Movember 30th + 1

At last! After a long month of enduring quizzical glances, sceptical standardized patients, and amused upper-years poking fun, Movember is now over!

My apologies to those who said they liked the ’stache: your opinion has been vetoed… by me. The mo’ is gone! Gone, gone, gone. 

I’m delighted to report that Movember was a huge success!! Our class raised a grand total of more than $5800, which is nearly double our predecessors’ success from last year.

Special thanks from me goes to Lukas, who made a completely unexpected but massive donation in the last throes of the competition!! Thanks Lukas! Also, thank you so much to EVERYONE who donated and contributed towards this month! Your money is going to a great cause, and you got to completely embarrass a friend out of the deal, so I’m sure that it was well worth it!

The whole point of Movember was to learn something about men’s health and, specifically, prostate disease. In case you missed them, here’s what we were talking about:

• Do You Know Where Your Prostate Is At?
• Benign Prostatic Hyperplasia
• Prostate Cancer

Here’s the final entry to the Photo Diary,

Photo Diary:

Movember 30 + 1: The final product in all its terror.	Movember 30 + 1: Here’s what I could have looked like this month! Wow, am I ever glad you convinced me to do the handlebars!	Movember 30 + 1: Yes! Finally myself again!

Prostate Cancer

Like other forms, cancer of the prostate occurs when there are sufficient genetic mutations to a clone of cells within the prostate that allow them to proliferate uncontrollably. By definition, cancers are invasive to the surrounding tissue and have the potential to spread to other sites of the body through the bloodstream. It’s the secondary tumours, or metastases, that are created when this happens that make untreated prostate cancer lethal.

The good news, is that as long as a prostate cancer is detected early enough, it can be cured 90% of the time. Treatment may require surgical resection of the tumour, radiation therapy, and/or chemotherapy. No doubt it would be a very difficult treatment to undergo, but fortunately the cure rate is very high.

Clearly then, one of the biggest concerns with prostate cancer is its detection. The longer a cancer goes unchecked, the more opportunity it has to metastasize to another location and eventually progress beyond rescue. In contrast, the earlier it is detected the better the chances are for being cured.

Once over the age of 50, men are routinely screened for prostate cancer. There are two tests in general use: the infamous Digital Rectal Exam (DRE), and a blood assay for Prostate Specific Antigen (PSA). PSA is a protein enzyme produced by the prostate whose levels usually rise due to prostate cancer. An increase in PSA can be detected from a blood sample, and is fairly sensitive in screening for the presence of prostate cancer. One caveat, is that you generally want a baseline PSA amount to compare to. In other words, to detect whether levels of PSA have increased, you first need to know what the normal levels are, and these may vary from person to person. 

One final note, is that there is some controversy over screening for prostate cancer. Certainly it can be proven that many more men have been diagnosed and treated for prostate cancer since the establishment of routine screening programs. But did treatment actually make a clinical difference for these men? Prostate cancer is slow-growing, and the screening tests are sensitive enough to detect it before any symptoms are felt by the patient. Would these men, who then received aggressive treatment, ever have shown symptoms? It is possible that they could have lived out the rest of their life, never affected by the cancer. We cannot know for sure.

Benign Prostatic Hyperplasia

Benign Prostatic Hyperplasia (BHP) is incredibly common. My pathology textbook says that BHP is found in:

• 20% of 40-year-old men
• 60% of 60-year-old men
• 90% of 70-year-old men

Consider those rates of incidence carefully. How old are you? How old is your father? What are the odds that someone you know has BHP?

Accordingly, when was the last time that you heard anything about BHP? If you’re anything like me before I came to medical school, you may have never heard of it. Subjectively then, it’s easy to appreciate that men’s health issues are under-discussed, and need more attention.

BHP is non-cancerous enlargement of the prostate gland. Compare the pictures below:

The left shows a normal prostate. The right is a prostate with BHP. If you recall the normal prostate anatomy that was discussed in an earlier post, you’ll remember that the urethra travels directly through the prostate gland, carrying urine from the bladder to the exterior. When the prostate becomes enlarged in BHP, the urethra can become compressed and narrowed.

The symptoms of BHP are exactly what you might expect for a narrowed urethra: difficulty voiding, slow stream, frequency of voiding, nocturia (needing to wake up in the night to void), and urgency. There can also be an increased risk for bladder infections.

BHP is treated in a few different ways, depending on the severity:

• Lifestyle changes: reducing fluid intake (particularly before bedtime), developing a voiding schedule, and avoiding diuretics like coffee and alcohol.
• Medication: some drugs can relax the smooth muscle of the bladder and urethra for some relief of symptoms
• Surgery: removal of the prostate and reconstruction of the urethra will permanently relieve BHP. But it comes at a cost: the vas deferens joins with the urethra in the prostate, and so men undergoing this surgery will be rendered infertile.

There’s good evidence to suggest that BHP is induced by androgens (male hormones) like testosterone. Androgens bind to receptors in the prostate gland, signalling it to grow and expand. It’s a signalling/response process that takes a long time, hence why the incidence of BHP increases with age, and why most men will get BHP if they live long enough.

Do You Know Where Your Prostate is At?

As Movember is already a few days underway, I’m starting a series of posts to learn about men’s health issues. In case you’re just joining the bandwagon: find out about Movember, read how I decided to participate, and if you are able, please donate! Thank you so much to those of you who have already donated!!

Before we start talking about prostate cancer, prostate hyperplasia, or anything else, you’ve got to ask yourself: do you know where your prostate is at?

If you happen to be a woman, then don’t worry too much about it because you don’t have one! The prostate is a male-only organ located within the pelvis. Have a look at the diagram above of a normal prostate. Try to identify the following anatomical relationships:

• Centrally in the picture: the prostate
• Above the prostate: the urinary bladder
• Below: the pelvic diaphragm, which divides the pelvis from the perineum
• Anterior (left-side of the picture): the pubic bone – part of the bony pelvis
• Posterior (right-side of the picture): the rectum
• Running straight through the prostate: the urethra

That last bullet point is crucial! The urethra is a tube that conducts urine and semen to the exterior. Before passing through the penis, it first travels straight through the prostate gland. We’ll see in a future post how this arrangement means that prostate disease can have detrimental effects on urination.

A healthy prostate functions to produce fluid secretions for the semen. Sperm that are secreted with prostatic fluid are more mobile and survive longer, illustrating the importance of the prostate to fertility.