Introduction

Let's face it, guys: many of us aren't exactly rushing to the doctor to talk about what's happening downstairs. There is a strange, unspoken rule that says we will just tough it out, ignore the niggling little changes, and hope it works itself out. But when it comes to your health and your prostate, it's not just unwise—it's downright dangerous.

Prostate cancer is a sneaky character. It can exist in the earliest, most treatable stages without making a fuss or sounding alarming. It can be a quiet tenant for years. This is why understanding the subtle, and sometimes not-so-subtle, messages your body could be trying to tell you is so critically important.

This is not about instilling fear. It is about giving you knowledge. Because having knowledge about what to look for and when to have a discussion with your doctor is your single greatest weapon.

First, an important part of the conversation: the symptoms we are going to talk about are rarely exclusive to prostate cancer. In fact, they are more often caused by a much more common, and completely benign, condition called Benign Prostatic Hyperplasia (BPH) which is basically a natural enlargement of the prostate that occurs with almost all men as they get older. It is like going grey—it is annoying but not dangerous. Infections, inflammation, and other issues can also look like these signs. So if you are hearing yourself in any of this, your first job is not to panic. Your next task is to take the phone and set an appointment. Let's talk specifics.

The Words Your Body Speaks: The Underlying Message

The prostate gland is about the size of a walnut. It is located just below the bladder. It is wrapped around the tube (the urethra) that carries urine out of the body. Because of where it hides out, in early stages, the majority of warning signs of a problem relate to urination. A growing prostate (whether from cancer or BPH) squeezes that urethra, just like stepping on a garden hose. The flow changes.

The Changes in the Flow: The Urinary Symptoms

Most men first notice something is wrong here. It often starts out so gradually that many may tell themselves this is just "getting older", but recognizing the nuances is important.

The Dribble and Delay

You stand there, ready to go--and nothing! You certainly experience hesitancy; you never used to experience a waiting period before the stream starts. And after you are done, it never just "stops." There will always be some dribbles, a few drops of urine that make it into your underwear. This is all new and a little annoying. It's not necessarily a weak stream, but it's the beginning and the end of the process that you are noticing.

The Weak Stream

The strength you took for granted before is no longer there! It is weak; it is thin; and it seems like it will take forever to drain your bladder. You may experience straining or pushing to get started, something you did not have to do before.

The Unrelenting Urgency

This is a big one: frequency. You are constantly going to the bathroom. All the time. Lots of trips. Especially at night. Nocturia—awaking at night specifically to urinate—is a huge disruptor of sleep. You may awaken two, three...even four times during the night! It's not a matter of simply needing to get to a bathroom when you're out; the urge is also strong and sudden, with little warning. This can lead to an uncomfortable feeling of urgency when you are not really sure why. There may be a sensation of "if I do not find a bathroom ASAP, there could be an accident" urgency.

Incomplete Emptying

This is a feeling that is difficult to describe but I suspect once you have experienced this sensation, you will know exactly what I mean. You have just spent a good minute urinating, you shake, you are done.... But, you still have the uncomfortable feeling that there is still more to be eliminated. It's a funny, deep, unsatisfying feeling that the job was not a complete job. This can lead to subsequently immediately feeling the pressure to go a bit more after you have just finished urinating.

When There Are a Few More Personal Symptoms: Sexual Symptoms

Yes, the prostate plays a supportive role in the reproductive system by producing fluid that is ultimately part of sperm. So, if there is a problem with the prostate, it may also show up here.

Erectile Dysfunction (ED)

Now, ED is simply super common in a multitude of reasons such as vascular issues, stress, Yet, if it develops rather quickly and it aligns with any of those urinary symptoms we just learned about, that is a relevant piece of information to share with your physician. It is certainly not a tennis ball-sized reason to suspect cancer, but it is a piece of your body's story.

Painful Ejaculation

This is not one of the most common, but perhaps the most specific symptoms that can also be worrying. If it causes pain or discomfort during or in the moment following ejaculation, that is a signal that there is something irritating your prostate that should be evaluated by a physician.

