begin to develop in the prostate gland and stay localized there, where it often remains dormant. In other instances, the cancer can grow and spread (metastasize), often to the bones.

Prostate cancer has a better chance of successful treatment if it is detected early which is why men are encouraged to undertake regular screenings from the age of 40 upwards depending on their associated risk factors. Men who experience risk factors, such as a family history are encouraged to undergo screening from the age of 40 years of age. We will further talk you through the risk factors later in this article.

Prostate cancer screening involves a PSA test which measures the volume of prostate-specific antigen in the blood as well as a rectal examination in which a medical professional will examine the size and consistency of the prostate gland.


What Are The Symptoms Of Prostate Cancer?


Some of the early signs and symptoms of prostate cancer may include:

  • An increased need and urgency to urinate
  • An increased need and urgency to urinate during the night (nocturia)
  • Difficulty during urination in emptying the bladder or maintaining a steady stream of urine
  • Pain or burning during urination
  • Blood in the urine
  • Blood in seminal fluid during ejaculation
  • Erectile dysfunction
  • Discomfort during sex
  • Discomfort or pain when sitting

Some of the later signs and symptoms when prostate cancer has become more advanced may include:

  • Chronic fatigue
  • Unexplained weight loss
  • A change in bowel habits or digestive discomfort
  • Swelling or fluid buildup in the legs or feet
  • Pain in the bones, mostly localized in the hips, thighs and shoulders

Dr. Robert Mordkin Explains Prostate Cancer




What Are The Risk Factors For Prostate Cancer?


Age
The risk of prostate cancer increases with age, however, prostate cancer should not be stereotyped as “an old man’s disease” because it can affect you at any age. 57% of prostate cancers may be diagnosed after the age of 65, this risk of developing prostate cancer drastically increases after the age of 50 which is why men over the age of 50 that are not classified as "high-risk" should begin baseline testing every two years. For men who have higher risk factors such as their family history or those who are African American, baseline testing should begin from the age of 40-45, and should be carried out annually.

Family History
Hereditary prostate cancer is very rare and accounts for only 5% of all cases. However, a family history of prostate cancer is a significant risk factor and impacts on your overall chances of being diagnosed with this type of cancer.

One Swedish study, cited by the American Cancer Society, including a sample group of 52,000 men, investigated the level of risk involved in prostate cancer if a first-degree relative was also diagnosed with prostate cancer and found that:

  1. Men with a brother who had or has prostate cancer are twice as likely as the general population to be diagnosed with prostate cancer. Men with brothers who live with prostate cancer have a 30% risk of being diagnosed before the age of 75 compared to 13% of men with no history.

  2. Men with a brother and father living with prostate cancer were 3 times as likely to be diagnosed with prostate cancer than the general population. The chances of developing an aggressive cancer before the age of 75 was 14% in contrast to the rest of the population who carry a 5% chance.

Race/Ethnicity
It is not commonly known why black men have a higher risk of prostate cancer than white men but it is thought to be connected to genetic and socioeconomic factors. Prostate cancers also have a higher incidence rate in North America and Northern Europe, with an increased incidence rate in Asian men living in Hong-Kong and Singapore. Some contributing factors are said to be connected to exercise and diet.

Eating Habits
Emerging evidence suggests that your eating habits can impact your risk of developing prostate cancer. Traditionally what you eat has been connected to conditions like heart disease, diabetes and obesity but it has now been proven that what you eat is also connected your cancer risk, with some foods being known to aid in preventing cancer. Some simple guidelines for good prostate health include following a plant-based diet with lots of fruit and vegetables, fiber, low fat and limited number of sugars. Red meat and fatty foods should be avoided if you want to optimize your health and minimize your cancer risk.

Smoking
Cigarette smoking undoubtedly increases your risk of all cancers. Smoking isn’t just a risk factor for prostate cancer but it is also tied to a more aggressive type of prostate cancer. One report which analyzed 51 studies with a sample group of over 4 million men found that smokers have a 24% higher risk of death from prostate cancer than non-smokers.

