For Weekly SurgeAugust 21, 2013 

Drop your pants, bend over and spread them – a phrase that often causes dread and cold sweats in men. We’re not excluding women, there’s probably equal dread for all the poking and prodding the fairer sex has to go through on their journey to health and body awareness.

But let’s be honest, men are terrified of bad news, and most men are more afraid of a doctor’s finger than getting smashed in the face with a fist.

These are the thoughts running through our minds while our pants are around our ankles, buns up and bending over an exam table. A doctor is poised behind us with a well-lubed finger outstretched, ready to plunge into our nether-regions and poke around to determine if we have signs of or are at risk of prostate cancer.

It’s called a digital rectal exam, just another step in the process of aging, a necessary evil in detecting early signs of prostate cancer. Early detection is critical in any cancer, but for men, prostate cancer can be an ugly business if left unchecked, and this ugliness can be avoided with preventive measures or treatment in the early stages.

In an effort to make people aware of these precautions before they hit home, Atlantic Urology Clinics and Carolina Regional Cancer Center is hosting the Sixth Annual Know Your Score Golf Tournament and Gala this weekend in Myrtle Beach. The celebrity tournament is rich with sports greats, including Julius “Dr. J” Erving, Ed “Too Tall” Jones and former Chicago Bears defensive end Richard Dent, just to name a few.

But before we get to that hoopla, let’s get down and dirty, to find out what all the finger-pointing is about.

Getting Tested

In an examine room at Life in a Blender Family Medicine in Conway, there’s a finger hovering outside our sphincter. Our doctor, Joseph Papotto, is also a professionally trained clown. So when the digital rectal exam starts, we have to question whether it’s a digit or a rubber chicken. “Just count yourself lucky I have slim fingers,” Papotto says.

But wait, before our doctor slides into home, we needed to know exactly what a prostate is and what it does. “It’s a gland under the bladder, about the size of a walnut,” Papotto says. “It produces a portion of the fluid in men’s semen.”

The Centers for Disease Control and Prevention has prostate cancer listed as the most common cancer in men. Sometimes, it grows little by little, without doing much harm. Sometimes, it’s pissed off and spreads like crabs in a coed dorm. In both scenarios, it can usually be detected by one of two easy tests – the digital rectal exam (DRE) or a prostate-specific antigen (PSA) blood test which checks for specific enzymes that work to liquefy sperm.

To make a complicated process as simple as possible – if these enzymes go gangbusters or rogue around your taint, bad stuff can happen. PSA levels measure these rogue enzymes. It works kind of like this: If your PSA level is less than 10, it means low risk. If your level is 10 to 20, it means intermediate risk. If it’s more than 20, it means high risk.

But the PSA blood test has ups and downs. The downs are it’s a more expensive test than a DRE, and it isn’t always reliable. Spotting high PSA levels in your blood can be a sign of the big C, but they can also spike because of inflammation in the prostate from an infection or an enlarged prostate or recent ejaculation.

In 2012, the United States Preventive Services Task Force (USPSTF) released a study recommending men stay away from PSA blood test. The report states, “The potential benefit does not outweigh the expected harms,” and goes on to cite that “about 100-120 of every 1,000 men screened receive a false-positive test.” These false positives often result in “over-diagnosis/overtreatment,” and “only 30 percent of patients who have high PSA levels are cancer prostate positive after biopsy.”

“The PSA tests have become pretty controversial in the medical journals. It seems like some agencies are putting cost over care,” says Papotto. “I recommend both. I’ve picked up cancer early in patients with no symptoms from the PSA test and DREs.”

Either way, you should be tested annually if you’re 50-years-old or older or 40-years-old or older and have a family history of prostate cancer or you’re African-American or you have a history of smoking.

Here’s the tricky part of this whole business – some of the symptoms of prostate cancer can be really similar to an enlarged prostate or benign prostatic hyperplasia (BPH). The rub is a man’s prostate gets bigger naturally with age. “At 20, it’s around the size of a walnut. At 40, it’s the size of an apricot. At 60, it’s the size of a lemon,” says Papotto. “As it gets bigger, it presses the urethra tube.”

This pressure on the urethra causes infuriating symptoms like the feeling that you need to pee but not being able to. Or it can cause that frustrating weak flow when you go. Or it causes the damnable start/stop/start again pee. Or you may have to go all the time like a fountain. Or it can cause a burning sensation like you have the clap.

