Prostate Disease (Part Three)
Dr Vernon Coleman
Prostate cancer can develop for several years without any symptoms developing. But the early signs may be similar to the early signs of ordinary prostate enlargement: discomfort or pain on passing urine or having to get up at night to pass urine.
A decade or so ago the only way to test for prostate cancer was for a doctor to put a finger into a man’s anus and feel the prostate with a finger. This test was and is known as a Digital Rectal Examination (DRE). The examining doctor would be worried if the prostate felt large, uneven or unusually hard.
These days doctors sometimes regard DRE as primitive, old-fashioned, out-dated and rather hit and miss – and unlikely to pick up anything other than a well-developed cancer that may be too late for treatment.
The modern way of checking for prostate cancer is to perform a Prostatic Specific Antigen (PSA) blood test. This test measures the amount of a substance produced both by normal prostate tissue and by cancerous tissue. When the prostate is healthy the level is low – but when there is cancer within the prostate the level rises. Ultrasound imaging can be done to check the shape and size of any prostate cancer tumour.
There is still much doubt about whether or not screening for prostate cancer is worthwhile. Those in favour claim that regular PSA tests can pick up the disease early – when it is easier to treat. Those against claim that the test isn’t all that reliable (it is possible for the PSA result to be high and there to be no cancer present) and that the test is just another example of unnecessary ‘high tech’ medicine which may result in the over-treatment of men who may have prostate cancer but for whom treatment may be neither necessary or appropriate. Approximately two thirds of men undergoing biopsy because of an elevated PSA are not found to have prostate cancer at all. Whether the anxiety, and additional hazards of being further investigated make PSA testing worthwhile is debatable. (It is also possible that a man might have a negative PSA test and yet have prostate cancer. False reassurance can be a major killer since a negative PSA test can encourage both a patient and his doctors to ignore other symptoms.) One of the test’s most enthusiastic, and eminent, medical supporters claims that: ‘I believe that a decision to be screened would increase my chance of being diagnosed... and the diagnosis would come five to eight years earlier.’ But, and it’s a big ‘but’, he admits that: ‘There is no good evidence that the greater likelihood of knowing, and knowing sooner, would reduce my chances of a prostate cancer death.’
PSA tests are now regularly performed on American men – a fact which probably explains why the incidence of the disease is increasing so rapidly in the USA – but there is still some doubt about whether having annual PSA tests makes any difference to life expectancy. (In just the same way that there is real doubt about the value of breast and cervical screening programmes).
Elsewhere, PSA testing is not routinely offered on the grounds that: ‘screening would undoubtedly lead to some men (with indolent disease) suffering from impotence, incontinence and even death, who would not have done so had screening not been introduced.’ It is possible that PSA testing may do more harm than good.
NOTE
The condensed essay above is taken from the book `How to conquer health problems between ages 50 and 120’ by Dr Vernon Coleman and Donna Antoinette Coleman. For details of how to purchase a copy of this book (which contains information about scores of disorders affecting those between ages 50 and 120) please CLICK HERE
Copyright Vernon Coleman and Donna Antoinette Coleman July 2025
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