Patients with prostate cancer come to their doctors with all kinds of wrong notions. Here are 3 of the most frequent misconceptions:
#1: Big Prostates are Bad
All problems related to the urinary system seem to get blamed on prostate enlargement. This can’t be true because men with small prostate glands also complain of going to the bathroom too frequently. Even women suffer these problems and they have no prostate at all.
An increased urge to urinate is normal as people get older. Why? It is a protective mechanism. Remember, most bodily urges and sensations grow weaker with age. Eyesight dims, libido fails, hearing diminishes. If the urge to urinate disappears, kidney failure results.
This is not to say that the increasing urge to urinate, as people get older, is convenient. No, it can be a real problem, especially when it disrupts sleep. However, it is just not accurate to place all the blame on prostate enlargement. From a cancer perspective, there is one advantage to having a big prostate gland. Several studies show that larger prostate glands generate lower grade cancers, have less extracapsular spread and experience lower cancer recurrence rates, after treatment, than small prostate glands.
Having a big prostate gland is not always good; there are indeed some men with big prostate glands who suffer urinary blockage symptoms. However, men with enlarged prostates can at least be thankful that their enlarged gland has some protective effect against prostate cancer.
#2: Prostate Cancer Causes Symptoms
Throughout history, men only visited doctors when some part of their bodies hurt or malfunctioned. But prostate cancer doesn’t cause any symptoms at all until it becomes very advanced. This is not to say that men can’t have symptoms coming from the area of the prostate due to other things like urinary tract infections or sexually transmitted diseases. But symptoms from cancer such as bone pain, changes in urination, and pelvic pain only occur with very advanced disease, when cancer spreads outside the gland. As long as men do appropriate annual screening with PSA, cancer will almost invariably be diagnosed long before it is capable of causing symptoms.
#3: PSA Comes from Prostate Cancer
Some PSA may come from prostate cancer, but it is mostly produced by the prostate gland. Benign enlargement of the gland occurs as men age, causing the PSA to rise. Another noncancerous cause for high PSA is prostate inflammation, called prostatitis. Therefore, using PSA alone to diagnose cancer is very imprecise, especially if the PSA is under 10.
This is not to say that PSA is useless. As noted above there are no symptoms from prostate cancer in its initial stages. So, a high PSA only indicates that something is going on with the prostate. It is a totally false assumption to simply conclude that a rise in PSA signals cancer. Men who have a high PSA should repeat the test. If it continues to be elevated they should further investigate the possibility of prostate cancer by getting a three Tesla multiparametric MRI, not a random biopsy.