Prostate Cancer

According to the American Cancer Society’s 2010 estimates, 1 out of 6 men in the United States will be diagnosed with prostate cancer at some point in their lives, and 1 out of 36 men will die from it. The more you know about your health, the more you can do to take care of yourself.

What Is Cancer?

The cells in our bodies are usually programmed to break down and be replaced by new cells after a certain period through a process called apoptosis. Cancer cells, however, don’t break down but continue to reproduce, forming a tumor. Over time, they can hinder the function of the organ they’re part of and sometimes, they spread to other organs and affect them too. This is called metastasis.

Prostate cancer usually causes few symptoms in and of itself. In fact, it’s common for medical examiners to discover that a man had prostate cancer, but died from an entirely different reason. He might not have even known about it. If cancer symptoms do occur, they may include:

  • Frequent or urgent need to urinate, difficulty in passing urine, interrupted or weakened flow of urine, dribbling afterward
  • Pain during urination or ejaculation
  • Blood in the urine or semen
  • Pain or stiffness in the lower back, pelvis, hips, or thighs
  • Partial erections or impotence
  • Decreased quantity of semen during ejaculation

But by the time these happen, the cancer is usually advanced and may have spread to other organs.

What Causes Prostate Cancer?

As with many other kinds of cancer, we don’t yet really know what causes it. While some experts believe that testosterone is one factor, the fact that many men with low testosterone levels still develop deadly prostate cancers calls this into question. Further, since prostate cancer rates increase at about the same time in men’s lives that testosterone declines, it seems likely that other factors are at play.

There are some risk factors that are important to know about:

  • Being more than 50 years old, with increasing risk as you age (about two-thirds of cases are diagnosed in men over 65)
  • Having relatives who have had prostate cancer
  • African-American men are at increased risk when compared to other ethnicities in the US
  • Nationality/geography (some countries have higher rates than others) and diet may also play a part in increased risk

Cancer Screening and the PSA Test Controversy

Since prostate cancer is usually symptom-free, the only way to know if you have it is to get tested. Two tests are currently available. First, a doctor may check the prostate with their fingers to see if there are lumps that might be tumors. This is called a digital rectal exam. Second, a doctor may take a blood sample and test for prostate specific antigen (PSA). This is called a PSA test. Since PSA levels vary from person to person, as well as over time, the purpose of the test is to look for a sharp increase in PSA, which might indicate cancer.

If you’re scheduled for a PSA test, many doctors suggest that you refrain from ejaculation and prostate massage for 48 hours before the test since they may temporarily increase your PSA levels and make it look like you have cancer growth when in fact you may not.

However, there is currently a lot of disagreement over the value and reliability of the PSA test. The U.S. Preventive Services Task Force recently recommended against use of the test, saying it may do more harm than good. That’s because recent studies suggest that men who have prostate cancer detected through screening don’t necessarily live any longer than those who have it detected by rectal exam, or even those who do no screening at all.

On top of that, many prostate cancers grow very slowly and might never cause trouble during a man’s lifetime. The PSA test can’t tell which cancers will or won’t be deadly, so many men are treated unnecessarily or earlier than necessary. That might not seem like a big deal in the face of avoiding death, but the effects of prostate cancer treatment can significantly reduce quality of life: incontinence, erectile dysfunction, plus the extreme psychological stress and financial burden of surgery or other treatments.

Because of this controversy, many medical professionals recommend that men talk with their doctors about the possible benefits of screening and decide for themselves whether or not they will pursue it.

Prostate Cancer Treatment

If prostate cancer is in its early stages, many men decide to follow a course of watchful waiting or active surveillance. (Some people use these terms interchangeably while others consider active surveillance to be a more vigilant approach.) This might include regular blood tests and prostate exams, as well as repeated biopsies of the prostate.

If cancer is diagnosed and it is still limited to the prostate, the most common treatments are radical prostatectomy (removing the gland) and radiation therapy. If the cancer has spread, the focus of treatment shifts to slowing its growth and minimizing symptoms.

Sexual Effects of Prostate Cancer Treatment

Different treatment options can have different effects. Many men who have had a prostatectomy report that orgasm feels less pleasurable. Also, some report a decrease in sensation during anal penetration, though they still enjoy being penetrated.

Since the nerves that control the bladder and trigger erections are sometimes damaged during prostatectomy, incontinence and erectile dysfunction can occur. In many cases, these improve over time, but not always.

Radiation therapy, especially external beam therapy, can irritate the rectum, causing diarrhea, rectal bleeding, and discomfort. These symptoms usually disappear after the end of treatment, but in the meantime, anal penetration is probably off the menu. In rare cases, the symptoms may persist.

Another effect of prostate cancer treatment dry orgasms (no fluid is ejaculated). And in some cases, the penis may decrease in length, as well.

Where to Go for More Information

Although most resources for prostate cancer don’t address the sexual effects, there are some excellent guides out there. The American Cancer Society offers Sexuality for the Man with Cancer for free on their website. While it covers many different kinds of cancer and treatments, their information on prostate cancer is extensive. Dr. Anne Katz is the author of Man Cancer Sex, one of the most useful guides on the topic for men and their partners. Also, A Gay Man’s Guide to Prostate Cancer gives particular attention to issues related to queer men.