Prostate Disease

Are there official guidelines for prostate cancer screening?

DEAR DOCTOR K: I've heard so many conflicting opinions about whether or not to get screened for prostate cancer. Are there official guidelines? What do they recommend?

DEAR READER: To say that prostate cancer screening has been controversial is an understatement. I spoke to my colleague Dr. Marc Garnick, clinical professor of medicine at Harvard Medical School, to hear his thoughts. The two ways to screen for prostate cancer are the digital rectal exam (DRE) and the prostate-specific antigen (PSA) blood test.

Why delay treatment for slow-growing prostate cancer?

DEAR DOCTOR K: I was recently diagnosed with prostate cancer. My doctor says my cancer is slow-growing and that we should just monitor it for now. Why not treat it right away?

DEAR READER: I know this will sound odd, but cancer is not always bad for your health. There are types of cancer that can cause no symptoms, that grow slowly (if at all) and that are unlikely to spread. There are types of cancer that you will never know you had. You will die with these cancers, but you won't die from them.

Does eating fish help prevent prostate cancer?

DEAR DOCTOR K: Does eating fish help prevent prostate cancer?

DEAR READER: You've certainly heard me encourage readers to eat plenty of fish, particularly fatty fish such as salmon and mackerel. That's because many good studies have found that people who eat fish frequently have lower rates of many serious diseases, including heart disease and several types of cancer. A recently published study from the Prostate Cancer Prevention Trial (PCPT) was described in the media as coming to the opposite conclusion. I don't agree, but to explain why, I first need to talk about the substances in fish that are thought to be beneficial for humans.

I was diagnosed with prostate cancer and now my doctor wants an MRI– what new information will the MRI provide?

DEAR DOCTOR K: I recently had a prostate biopsy and was diagnosed with prostate cancer. Now my doctor wants to do an MRI. Why? What new information will the MRI provide?

DEAR READER: I can understand why you're puzzled. A biopsy is the gold standard for diagnosing prostate cancer, so why do you need any other test?

I have elevated PSA levels and am scheduled for a prostate biopsy — what can I expect?

DEAR DOCTOR K: I recently had a PSA test and my levels came back elevated. I'm scheduled to have a prostate biopsy. What can I expect?

DEAR READER: The prostate-specific antigen (PSA) blood test is a screening test designed to detect prostate cancer before symptoms develop. An elevated PSA value can suggest that cancer may be present. But only a prostate biopsy can confirm the actual presence of cancer.

Urinary symptom score

This urinary symptom score from the American Urological Association helps to evaluate the severity of your benign prostatic hyperplasia (BPH) and determine what treatment, if any, might be best for you.

Do I need to seek treatment for benign prostatic hyperplasia?

DEAR DOCTOR K: I have BPH. I have some urinary symptoms, but because I work from home they're not difficult to manage. Is there any danger in not actively treating my condition?

DEAR READER: Benign prostatic hyperplasia, or BPH, is the most common cause of prostate enlargement. As the name suggests, BPH is harmless; it does not lead to prostate cancer. Up to two-thirds of men with BPH never develop any symptoms. Others find that BPH can make life miserable. You seem to be somewhere in between.