Q. I’m 53 years old and have been a T9 para for 15 years. I’ve read that, around age 50 men should start getting checked for prostate cancer. None of my physicians has mentioned this to me. Do the same prostate cancer screening guidelines apply for men with spinal cord injury as for able-bodied men?
A. Good question, Dave. The short answer is yes, the same guidelines should apply. According to the American Cancer Society, prostate cancer is one of the most common forms of cancer among American men — approximately 40,000 die from the disease each year. When it comes to screening men with SCI for prostate cancer, doctors often forget about us. One reason for this may be that prostate cancer usually strikes older men. The older you get the greater your chances of getting it — studies show that by age 75, between 50 percent and 75 percent of men have it. Until recently, people with SCI didn’t live long enough for prostate cancer to be much of a concern. In addition, SCI usually hands us so many other health issues to juggle, getting screened for the disease doesn’t make our list of concerns, or our doctor’s. But it should.
A PubMed search of prostate cancer and SCI turned up page after page of recent studies on the subject. The studies agree, now that life expectancy with SCI is about on par with that of nondisabled men, the chances of a person with SCI developing prostate cancer is about on par as well, and we should be following regular screening guidelines.
Getting screened for prostate cancer involves a simple and inexpensive blood test called a PSA test — for prostate-specific antigen. PSA is a protein produced in the prostate gland and is found in the blood. PSA numbers are like golf scores, the lower the better. According to journal articles, a PSA below 2.5 is good, between 2.5 and 4 means you are in a gray area. If your PSA gets above 4, your doctor may want to discuss doing a prostate biopsy — prostate tissue is removed with a needle and examined under a microscope to determine if it is cancerous.
According to the National Cancer Institute, regular PSA testing detects 90 percent of prostate cancers in early, localized stages — when they are likely to be curable by the least invasive methods. The American Urologic Association, American Cancer Society and National Comprehensive Cancer Network recommend that all men over age 50 have an annual PSA test. Guidelines say some men should get PSA tests even earlier. Since prostate cancer is genetically linked, having a brother or father that developed prostate cancer before age 60 increases your prostate cancer risk. In addition, studies show the disease is more common in African American men. It is recommended you start getting annual PSA tests between ages 40 and 45 if you are in one of these groups.
A raised PSA does not automatically mean prostate cancer — it is just an indicator that something is going on in the prostate. Factors that can raise PSA levels include UTIs, prostatitis (a prostate infection), and benign prostatic hypertrophy (an enlarged prostate). Also, several studies showed that men using indwelling catheters for bladder management will likely show a higher PSA — something to communicate to your physician so they can get a baseline PSA and monitor it from there.
Multiple studies have found that men with complete SCI at levels of T10 or above have slightly lower PSA levels and may have a slightly lower chance of developing prostate cancer than nondisabled men. The lower PSA levels may stem from impaired nerve supply to the prostate, although no studies have been done to investigate this theory. The studies caution that despite of this, prostate cancer can and does happen in people with SCI levels above T10, so we should follow the same PSA screening guidelines as everybody else.
Prostate cancer, when caught early has a very high cure rate and can often be treated with minimally invasive procedures. If caught at a later stage, it can spread beyond the prostate, become very difficult to treat, and can be fatal. The bottom line: If you are over 50 (or 40-45 if you are African American or have a brother of father with prostate cancer) it is a good idea to discuss a PSA test during the next visit to your primary care physician or urologist.
The Importance of Communication
When talking with your doctor, communication and understanding of the message is vital. An important part of good communication is a “feedback loop,” which means saying, “Here is what I think you just told me (asked me); am I right?”
I was reminded of the importance of this when I attempted to answer the following e-mail — without fully understanding the question.
Q. I’m a C5-6 quad. I can’t cath myself in the chair due to access and limited hand function. Any solutions out there?
A. To answer Bart’s question I started searching bladder management options for him to discuss with his urologist. I looked up options like ways to allow him to “free drain into an external catheter and leg bag,” Foley catheters, and even surgical options like a suprapubic catheter. Before I was finished, Bart e-mailed back with a simple solution: “I found these pants online and I think they will solve my problem. Wheelchair Trousers with a Drop Front. They have a Velcro ‘drop front’ that I can easily open and close that will give me the access I need to cath with my limited hand function.”
The pants are available at Able2Wear Ltd. (based in the UK): www.able2wear.co.uk.
Bart’s question and his logical follow-up answer made me wonder what “could” have happened if he had posed this question to his urologist, without feedback on both sides. A good reminder for all of us to provide feedback in order to make sure communication with our physicians is fully understood.