In another Austrian research study using a sample group of 22,000 men, it was found that smokers were nearly twice as likely to die of prostate cancer than non smokers. The risk that the prostate cancer would spread was at a 151% higher risk and there was a 40% higher risk chance that their prostate-specific antigen PSA would rise again after prostate cancer treatment signalling that the cancer had returned.

Genetic Changes
There are numberous of gene mutations that can be passed from one generation to another and and are found in all cells of the body. This risk factor accounts for 5-10% of all prostate cancers. Gene mutations can occur during a person’s lifetime and are not passed onto children, these are known as “acquired mutations.”

During cell division, each new cell must take a copy of DNA. In rare cases, this duplication of DNA is imperfect and can create defective DNA. This occurrence can be totally random but may be influenced by hormonal imbalances and diet. The faster your prostate cells divide, the more likely chance there is of mutations.

There is further study required on this topic but one example shows that men with higher levels of androgens, such as testosterone speeds up the the rate of growth of prostate cells, therefore in some men, higher levels of testosterone may play a part in the rate of prostate cancer.



Surviving Prostate Cancer | Michael’s Story


Michael J. Russer previously spoke to LetsGetChecked about living with erectile dysfunction. This condition was born through treatment for prostate cancer. Prior to his diagnosis, Michael had lost 5 family members to prostate cancer. Today, he views his early detection and diagnosis as a blessing.

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Michael’s mission in life is to share how anyone, no matter how disconnected they feel, can “reconnect” with their own health and those of others and in so doing transform their own life experience. He says "this is especially important now in our age of rampant “digital distraction”, where interaction via smart devices is a poor substitute for real human connection."

When were you diagnosed with prostate cancer?

It was almost exactly 7 years ago, It was November of 2011. To put some context around this, I come from a large family where half of us were decimated by cancer. Five members of my immediate family including my mother, my father, my oldest brother, my oldest sister and another older brother all died from cancer.

What was the first thing that crossed your mind when you were diagnosed with prostate cancer?

Cancer is a big deal in my family and that was the first thing that went through my head; “Oh boy, this is not good.”

On the other hand, I’m also a very positive person, so I thought “you know what? we’ll do whatever it takes and we’ll figure it out.”

It definitely brings up existential issues and ironically, I now have two cancers and I was diagnosed with my second cancer two or three years later. Neither of them are curable at this point and my partner and I talk about my death all of the time but in a very positive way.

It is a very healthy thing, we think. After the diagnosis, I also knew the implications of treatment might be. When they diagnosed me they said it was a very mild case. The Gleason Score was low on one side and there was no apparent cancer on the other hemisphere.

("The Gleason Score" is a grading system which is used to help evaluate the prognosis of men with prostate cancer. The Gleason Score is graded by group 1-5. It starts at 6 and goes upto 10. Those with a score of 6 would be seen as having a less aggressive cancer, those with a score of 9-10 would be viewed as higher risk patients.)

“They said “You have months to think about it.” I said “I thought about it, take it out and take it out now, I have a family history. It’s a good thing they did because if they didn’t, you and I wouldn’t be talking right now. I would be pushing daisies.”

It turned out to be very aggressive, and they didn’t get it all. I have had it ever since, my hope is that eventually I will be able to beat it permanently.

Did you experience any symptoms in the lead up to your diagnosis?

None whatsoever, my PSA was quite low but my doctors were very aware of my family history of cancer and so they said, “we better go in there and check it out.” It’s a good thing they did.

"I think that many men if not most men avoid going for screening. It’s not very much the existential issue of the cancer but more the implications of the treatment and potentially and can often lead to partial or in my case, complete erectile dysfunction."

In our society, for a lot of men, that is worse than death but that is how they may take it. As a result they either avoid it or they do go through the process and they can end up with some form of erectile dysfunction and shut down entirely. Life can become very rough for them and very lonely because they don’t know how to reach out.

Do you think men or women are more open about discussing sexual issues?