But even if you don’t have any of those symptoms, always be on the lookout for blood in both your urine and your sperm – Don’t be afraid, take a look, just don’t taste it…there’s no such thing as a taste test. Also, intense pain in the back, hips or upper thighs is a symptom of advanced cases of prostate cancer.

And just because you have an enlarged prostate, doesn’t mean it will lead to cancer. In most cases of enlarged prostates, medicines can treat and get the problem under control. But that’s what the tests are for, to determine what you got hiding behind your backdoor.

As we sense the entry of Dr. Papotto’s digit, the slight tickle of a gloved fingernail, we tense up and wonder – what can help us prevent prostate cancer?

The importance of prevention

While Papotto’s finger breaks our comfort precipice, there are a few myths floating around about causes and preventions of prostate cancer that must be dispelled. Just as blindness and hairy palms aren’t the result of self-pleasuring, masturbation doesn’t cause prostate cancer. The same is true of having too much sex or a vasectomy. The reverse is also true – there is no scientific data showing that frequent sex and masturbation can reduce the incidents of cancer (sorry, can’t use that line on your significant other).

“But if you don’t use it, you lose it. Regular masturbation and sex helps build stamina and can reduce stress,” Papotto says. “And that’s important because the stress has to be dealt with. People living under prolonged stress are predisposed to cancer.”

Here are a few factors of prostate cancer you have no control over – being a man, getting old, having a family member who’s had it or being African-American. African-American men have the highest rate of prostate cancer in America.

One preventive factor you can control is diet. You can limit the amounts of high-fat red meats you eat. Keep your booze intake to one or two drinks a day. And cut out all the processed meat, that means saying goodbye to hot dogs and bacon…yes, we said bacon. What you can eat is a bunch of fresh fruit and veggies. Switch out the white bread and rice for whole grain, and eat foods that are high in folate, such as spinach, certain beans and orange juice. As with every health issue, regular exercise helps. So eat a peach, make yourself a screwdriver or two, do a little Zumba and relax.

Then Papotto throws us a curve ball. “There was a recent national scientific study showing that drinking three to six cups of coffee a day, helps reduce the risk of cancer,” he says. “Caffeine is a major player in prevention, and it works with the natural antioxidants in coffee.”

There seems to be a wariness about supplements advertised and sold as cure-alls. But Papotto did recommend taking a daily dose of zinc (30 milligrams) and selenium (200 micrograms). “There are no side effects and they have other health benefits,” he says.

Papotto’s finger taps at my insides and we begin to worry, what if he finds something in there?

Getting treatment

According to the National Cancer Institute, more than 238,000 men will be diagnosed with prostate cancer and more than 29,000 will die from the disease in 2013. If detected and contained in the prostate, the survival rate for the first five years is close to 100 percent. But if the cancer goes more than five years undetected or spreads aggressively, the survival rate drops to approximately 30 percent.

If there’s anything abnormal detected in PSA or DRE screenings, there are levels of treatment. The first is seeking a second opinion just to make sure everyone is on the same page before decisions about treatment are made. And once that’s done, treatment can go in a few different directions.

First, a biopsy is done. Here’s where it starts to get serious. In a biopsy, a needle collects tissue samples either through the rectum or it is inserted in the taint (defined by Urban Dictionary as “the area between the nutsack and asshole”). After it’s examined, it’s graded with the Gleason Grading System, named for pathologist Donald Gleason. Bunches of numbers are thrown in to measure tumors and whatnot, and somehow doctors come up with a single number, known as Gleason scores. These scores help determine how fast the cancer will spread. A-2 means it’s slow-growing. A-10 means it’s severely aggressive.

If the cancer has already started to spread, sometimes doctors will need to run other tests such as CT scans, ultrasounds, MRI scans or a radionuclide bone scan. These tests lead to doctors determining the stage of your cancer which dictates the next phase of your treatment.

Stage one means the cancer is in the early stages and contained within the prostate.

Stage two means the cancer has advanced, but still only in the prostate.

Stage three means the cancer has spread outside the prostate to seminal vesicles.

Stage four means the cancer has spread to lymph nodes and other organs such as the bladder or rectum or stretching out into the bones or lungs.

The first type of treatment is surprisingly doing nothing. It’s called the “wait and watch” approach. It depends on your age and the status of your health. If it’s a low-risk cancer and you’re healthy, you can wait and watch and test periodically to see if it gets worse. In older patients or in cases of existing health conditions, the treatment may be worse than the cancer.

In cases of aggressive cancer, radiation therapy might be an initial treatment. Sometimes, external beam radiation is used to stop the cancer cells. Other times, radioactive pellets are placed into the prostate. Erectile dysfunction, fatigue, urinary problems and diarrhea are common side effects.

