Wednesday, October 29, 2008

CYA and know your PSA

I’m watching my behind these days, because something may be sneaking up on me in a blind spot.

That something could be a problem with my prostate, a walnut-sized gland in my abdomen just below the bladder and in front of the rectum. It helps control urination and helps in sexual activity.

You guys know that gnarly test the doc does with his finger when you have your physical, the one he apologizes for doing? He is checking the prostate, to see if it’s normal size, shape and feel.

At this point, probably half of you guys reading this are feeling a certain puckering reaction and are about to click away. Please don’t. What you don’t know could cost you dearly.

Here’s why it’s important: The odds of men having prostate cancer average 1 in 6. It’s the second-leading cause of cancer deaths in men and the most common kind of male cancer, except for skin cancer. The sooner you catch a problem, the more treatment options you have and the better your odds of beating it.

I had my annual physical the other day, and a test indicated there might be a problem. The test, called PSA, measures the amount of “prostate-specific antigen” in my blood. The PSA test can be done with the blood sample you give for checking your cholesterol, sugar levels and so on.

Like in golf and cholesterol, the lower the score the better when it comes to your PSA. According to the U.S. government’s cancer site, PSA “may be found in higher levels in the blood of men who have prostate cancer, benign prostatic hyperplasia (BPH), infection or inflammation of the prostate.”

BPH is a fancy way of saying the prostate swells. The tube that carries urine runs through the prostate – if the gland is infected, inflamed or starts to swell, it makes urination more difficult. It’s pretty common in older guys.

Normal PSA scores run from 0 to 4, although the docs are looking harder at the higher numbers. If the score starts to rise fairly quickly, as it has for me, the sawbones like to determine how fast it’s going up; they call it PSA acceleration. If it looks like something is putting the pedal to the metal in your posterior, then it’s time for further diagnosis.

After learning about the test around 10 years ago, I had one at my next annual physical so we’d have a baseline – like getting the baseline on how your engine normally performs, so if something goes awry, you have something to measure against. I’ve had one every year since, to see how it’s behaving.

Guys should have PSA tests done fairly early in life, especially if a blood relative had or has prostate cancer, and at least by age 50. Again quoting the government site:

“Several risk factors increase a man’s chances of developing prostate cancer. These factors may be taken into consideration when a doctor recommends screening. Age is the most common risk factor, with nearly 65 percent of prostate cancer cases occurring in men age 65 and older.”

Men who have a father or brother with prostate cancer have a greater chance of developing prostate cancer. African American men have the highest rate of prostate cancer, while Asian and Native American men have the lowest rates. In addition, there is some evidence that a diet higher in fat, especially animal fat, may increase the risk of prostate cancer.

With the possible exception of eating more fat than I should and being much closer to 60 than I like, I don’t have any of those risk factors. So I am cautiously optimistic that the problem will turn out to be some latent infection or inflammation, curable with antibiotics.

But I am not willing to bet my ass on that. So, if further tests are needed – ultrasound, even a biopsy – I’ll beat them to the exam room.

Look for updates here in the days to come.