We speak in front of all sorts of audiences and cancer survivors. Women are more open to talking about it and more open to addressing it, whereas in our culture men don’t even want to talk about it which is not helpful at all.

“It is so sad and it’s all culturally imposed but it’s so unnecessary, so so unnecessary.”



Can you recall your prostate cancer treatment?

Well I had the orthodox treatment and then I explored the non-orthodox routes. The orthodox treatment was obviously the surgery and the when my PSA was still non-zero after the surgery, my surgeon said “Oh well.” I mean literally that is what he said.

I found out later that many surgeries fail so he then suggested I go through intensive, daily radiation for 7 weeks and that did nothing other than make things worse in the erectile department. At first I was rather angry about the whole thing and I wasn’t ready to give up my sexual function.

After that, I got over the anger and I didn’t experience depression because I’m quite an optimistic guy, I went into negotiation as they say.

I figured “Okay, we’re going to figure this out.” I thought “There has got to be a way to fix this.” and that is when I started exploring non orthodox ways when the orthodox ways were not working.

I mean you can get an injection, a penile injection and that sort of worked but I wasn’t about to use my penis like a pincushion nor would I accept surgery. The failure rate is was quite high and potentially very dangerous and I just didn’t want this, so the non-orthodox ways that I started looking at including Reiki healing followed by acupressure, acupuncture and watsu water massage.

I went for upper and lower colonics which was kind of interesting.

Everyone of them told me; “It’s going to come back, it’s going to come back.”

How did the long term effects of prostate cancer treatment develop?

I thought, “alright, okay I’m not dating anyone so I’m willing to wait” and I was waiting, but as it turned out, nothing worked. I am permanently impotent and now chemically castrated but I am in an emotional and physical level of intimacy that most people with no physical problems can barely imagine. This will be hard to understand or to listen to, especially for the men but it ended up being a gift.

It sounds like a cliche but it’s not for us. Every moment we live fully and the erectile dysfunction was an enormous gift because it allowed me to slow down.

That is a tough one for men to get, women seem to get it a little bit more but men are like “What?!”. You have to accept it, I got to the point where everything failed on my first attempt to be intimate with my partner Jacqueline, who I met a year after first being diagnosed.

Prior to exploring different ways to be intimate with your partner, what other methods had you tried?

I brought all forms of erectile aids and they all failed spectacularly, the last one, painfully so but that was what I needed to get to that point of acceptance and no longer fighting. Once I did that I was able to become present for her and I have been ever since.

“If I were to die tomorrow, I would die the happiest man that anyone can ever imagine.”

There isn’t a time in my life previously that even comes close to what I’m living now and I mean that with every fiber of my being and it just keeps on getting better.

What would you say to men who might be putting off prostate cancer screening?

"I would say you are taking your life into your own hands."

I would say you are willing to gamble your life for an erection and that is the big issue. If you are hesitating getting screened, that is probably why you are hesitating and this comes down to the way you were raised, our culture, our media, the porn industry, the pharmaceutical industry, all conspire to say that you’re not a man unless you can get it up and that is total B.S.

You are a man in the way that you are with your partner and there is much much more involved than the ability to penetrate. If you buy into that cultural myth, you are going to be a very lonely and miserable man. If you have the courage, because it does take courage to break free from that imprinting and consider the possibility that maybe there’s another way to look at this, you will be rewarded in ways that you cannot possibly imagine and I know it sounds like “Oh this guy is on drugs or something”, but no, I’m living it and other people are living it too because you need to be willing to accept the situation and then be open to the possibilities because those possibilities will be invisible to you as long as you are attached to only getting your erectile function back.

What do you think need to happen so men can become more comfortable with the idea of screening and treatment?

You know the message is being received but it has to keep going. This discussion, not just between men but between men and their partners and that is just as crucial. The partners need to be very very involved in this, otherwise, it’s going to be much more difficult for men going forward.

"Erectile dysfunction is the biggest concern among men without question. I know men who haven’t gotten themselves tested out of fear that they might lose their erectile function."