If the prostate is riddled with cancer, but confined, surgery can be done to remove the affected pieces of the prostate or it can be removed all together. It’s called radical prostatectomy. Advances in surgery have helped avoid damaging nerves around the prostate. Side effects can be impaired urinary tract, erectile dysfunction and loss of sexual function.

Hormone therapies have been used to slow down the growth or the spread of cancer, but it won’t totally get rid of it without being paired with other treatments. Doctors use hormones that stop the production of testosterone. The side effects are weight gain and impotence, as well as more feminine occurrences including hot flashes and growth of breast tissue.

If the cancer advances past hormone therapy and radiation to the later stages, chemotherapy is used to kill cancer cells throughout the body. Chemo is delivered intravenously and can last three to six months, in different cycles. The side effects of chemo have been well documented – hair loss, mouth sores, nausea, loss of appetite, vomiting and fatigue.

When the cancer is getting out of control and not responding to other treatments, there’s a prostate cancer vaccine which bulks up your own immune system by taking the immune cells from your blood, activating them to battle the cancer and then injecting them back into your bloodstream. The whole process happens over the course of a month, in three treatments. Side effects are mild – fatigue, nausea and fever.

In rare cases, cryotherapy is used. Because it’s a newer treatment, the long-term effectiveness are inconclusive. The long and short of the process is this – they freeze and destroy cancerous cells within the prostate. It has a short recovery time, but WebMD reports that “because the freezing damages nerves, as many as 80 percent of men become impotent after cryosurgery.”

Feeling it in Myrtle Beach’s bones

Back in May, the FDA approved a new prostate cancer treatment, Xofigo (Radium-223 dichloride). And the first worldwide commercial dose of it was administered right here in Myrtle Beach. The treatment is for patients in the advanced stages of prostate cancer, when it has spread to the bones, where other treatments are limited.

Board certified urologist at Atlantic Urology Clinics and the director of the Carolina Urologic Research Center, Neil Shore became the first physician to administer Xofigo on May 24. Extensive research was done for the treatment, and the clinical trials have shown increased survival rates and delays in the complications associated with bone metastases.

“We’re proud to begin offering Xofigo infusion on a broader scale to more patients who would otherwise have limited or potentially less effective treatments for late stage prostate cancers,” Shore said in a press release. “We’re looking forward to this treatment helping our patients improve their quality of life as well as extending their survival.”

Here are the drawbacks – nausea, diarrhea, vomiting, swelling of the arms or legs and low blood cell counts. Those seem minor compared to some of the other treatments. But wait, Xofigo is new, there’s no guarantee that your insurance will cover the treatment yet. To find out, you can call 855-696-3446 or check out

Coping with recovery

Here’s the clichéd good news/bad news scenario. Good news: In this new world of scientific discovery we’re living longer, better lives. Bad news: Prostate cancer will be diagnosed in an estimated 80 percent of men who reach the age of 80. More good news – prostate cancer is a notoriously slow-growing cancer, and if tested annually, the majority of the cases are caught early on and confined to the prostate. Because of this proactive attitude, the recovery rate of older men continues to rise.

In regard to recovering from the side effects, most patients bounce back naturally from the common ones, including erectile dysfunction. Those who don’t bounce back naturally, always have a multitude of colorful pills to choose from. And there’s always the availability of penis injections, suction vacuums and dozens of other dick-aids that get e-mailed to your spam folder daily.

As far as how our exam went, we are proud to report our prostate is in complete working order, or as Papotto puts it “it’s smooth, symmetrical, nicely textured and the perfect size for our age.” He pulls his digit from my clenched cheeks, wipes his finger on a small card and drops the card into an eye-dropper-sized bottle full of clear fluid. “This tests to see if you have blood in your stool, which is an indicator of colorectal cancer,” he says and shakes the bottle. Looking at the card still in the bottle, he says, “You’re clean.”

Nothing about this feels necessarily clean. But it does feel necessary.

If you or someone you know falls into the need-to-get-checked category, go see your doctor and discuss which screenings are right for you.

If you don’t have a doctor, you can get a PSA blood test for $15 on Sept. 6 at Belin Memorial United Methodist Church Family Life Center in Murrells Inlet. The Georgetown Hospital System is sponsoring a regional health screening from 7:30 until 10:30 a.m. There will be other health screenings as well, some free, some for a small fee. For more information, call 520-8447 or visit

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