Fact: one in six men will develop prostate cancer.
And men should start screening at age 45 to 50.
Here’s what you need to know, according to Dr. Hyung Kim, Chair in the Department of Urology at Cedars-Sinai Medical Center in Los Angeles.
“Prostate cancer is the most common solid tumor in men and the second-most common cause of cancer death in men. Lung cancer is first. Prostate cancer is a distant second.”
The challenge, he says, is that the common PSA (prostate-specific antigen) test doesn't tell you for sure whether you have prostate cancer or not. “If your PSA is elevated, it could be just from benign enlargement that all men undergo as they age, it could be from cancer, or from passing inflammation.”
If you are at high risk, he adds, “you can start screening earlier. High risk is defined as someone of black ancestry, someone with a strong family history of cancer, or someone with what we call a germline mutation.”
The good news, or bad news, depending on your taste, is that the DRE – or digital rectal exam – is now optional. “It's still not a bad test. It's just not a very good test.”
WATCH FOR THESE SYMPTOMS
“An inflamed prostate can be very painful. You can get septic from it and die. Symptoms might include fevers and chills and a drop in blood pressure, but often it may simply be burning with urination or urinary urgency without much actual urine. If you have these symptoms, you should get checked out. There are some studies in mice that suggest inflammation puts you at a higher risk for cancer.”
AFTER AGE SIXTY NINE
“For older men, you could argue that it's best never to discover it and to leave it alone. If the potential benefit of treating it is so low,” Kim says.
“If you take 80-year-old men and biopsy all their prostates, everyone's got prostate cancer. If you live long enough you're going to get it. It’s the disease that most men die with and not die from.”
That said, only 10% of prostate cancers can kill you. So the key is distinguishing a potentially deadly cancer from one that ought to be left alone.”
Why the decision not to screen after age 70?
“At advanced ages, screening and looking for prostate cancer doesn't make sense because you're not going to treat it with surgery and radiation. Both treatments can lead to permanent incontinence and permanent erectile dysfunction – so the treatment can be worse than the disease.”
The worst case scenario is you develop cancer, it spreads, and you die.
If it metastasizes, doctors can treat it with hormone therapy, removing the testosterone from your body which the cancer needs to grow.
“We can control that cancer for 10 years and give you a good quality of life. People on ADT or hormone therapy are living normal lives.”
Therefore he gives a caveat: “if you're 70 years old, and you feel like you have the longevity and the health of a 50 year old? You should be screened.”
A NOTE ON TRT
Dr. Kim has some surprising things to say about testosterone replacement therapy.
“Lowering testosterone can shrink prostate cancer and it's still the mainstay of how we treat prostate cancer. There is some data that suggests that low-T can put you at a higher risk. But once the cancer forms, you know, you’ve got to get rid of the testosterone. That's for sure.”
The New England Journal of Medicine published a definitive study on TRT in 2016 that showed increased testosterone in low-T men increased libido and erectile function improved modestly.
But for men with average T-counts, improvements were not statistically significant over the placebo. Neither in grip or muscle strength, nor in cognitive ability, short or long term memory, executive function, fatigue, or mood.
The downside?
“The testosterone group had a statistically significantly higher risk of atrial fibrillation and PEs [pulmonary embolism]. If you use testosterone, you should know that you are probably at higher risk for PEs and AFib, and may be at a higher risk for heart attacks and strokes, but not in the short term.”
The placebo group had a huge benefit without the risks.
“As a doctor, I have to conclude, if I want to improve someone's vitality, I can give them a placebo and tell them it's testosterone. Then they don't have the side effects of testosterone, and they get a huge benefit to vitality – like a 70% improvement – just from telling someone that they're on T. That’s the data!”
Takeaways:
- Prostate cancer screening can save lives.
- You should get screened if your life expectancy is at least 10 years.
- Testosterone replacement helps with sexual activity and perhaps erectile function. All the other benefits are probably largely a placebo effect, more than anything else.
For more information, and to watch the full interview, go here.
Written by Adam Gilad
Trending Now
Tim Minchin’s Life Lessons: A Blueprint for Thriving in a Complex World: It’s rare these days to hear advice that cuts through the noise. We’re constantly bombarded with messages telling us to “find our purpose” or “live our passion.” Yet here comes Tim Minchin, with all his wit and irreverence, reminding us that maybe we’re looking at life all wrong. His speech, far from the polished, Pinterest-board platitudes of the self-help circuit, is exactly what we need in a world that’s grown obsessed with an endless (and often hollow) quest for meaning. (Ken Rutkowski)
How Leaders Can Tap the Power of Vulnerability: To become a great CEO, one needs a blend of tangible skills like financial acumen and operational management. Additionally, there's a consensus on essential traits such as confidence, resilience, and versatility. However, through numerous leadership discussions over the years, it's evident that many CEOs struggle with integrating a range of softer skills. (Mckinsey)
Longest Hyperloop Vacuum Journey Completed in European Test Facility: In news reminiscent of 2016, a European Hyperloop testing facility has achieved the longest vacuum capsule journey to date. This achievement may advance the once-dormant prospect of high-speed transportation closer to fruition. Elon Musk first proposed the Hyperloop in a 2013 white paper, which calls for magnetic levitation to propel train-like pods through vacuum-sealed tubes at high speeds. (NewAtlas)
