Facing New Medical Issues at 50

I just turned 50 a month ago. There are a host of issues surrounding this milestone, but since I work at the Cancer Center at , there are two issues in particular that confront me in a special way, both having to do with early detection.

The first: prostate cancer detection. African-American men should actually begin screening for prostate cancer at 40, as should any man with a close family history (father, brother) of prostate cancer. The rest of us can wait until 50. Unfortunately, when I turned 40, I was seeing a very young and very aggressive family physician who decided I shouldn't wait.  And herein lies the issue–without being too blunt–that prevents many men from regular prostate cancer screening: the PSA blood test is not enough. You have to get a DRE.

PSA stands for "prostate-specific antigen," a protein found floating in your blood that should be present only in minute quantities. An increase in the level of PSA may signal the presence of prostate cancer or it might point to something more benign; specifically, BPH (benign prostatic hypertrophy) or enlarged prostate.

(By now you discovered the penchant among medical professionals to speak in alphabets. Some folks think they do that to show off, but I think it's because they have the same trouble the rest of us do trying to pronounce those seven-syllable words with extra consonants).

Speaking of acronyms, I haven't told you yet what DRE stands for. In general, your doctor won't either, until it's too late, and you're facing the wall with your hands against the exam table and your pants at your ankles. When the doctor told me she was going to perform a digital rectal exam, I was excited, being somewhat of a techno-nerd and mistakingly believing that medical science had invented some sort of computer that scans your derriere with painless x-rays or ultrasound waves.  That's when I learned, the hard way, that "digit" is another word for "finger."

Which led me to my first discovery about the difference between male and female doctors; and that is, women tend to have thinner fingers (as I discovered when my female doctor left the practice and was replaced by a male with some pretty fat fingers).

As I said, a complete prostate screening requires both the PSA blood test and the DRE. What the doctor is feeling for (no, not your tonsils, though it might feel that way to you) is if your prostate gland–which is supposed to be about the size of a walnut–is enlarged or lumpy or hard and dense. These findings, together with the amount of PSA in your blood, will alert your physician as to whether you should get checked out further by an urologist.

You might have read or heard in the news media that a PSA level of four is normal. That's not completely correct. You can have a PSA less than four and still have prostate cancer.  Conversely, you can have a PSA greater than four and NOT have cancer. Your doctor may want to do a series of two or three PSA readings over a few months to see if the level is changing quickly over time (how quickly the PSA level rises is known among doctors as "PSA velocity." What they haven't begun calling it PSA-V I can't say).

The important thing is not to panic if you do get an elevated PSA, but to do what your doctor tells you to do to follow up on your screening.  The other important thing, men, is that you don't avoid getting screened in the first place.

My first time, I came home and whined to my wife about feeling violated. Heck, I didn't even get flowers, or chocolates. My wife showed me no sympathy. "Take it like a woman!" she said, followed by, "Welcome to my world. What do you think the gynecologist does to me? You think we're taking a walk in the park?" 

Nothing like a loving wife to make you "man up."

Remember, REAL MEN DO get their prostates checked.

Next time I'll talk to you about the other probing medical issue that arises at age 50, and this one is for the boys and the girls: colonoscopy.