What you need to know:
- Prostate cancer is the second leading male cancer worldwide and the first in the United States.
- PSA (prostate specific antigen) screening is done by a simple blood test.
- Men over 50 should make an informed decision whether to get tested or not.
- Benefits of PSA testing include lower risk of death from prostate cancer.
- False positives are common in PSA testing, leading to unnecessary procedures and stress.
- Men who belong to prostate cancer risk groups should consider getting a PSA test.
- Prostate surgery may lead to sexual complications, including difficulties with orgasms and ED.
- Erectile dysfunction after prostate surgery is best treated with sildenafil.
Prostate Cancer Is Very Common Worldwide
Prostate cancer is the leading cancer for men in the United States and the second most common male cancer worldwide. According to the American Cancer Society, 1 in 8 men will hear the diagnosis of prostate cancer in his lifetime. In 2018 there were 1.3 million new cases globally.
While this cancer is highly treatable when detected early, the treatment itself has many side effects. For example, erectile dysfunction after prostate surgery is very common. With such high prevalence of the disease, prevention and screening are key healthcare components.
What is PSA testing
PSA stands for prostate-specific antigen, a protein found in blood. All men have some level of this substance in their bodies, but high PSA may suggest prostate cancer or another problem. It’s normal for PSA levels to rise with age, but when tests reveal a significant increase, this could indicate a health issue.
To do the PSA test, you need to have your blood drawn in the lab. You should abstain from sexual activity leading to ejaculation within 48 hours before the exam. Usually, test results come back in a week.
Benefits of PSA testing
There is an ongoing medical discussion whether all men over 50 should be screened for prostate cancer. U.S. Preventive Services Task Force recommends men aged 55-69 to make an informed decision, balancing the possible benefits and disadvantages.
PSA testing has many benefits:
- It is inexpensive.
- It can help detect non-cancerous prostate issues that need to be monitored or managed.
- Screening helps prevent some prostate-cancer-related deaths.
- With the advances in diagnostics, doctors can make more patient-specific decisions on further tests and treatment This means men nowadays can often avoid an unnecessary biopsy or even surgery.
Controversies Surrounding PSA Testing
Before deciding whether to have your PSA tested, it’s good to know the controversies surrounding the topic.
- False positives are common. There are many factors that can affect the result, for example, urinary tract infection or taking certain medicines. One European study revealed that 20% of men screened regularly for prostate cancer had at least one false positive.
- Since the tests do not say whether the increase in PSA means cancer or something else, doctors tend to order more tests to determine the best course of action. This can lead to high costs and stress for the patient. Invasive procedures, such as biopsy, have their own side effects that need to be considered.
- Overdiagnosis leads to unnecessary procedures that can seriously impact quality of life. Some men have prostate surgery even if their cancer would not have developed in a life-threatening way. These men must deal with the negative consequences of treatment, such as erectile dysfunction after prostate surgery, incontinence, or irritable bowel syndrome.
- The psychological burden of false positives, invasive testing, and treatments can be very high, leading to anxiety, chronic stress, or depression.
Who Should Get Tested?
The best advice for all men is to talk to your primary care provider before making a decision. There are, however, specific cases where PSA screening is advisable.
- If you are over age 70. Your cancer risk goes up with age. Most men are diagnosed at the age of 50 or over. But keep in mind that your PSA levels will be naturally elevated at this stage, so a risk of a false positive is high. Official guidance is against routine screening for men over 70.
- If you belong to the group of non-Hispanic black men, you are also at a higher risk of prostate cancer. Scientists don’t really understand why.
- If you have a family history of prostate cancer, you may be at a higher risk too. Your doctor may recommend genetic testing to know more.
- If your diet is rich in animal fats and you avoid eating veggies, you may be in the high-risk group.
Dealing With Erectile Dysfunction After Prostate Surgery
Some men are so afraid of the negative consequences of prostate removal that they choose not to do PSA screening. They worry the treatment will put an end to a satisfying sex life. This is not the best way to approach this decision.
While prostate cancer treatments, especially surgery and radiation, can lead to complications, these can be managed, and you can enjoy sex afterward. Most common questions men ask concern orgasms and erections after prostate surgery. Here’s what you need to know:
- It is possible to have orgasms after prostate surgery, though some men say pleasure feels different. Note that it may take some time to get the old sensations back. Other patients need to discover new ways to enjoy sex again. There is an array of sex toys that can help with that. Interestingly, the removal of the prostate gland results in orgasms without ejaculation.
- Erectile dysfunction after prostate surgery is a very common complication. For some patients, the ability to get hard returns within a few months to a year. For others, ED may be permanent because of nerve damage.
- It is important to know that erectile dysfunction after prostate surgery can be managed in a variety of ways. Even men with serious and long-lasting problems can have intercourse using penis pumps or with implants.
- For most men, the use of ED medication is the first-line treatment. A 2021 meta-analysis proved sildenafil (the active ingredient of Viagra) to be the most effective treatment for erectile difficulties in prostate cancer survivors.
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