This is the way it works, this is the way that fear works. Men are terrified that they are no longer men, men are terrified that we can no longer function in society as a viable man. This B.S. is killing people and if it doesn’t kill them, it destroys the ability to have relationships.

"Cultures are changing and perspectives are shifting and that is a good thing but I think it will take another generation to turn this thing around."

We chip away at this as best as we can, we’re nobody special, we just went through a process where we accepted fully what happened and explored fully what is possible. What was possible was 100 times better than if I didn’t have that problem in the first place.


What Are The Screening Recommendations For Prostate Cancer?


Prostate cancer screening involves the use of a PSA test as well as a rectal examination.

Dr. Robert Mordkin states that “any man who does not have a family history of prostate cancer or is not African American should begin baseline testing at the age of 50. If the test results are normal, these tests should be repeated once every 2 years.”

He adds, that “if a man has a family history of prostate cancer or is African American, earlier and more frequent testing is recommended starting at the age of 40 year of age with a test once every year.”

The American Cancer Society recommends that the following groups who should seek out screening options with their physician include:

  • Men aged 50 years old who are at an average risk of prostate cancer.

  • Men aged 45 years of age who are at high risk of developing prostate cancer including African Americans and men who have a first-degree relative. Examples of a first-degree relative include your father, brother or son who has been diagnosed with prostate cancer under the age of 65.

  • Men aged 40 who are at a higher risk, this is higher risk is defined as those who have more than one first degree relative who has been diagnosed with prostate cancer at a younger age.


Listen To Our Prostate Podcast On Itunes


In our very first podcast, Dr. Robert Mordkin talks you everything you need to know about prostate cancer when it comes to signs, symptoms and screening as well as risk factors, why men might not want to undergo screening and some of the steps that you can take to better know your health and wellbeing.

Click Here To Listen To Our New Podcast!

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What Are The Testing Options For Prostate Cancer?


Dr. Robert Mordkin advises that you should get both a PSA test and a rectal examination as there are a number of variables that may raise your prostate-specific antigen.

As outlined, you should be considering screening at the age of 40 if you are very high risk, 45, if you are classified as high risk and at 50 years of age if you are considered to be at an average level of risk.

When it comes to your testing options, you can visit your physician's office for both blood work and a rectal examination.

With LetsGetChecked, you can take the PSA Test from home. If your PSA returns at an out of range level, our medical team will advise you on next steps.

The Prostate (PSA) test measures and calculates your prostate specific antigen (PSA) levels and helps to detect possible signs of prostate cancer.

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So what exactly is the PSA test measuring?

Prostate Specific Antigen
Protate Specific Antigen or PSA is a protein that is produced in the prostate gland can can be found in the blood.

The LetsGetChecked PSA Test specifically measures:

Total Prostate Specific Antigen (PSA)
Total Prostate Specific Antigen (PSA) refers to the total volume of PSA in the blood. PSA is mainly found in semen but can also be found in small amounts in your blood.

Calculated Prostate Specific Antigen Ratio
Calculated Prostate Specific Antigen (PSA) Ratio refers to the volume of total PSA levels versus free PSA. If you have a high PSA level and a low level of free PSA, you are at a higher risk of being diagnosed with prostate cancer.

Free Prostate Specific Antigen (PSA)
Free Prostate Specific Antigen (PSA) refers to the amount of PSA in the blood that is not bound to other proteins, the level of free PSA is divided by total PSA to obtain the calculated prostate specific antigen ratio.

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PSA testing with LetsGetChecked all happens within one week from the moment you order your test online to the moment your results are delivered to your online personal dashboard.

Regardless of your results, our medical team will call you to offer advice and guidance on your next steps.

Now is the time to know the risks. Now is the time to make healthy changes and now is the time to get screened. With LetsGetChecked, the testing process becomes an easier reality.

Click here to find out more about our testing options.


Read: Do You Have Elevated PSA?


Written by Hannah Kingston, Approved By Dr. Dominic Rowley