Blood in the Semen (Hematospermia)

Blood in your ejaculation can be alarming, and it is completely understandable to immediately worry it means the worst. Although this can be a sign of prostate cancer, it is generally related to other routine reasons—a somewhat rough biopsy, an infection, or inflammation. Either way, this is a sign you should never ignore and/or at least get evaluated by your physician.

The Less Common, But Serious, Red Flags

Although most symptoms are related to urination, there are others that indicate the disease may be more advanced. Note these are not "early" signs in the purest sense but are the common first signs to some men. Remember, prostate cancer can arise and develop without any urinary symptoms for some men.

Blood in the Urine (Hematuria)

Even just a small amount of blood can change the color of your urine to pink, red and cola-colored. This is probably one of the most serious symptoms you might have, and it is again never probably to ignore. It could be a prostate problem, a kidney stoned, a bladder infection, or something else - but it needs to be checked out quickly.

Pain and Numbness: A Sign of Spread

If prostate cancer grows and spreads to other parts of the body, the cancer usually spreads first to the bones. This causes deep, throbbing pain in the bone that does not go away, frequently felt in the back, hips, pelvis, or thighs. Because it is constant, and it is not associated with any activity, the feeling is distinctly different from the normal soreness of a muscle strain, or a flare-up of arthritis. In some cases, if the cancer presses on the spinal cord, it can cause weakness or numbness of the legs or feet, or loss of bladder or bowel function. This is a huge red flag, and you need urgent care.

The Great Imitator: Why You Can't Self-Diagnose

The most important thing to take away from all of this: You can't, and shouldn't, diagnose yourself. Every single symptom has a great ability to trick you. The higher urinary frequency and weak stream? Odds are it is most likely BPH. Pain or blood? It could be prostatitis - an inflamed or infected prostate gland that is treated with antibiotics. E.D. is a complicated issue related to blood flow, hormones, and psychology. The human body is not a checklist. It's a complex organism where the same symptom could have a dozen different causes.

The reason knowing these signs is invaluable is not for you to go online and think you now have cancer, but because when your body is talking to you, it is saying, "Hey, something's going on. I need a medical professional to talk to who speaks the language."

The American Situation: The Issue of Risk Factors and the Screening Discussion

Understanding symptoms is only part of the issue. Here in the U.S., the discussion around prostate cancer has much to do with the issue of risk, along with the continuous debate around screening.

Who is at Risk?

Any man can develop prostate cancer; however, your risk is not the same risk as your neighbor. Some of the most significant elements include:

Age

The biggest single risk factor. Your risk of developing prostate cancer increases dramatically after age 50.

Race and Ethnicity

This is a harsh and formidable reality. African American males are at a notably higher risk; for example, they are more likely to develop prostate cancer, and at an earlier age, and are over two times more likely to die from prostate cancer. The reasoning for this could be numerous and complex, possibly relating to genetic, socioeconomic, and healthcare access issues. All of this heightens the urgency for Black men to actively engage their doctor for early and informed questions about risks.

Family History

If your father or brother had prostate cancer, your risk doubles, and with multiple family members, and younger, your risk climbs.

Genetics

There are some identified gene mutations that elevate the risk of cancer, including those associate with BRCA1 and BRCA2 (typically associated with breast and ovarion cancer), but with a noted prostate cancer risk.

The PSA Crisis

In the 1990s, the introduction of the Prostate Specific Antigen (PSA) blood test allowed early detection of cancer. The blood test allowed a primary care provider to find a cancer state that was detectable long before there were any symptoms. The downside to this good thing was a huge problem in over-diagnosis and over-treatment. The PSA test is not an oracle; elevated PSA levels could either be benign, or suggest malignancy, all depending. In men with updated benign prostatic hypertrophy (BPH), prostatitis, having an ejaculation, or taking a long ride on a bicycle, could all result in an elevated PSA level. Often, PSA testing found small, slow-growing malignancies that would likely never have caused a man any lifetime harm. Unfortunately by treating with surgical or radiation intervention led to functional consequences (incontinence, erectile dysfunction) that could diminish preexisting quality of life more than the cancer would have ever done. This had led to a seismic change in the American medical landscape.

