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What men and women should know but are afraid to ask about prostate cancer (PCa)

If you are a man, this book should be in your home: Walsh, Patrick C., et al. Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer. Fifth edition, Grand Central Publishing, 2023. [Lead author Edward M. Schaeffer]. ISBN: 9781538726860 (paperback) 9781538726877 (ebook)

Did you learn in school that the prostate is a gland that produces fluid included in semen? I didn’t. And did you know that prostate cancer is different from most cancers? It’s sensitive to male hormones—testosterone and its derivatives can fuel its growth. But here’s the surprising part: having normal testosterone levels doesn’t cause PCa, and low testosterone doesn’t prevent it. The relationship is complex, which is why we need to understand it better.

I have several friends and neighbors with varying experiences with PCa. I am using claude.ai and perplexity.ai with Claude to learn about PCa. I am on my 63rd trip around the sun. One in seven men will be diagnosed with PCa. My dad lived to be over 80. He was diagnosed when he was 80. He succumbed to Alzheimer’s disease four years later. Still, with my family history, this cancer hits home for me.

1. EARLY DETECTION IS KEY
- PCa is highly treatable when caught early—over 95% survival rate with early detection.
- Annual PSA blood tests are crucial after age 50 (or 45 if you have a family history).
- Track your PSA trend over time—single readings matter less than changes or steady increases.
- Schedule regular physical exams—PCa often has no symptoms until advanced stages.
- Family history matters: Tell your doctor if your father or brothers had PCa

2. KNOW YOUR NUMBERS
- PSA basics: A PSA level under 4 ng/mL is typically considered normal, but trends are more important than a single number.
- Rising PSA levels don’t always mean cancer; inflammation or infection can also cause increases.
- Digital rectal exam (DRE): It’s quick, important, and nothing to fear—it helps detect abnormalities.
- Biopsy: If needed, biopsies use local anesthetic and take multiple samples to confirm diagnoses.
- Gleason scores: These grade the aggressiveness of cancer (e.g., a score of 6 indicates low aggressiveness).

3. TREATMENT PATHS
- Active surveillance: For low-risk PCa, avoiding overtreatment while monitoring closely.
- Surgery (prostatectomy): Often robotic-assisted now for faster recovery and precision.
- Radiation therapy: Includes external beam radiation or seed implants (brachytherapy).
- Hormone therapy: Mainly used for advanced cases to reduce testosterone levels that fuel cancer growth.
- Treatment choice depends on age, overall health, cancer stage/grade, and personal preferences.
- Second opinions are normal and encouraged.

4. REAL TALK ABOUT RECOVERY
- Most men return to normal activities within weeks after treatment.
- Urinary control improves over time with pelvic floor exercises (Kegel exercises)
- Recovery takes patience; temporary changes are normal during healing.
- Medicare and most insurance plans cover approved treatments and medications.
- Regular intimacy during recovery can improve long-term outcomes.
- Sexual function can often be restored through medications or other therapies:
- Pills like sildenafil (Viagra) are one option among many.
- Quick-acting treatments for intimacy are available if needed.
- Modern treatments have high success rates—over 85% of men regain function.

5. PARTNERSHIP THROUGH TREATMENT
- Open communication with your wife is crucial during treatment and recovery.
- Physical intimacy can continue with adaptations as needed—many couples report satisfying intimate lives post-treatment.
- Support groups provide emotional strength for both patients and wives: local resources include Us TOO support groups and other community networks.

Let’s build a stronger support network in our community. Too often, men stay silent about PCa—it doesn’t have to be that way.

Useful Websites:
- Prostate Cancer Foundation (pcf.org)
- Us TOO support groups
- National Cancer Institute prostate cancer information

Based on handout tbcm0107a2 v2 by Sparky