Prostate Cancer Awareness begins with prostate awareness

This is not medical advice. Please consult your doctor(s) about medical questions and issues.

September is Prostate Cancer Awareness Month. I’m pleased to say that it’s also the month when my three-year post-surgery blood test returned good results. My PSA (more about PSA below) is still “undetectable,” as it has been since two months after my July, 2013 radical prostatectomy.

Prostate cancer awareness is very, very important. But what’s struck me forcefully over my three years as a prostate cancer patient and survivor is the number of men who have no idea what their prostate does. I’ve started asking them point-blank. Nine times out of ten, I get shrugs. Many men think the prostate does nothing, like the appendix. Those who know what the prostate does tend to have a medical background, or to have had prostate cancer themselves or in the family.

The prostate secretes semen. The testicles do not secrete semen, despite vulgarisms that suggest otherwise (like “bust a nut”). The testicles produce sperm cells. Those are the things that swim upstream looking for eggs to fertilize. Semen is the delivery mechanism for sperm cells. Semen comes from the prostate.

It follows, then, that after your prostate is removed, you can no longer ejaculate. When I mention this fact to other men, I often get asked “Why not?” or “Are you sure?” The answers to these questions are, respectively, “Because semen comes from the prostate” and “Yes, I am fucking sure.”

Here are some generalities, based on what I have learned as member of the Reluctant Brotherhood.

The nerves that enable erection run along the prostate. If those nerves are implicated in the cancer, they have to be removed. If they’re not cancerous, they still have to be peeled away from the prostate, which traumatizes them. In those cases they take a while to recover, possibly measured in years. In short, erectile function after a prostatectomy covers a wide spectrum. And medicine and/or devices play a role for many men.

While ejaculation is not possible without a prostate, orgasm is–even in the absence of erection. The strength and quality of orgasm will vary from man to man, and may improve over time.

Urinary incontinence after a prostatectomy also varies on a case-by-case basis (that’s a pattern with this disease and its treatments). At its worst, you’re looking at a lifetime of Depends and other ameliorative measures. But if you’re lucky, you don’t have any serious problems with incontinence. Maybe a little bit when you sneeze.

The main way you detect prostate cancer, or at least become suspicious of its presence, is through a PSA test. PSA stands for Prostate Specific Antigen. It shows up in the blood in higher concentrations when there’s cancer. If the doctor feels it’s warranted, they (yes, I know they is really plural but I hate “he or she”) will order a biopsy. A digital exam of the rectum is also used in diagnosing cancer and other prostate disorders.

Please do not fear any of these diagnostic techniques. Do them if your doctor suggests them. In fact, if you’re old enough–I think the guidelines say forty, but again, I’m not dispensing medical advice so please research it–and/or have a relevant family history, you should ask about them.

As regards treatment, the big three are surgery, radiation, and “active surveillance” (sometimes called “watchful waiting”). Active surveillance means not intervening, but continuing to measure and monitor via PSA and possibly follow-up biopsies, and then intervening with surgery or radiation if it becomes necessary. In my case, active surveillance was not an option because while the cancer was not terribly aggressive, there was quite a lot of it. I talked to two radiologists and two surgeons, and decided that surgery was right for me.

Prostate cancer is a grim disease. It has a reputation as a “good” cancer, because survival rates when it’s caught early are pretty spectacular and because some manifestations of it are slow-growing enough not to warrant intervention. But the permanent changes from treatment are significant in every case, and extremely significant in some cases. And around 30,000 men die from it every year in the United States. It’s not to be taken lightly.

So be prostate (cancer) aware, this month and every month.

Again: This is not medical advice. Please consult your doctor(s) about medical questions and issues.