PSA as screening tool
Prostate problems begin to surface once a man hits 50 years old. Medical organizations like The American Cancer Society recommend screening especially if one has a family history or a genetic risk factor. Commonly requested is the prostate-specific antigen (PSA) assay by blood test, but it is not routinely recommended by the US Preventive Services Task Force, notably if there are no symptoms and there is no risk other than age or gender.

Getting a high PSA doesn’t mean one has cancer, and experts have expressed concern that it can lead to net harm (undue anxiety, overtreatment, etc.). PSA density, derived by dividing serum PSA by prostate weight estimated from transrectal ultrasound and PSA velocity, which is the rate of change of PSA over time, are some of the other things physicians request for screening prostate disease.

The bottom line is that no trial yet has demonstrated the benefit of screening. Currently, screening should be discussed with patients and allow them to make a choice after being informed of potential risks and benefits.

Perhaps this confusion about tests leads patients to ask which test is best for prostate screening if he has symptoms like weak urinary stream, sensation of not being able to empty the bladder, difficulty in postponing urination, and urinary frequency – which are the common symptoms of prostate problems. In men with diabetes, going to the bathroom to pee may be mistaken as a symptom of hyperglycemia, and this can postpone the diagnosis of an enlarged prostate, also called benign prostatic hypertrophy (BPH) or even cancer.

Diabetes and prostate symptoms may overlap
In any diabetes clinic, when a man complains of urinary frequency, the diagnosis of diabetes is always considered. Patients coming in to the clinic would wonder aloud whether they have diabetes or not. It’s easy to confirm diabetes by blood test, but prostate problems like BPH, which gives a similar symptom (urinary frequency), may require more than a blood test and should always be ruled out, particularly in the older population.

The prostate gland is a small organ about the size of a walnut. It surrounds the urethra (the tube that carries urine from the bladder) and helps make fluid to nourish sperm as part of the semen (ejaculatory fluid). In men, over 50 years old, this can enlarge and cause symptoms. Understandably, urinary frequency will be among the symptoms because it can cause urine to go back to the bladder.

Insulin as culprit?
But aside from this contrived relation, is there a deeper link between diabetes and prostate? In a recent journal published in the Journal of Clinical Oncology, Dr. Matthew Smith explained that obesity is known to be associated with an increased prostate cancer mortality risk—and most men with diabetes are obese. Therefore, diabetes has been thought to be the underlying condition “responsible for greater risk of death from prostate cancer”. The study however concluded that it is the obesity and NOT the metabolic alterations of diabetes, that is associated with prostate cancer mortality.

In fact, another study published in the International Journal of Cancer suggests that diabetes may even be protective!

Now please read on because there’s a catch. These findings might seem to contradict previous theories that high levels of insulin —often associated with diabetes —can promote growth of prostate cancer. Why then, might diabetes show an opposite protective effect? It could be that the insulin levels in long standing diabetic patients are diminished. This makes patients, who already have diabetes for at least one year, less likely to develop prostate cancer because the stimulus of hyperinsulinemia is not there anymore (insulin levels decline as diabetes progresses). According to the report, prostate cancer is 17% less likely to develop in men with diabetes.

Similarly, another study that gathered data from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial, which followed more than 33,000 men for almost nine years, noted that men who had diabetes showed a 20% lower risk for non-aggressive, early stage prostate cancers.

Obesity is a risk
Obesity on the other hand, was associated with greater mortality due specifically to prostate cancer, but not with all-cause or non-prostate cancer mortality, the team reports in the Journal of Clinical Oncology. Men who had a body mass index or BMI (weight in kg/ height in meter squared) of more than 25 and high C-peptide (a marker of insulin level in the blood concentrations had quadruple the risk of dying from their cancer compared with men who had lower BMIs and C-peptide levels, the researchers reported. This tells us that obesity is a risk, and if you have high insulin levels, seen usually in early stages of diabetes, the risk of dying from prostate cancer is higher.

A pound of prevention
Obesity, as well as androgens, indeed plays a role in spurring prostate problems. But are they preventable? To date, there is no evidence that prostate cancer can be prevented but risks can be lowered. Substances in foods called antioxidants help prevent damage to the DNA in the body’s cells. Lycopenes, in particular, are antioxidants that have been linked to lower risk of prostate cancer. They are in foods such as tomatoes (raw or cooked), spinach, berries (especially blueberries), pink grapefruit, orange, and watermelons.

Do check the limit of your fruit intake with your diabetes doctor. Other purported treatment methods from taking Vitamin E or finasteride (medicine used to block androgen) to masturbation, will need further studies. Annual digital rectal examination, done by inserting a gloved, lubricated finger into your rectum, is also an option, and can start at age 40. This allows early detection of an enlarged prostate by a qualified doctor.

Nothing will substitute a consult with a urologist to ask about prostate problems, whether one is diabetic or not, and this usually starts at age 50. But Dr. Palapattu summarizes it best, “The simple things are still the important things. Don’t drink, don’t smoke, exercise, and eat well,” concludes the esteemed assistant professor of urology, pathology and oncology at the University of Rochester School of Medicine.

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