Currently, we are not recommending that all men be screened. Instead, the U.S. Preventive Services Task Force (USPSTF) recommends that men between 55 and 69 make an individual, informed decision with their doctor about whether to get screened. This decision should be based on a thorough discussion of the potential benefits (catching a dangerous cancer early) and the very real risks (false alarms, unnecessary biopsies, and overtreatment). For men 70 and older, the general recommendation is to forgo routine screening, as the risks of treatment often outweigh the benefits. This shared decision-making model is now the cornerstone of the American approach. It's not about avoiding the test; it's about being smart and personalized in its use.

Understanding the Modern Screening Landscape

The controversy around PSA testing didn't emerge in a vacuum. It came from decades of real-world experience showing that while we got better at finding prostate cancer, we weren't necessarily getting better at improving men's lives or preventing deaths. The pendulum swung hard in both directions before settling where it is today.

Beyond the Basic PSA: New Tools in the Toolbox

Medicine doesn't stand still, and neither has prostate cancer detection. While the standard PSA remains controversial, newer approaches are adding nuance to the conversation.

PSA Velocity and Doubling Time

Instead of just looking at a single PSA number, doctors now pay attention to how fast it's rising. A PSA that jumps from 1.5 to 4.0 in a year is more concerning than one that slowly creeps from 3.8 to 4.2 over the same period. This trend analysis can help distinguish between cancer and benign conditions.

Free PSA Ratio

Not all PSA is created equal. Some circulates "free" in the blood, while some is "bound" to proteins. Men with prostate cancer tend to have less free PSA. This test can help reduce unnecessary biopsies by identifying men whose elevated PSA is more likely due to BPH.

The 4Kscore Test

This combines PSA with three other biomarkers plus clinical information to calculate a more precise risk of finding aggressive cancer. It's particularly useful for men in that gray zone where PSA is elevated but not alarmingly so.

Prostate Health Index (PHI)

Another multimarker test that has shown promise in distinguishing between cancer and benign conditions. It's especially helpful for men who've had a previous negative biopsy but still have concerning PSA levels.

MRI-Guided Options

The use of magnetic resonance imaging of the prostate has developed to a high level. There's a specialized kind of MRI, called multiparametric MRI, that can oftentimes show suspicious areas that need to be investigated in further detail. This means we can take biopsy samples in a more targeted way, and also spare some men from unnecessary biopsies when everything looks normal on MRI.

The Psychology of Risk: Why Numbers Don't Tell the Whole Story

Something they won't teach you in statistics is that humans are really bad at understanding risk. We fear plane crashes but drive without seatbelts, we buy lottery tickets but avoid medical tests we need. The psychology of risk plays itself out in the context of prostate cancer screening in various ways.

Let's say your doctor tells you that screening may find a cancer and your have a 15% chance it will ever cause you symptoms in your lifetime. For some men, the 85% chance of no symptoms is reassuring. For other men, it eats away at them that there's a 15% chance. Neither response is right or wrong, just different ways of processing uncertainty.

The challenge is prostate cancer is not a binary condition. It's spectrum condition between "will never bother you" on one end and "will absolutely kill you if untreated" on the other. The complication we have is that we aren't very good at predicting where that particular cancer sits on that spectrum, notably early on. This has shifted the discussion from a universal screening approach to a personalized approach to risk.

We Live in a Time of Information Overload

There has never been a time when men are able to access information about their health. If you search "prostate cancer symptoms" on Google, you'll have 50 million results in half a second. You can participate in online forums, read research articles, and view YouTube videos by physicians from all over the world. While this has contributed to a democratization of medical information that is very useful, it poses new problems as well.

The internet does not differentiate between high-quality information and pseudo-scientific nonsense. The internet also cannot account for your individual risk factors, family history, or personal values. When a man reads about the PSA test, he may read everything from "every man over 50 should have a PSA test right away" to "the PSA test is a scam by the medical community." Both versions exist on the internet, often presented with the same authority and confidence.

