This year marks the 10th anniversary of the Movember phenomenon, aka the Movember Foundation's annual call-to-action for men to grow out their staches in an effort to increase awareness of men's health problems. In the foundation's words, it aims to "change the face of men's health" and for a decade, a major cornerstone of the campaign has been to promote screenings for prostate cancer.
Recently, other efforts have joined the Movember Foundation to raise public awareness of life-threatening men's health issues. In an October campaign by Save the Males, Dr. Drew Pinsky helped spread the message that one in eight men in the United States will eventually receive a diagnosis of prostate cancer. This year alone, the American Cancer Society estimates around 161,360 new cases of prostate cancer and about 26,730 deaths as a result.
For many men, the thought of going to the doctor to get tested for the disease makes them understandably queasy. So we enlisted Playboy sexologist Dr. Debra W. Soh to provide you with a handy FYI on all you need to know, from risk factors to the exam itself to how treatment of the disease can affect your sex life.
FACTORS THAT CAN INCREASE YOUR RISK
The prostate gland is located below the bladder and in front of the rectum. It is responsible for producing most of the fluid that makes up semen. It’s roughly the size of a walnut and grows larger with age.
Prostate cancer is the result of cells in the gland growing uncontrollably due to changes in their DNA. Factors that increase your risk of having the disease include older age and having a diet high in red meat or dairy. Family history also plays an important role—having a first-degree male relative, like a father or brother, with prostate cancer more than doubles your risk of developing it.
To lower your risk, the American Cancer Society recommends leading an active lifestyle, maintaining a healthy weight and eating at least two and a half cups of fruits and veggies everyday.
SIGNS TO WATCH FOR
Erik Wibowo, PhD, a prostate cancer and sexuality researcher at the University of British Columbia in Canada, tells me that early-stage prostate cancer often doesn’t have any symptoms. “As the tumor [...] grows, men may experience some difficulty urinating with a weak stream, or frequent urgency in urinating associated with difficulty emptying their bladder.”
In advanced-stage prostate cancer, however, men may begin to experience pain, particularly if the cancer has spread. This is due to tumors compressing the nerves in other parts of our body—“for example,” Dr. Wibowo says, “in the spinal cord or bone.”
THE 411 ON WHAT TO EXPECT DURING THE EXAM
There are several kinds of tests your doctor may perform. The digital rectal examination (DRE) is the one you’re probably the most aware of. For this test, the doctor is interested in feeling your prostate gland. A healthy prostate should feel soft, smooth and even, and your doctor will try to feel for any hardness, lumps or irregularities, which would be considered abnormal.
Because the prostate sits in front of the rectum, it can be felt through the rectum wall. (Here’s a nice illustration to help you picture what I’m talking about.)
Prostate-specific antigen (PSA) is a protein that cells in the prostate produce, and the PSA test measures the amount of it in a man’s blood. This is because men with prostate cancer have been shown to have higher levels of it.
Within the field, there is a highly polarized debate currently going on as to whether PSA testing should continue being done. In 2012, the US Preventive Services Task Force recommended against PSA screening, with the goal of avoiding unnecessary biopsies and tumor treatment in patients, as clinical trial data had suggested they were being over-used in men with low-grade prostate cancer.
As well, some men find living with a treatable disease stressful—not to mention the fact that it’s cancer. However, many urologists and men who have been treated for the disease argue that the test’s pros outweigh its cons, and men’s attitudes around living with the disease will likely change as they see fewer men dying of prostate cancer and rates of “active surveillance” going up (which I discuss below).
Both the DRE and PSA test are used as part of screening measures, but in order to confirm a positive diagnosis, a biopsy must be performed, in which small samples of prostate tissue are removed for examination.
Regarding how often you should undergo these tests, Dr. Wibowo suggests that men should begin discussing the topic of prostate cancer with their physician by the age of 50, and earlier than that if they have a family history of the disease.
WHAT HAPPENS IF YOU HAVE A POSITIVE TEST
Having a test come back positive is a stressful event, but isn’t necessarily a reason to panic. Prostate cancer that is growing slowly is considered to be low-risk, and for some men, it doesn’t warrant treatment for many years, if at all.
In this case, instead of beginning aggressive treatment, a doctor might recommend that a man go on what’s called “active surveillance,” which consists of regular DRE’s and close monitoring of PSA levels (the protein I mentioned earlier). If the doctor notices changes from either of these tests, follow-up biopsies may be performed. In some cases, a man may undergo an MRI scan so that the doctor can see if the cancer has spread.
For localized cancer (or cancer that remains contained within the prostate), Dr. Wibowo says, “Men may either receive a prostatectomy—surgical removal of the prostate gland—or radiation therapy.”
If the cancer has spread to other areas of the body, doctors may prescribe androgen deprivation therapy. This will stop the body’s production of testosterone, with the goal of halting cancer growth. In advanced stages, chemotherapy may also be started.
HOW PROSTATE CANCER AFFECTS YOUR SEX LIFE
The harsh reality is, all prostate cancer treatments can, to some extent, negatively affect a man’s sex life.
Both surgery removing the prostate and radiation therapy will reduce the amount of fluid during ejaculation since the prostate is responsible for producing most of it. They can also damage the nerves responsible for producing an erection. Androgen deprivation therapy can lead to the loss of libido and difficulties reaching orgasm.
“Sex after prostate cancer treatments may not be the same as it was before,” Dr. Wibowo says, but an open mind, and in some cases, professional counselling, may be helpful for both patients and their partners.
Penile implants are one possible route; however, a recent paper published by Dr. Wibowo and his colleague, Dr. Richard Wassersug, explores how non-surgical approaches, like incorporating sex toys for therapeutic purposes, can help men and their partners lead fulfilling sex lives, even when experiencing reduced libido and full erectile dysfunction.
Dr. Wibowo makes one final, important point when it comes to recovering one’s sex life after prostate cancer treatment: “Some couples come to appreciate and enjoy kissing and cuddling [since] sexual intimacy is about more than just penetrative sex,” words of advice we can all surely benefit from.
Debra W. Soh, PhD, writes about the science of sex and its politics. Her writing has appeared in Harper’s, the Wall Street Journal, the Los Angeles Times, the Globe and Mail and many others. Follow her and her writing: @DrDebraSoh.