This is why the physician-patient relationship matters more in the digital age, than ever. A good physician acts as filter and translator, to help evaluate and apply general medical knowledge to your particular situation.

The Real-World Experience: What Happens Next

Let's skip past symptoms and risk factors, to talk about what actually happens once you walk into a physician's office. Knowing what to expect can make the difference between walking in prepared and confident, or anxious and not prepared.

The Initial Consultation: Setting Expectations

Most likely, your initial appointment will start with a conversation - not an exam. A good doctor will want to learn more about your specific concerns, how long you have been having symptoms, and whether you notice patterns. Here is where that symptom diary we talked about earlier comes into play!

You will be having a discussion about your family history in relation to prostate cancer and other cancers. Your family's health history regarding heart disease, diabetes, or other health issues can impact your risk for cancer and what type of treatment options will be available if you do have cancer. Your physician will also want to know about your medications, as some medications can affect PSA levels.

The physical examination will also include the digital rectal exam (DRE). Many men do dislike this examination, but it can provide information that cannot be obtained any other way. The physician is checking the size, shape, and texture of the prostate. A normal prostate will feel smooth and uniform. Hard or uneven areas would be concerning for cancer, however, these findings can be related to other conditions. The DRE usually takes about 30 seconds and is uncomfortable for most men, but not painful. If you are especially anxious about this part of the exam, please let your physician know, and they may be able to provide reassurance and you're-okay talk to help you relax.

When Tests Lead to More Tests: The Biopsy Decision

If the PSA levels are elevated or the DRE findings do not look good, your physician might recommend a biopsy. This is generally where anxiety levels peak for most men, and it makes sense why. Biopsy sounds serious. The word biopsy takes you from "maybe there's a problem" to "we really think there's a problem."

In the typical case, prostate biopsies are performed as outpatient procedures. The most common way a biopsy is performed uses a transrectal approach which consists of placing an ultrasound probe through the rectum to visualize and guide a biopsy needle. Multiple small samples of prostate tissue are taken from several locations—typically 10 to 12 samples in total. The procedure itself lasts approximately 20 minutes. Most men report it feels uncomfortable rather than painful, though you will likely receive a local anesthetic. A few days after the biopsy, you can expect to see some blood in your urine, stool, or semen, all of which is normal.

The newer procedure is a MRI guided biopsy, which allows doctors to take samples from the very suspected regions identified on imaging, which can be more accurate and sometimes even eliminate the need to take as many samples.

The Waiting Game: From Biopsy to Results

The one to two week period from biopsy to results could be the longest period of your life. This is normal. Even the most calm, logical men find themselves looking at their phone hundreds of times a day for a call from the doctor's office. Sleeping could be tough. Concentrating at work may feel impossible. If you have a partner, you will be affecting them too. They are seeing you worry, figuring how to deal with their own fear, and determining how to help support you without being overbearing. Communication is important. Some couples organize themselves to set specific times to discuss their fears and worries, minimizing the conversation being at the front of each and every interaction. You should know, statistically, 75% of biopsies are negative for cancer. Statistically holding no bearing from helping you to wait the next week or two for the result.

When the News Isn't What You Hoped It Would Be: the Cancer Diagnosis

If your biopsy reveals cancer, you may feel your life has been completely turned upside down, which is perfectly normal. Even the man who may have fully acknowledged on some level that there was a chance he had cancer, may be emotionally caught off guard by the term itself. The first thing to understand is that prostate cancer is not a medical emergency. Prostate cancer is a slow-growing cancer, and you will be fully inundated with information and prep time before you make any serious decisions about treatments - in some cases, enough time to completely revise your medical care plans.

Your biopsy results will also tell you about something called a Gleason score, or how aggressive the cancer looks on the microscope slide. Gleason scores go from 6 (low grade) to 10 (high grade) - Gleason 6 cancer is considered low risk, and doesn't generally need treatment at all right away. Gleason's 8, 9 & 10 cancer is generally higher grade and needs treatment sooner or immediately. You'll also know the stage of the cancer- which means how far the cancer has spread. An early stage cancer is very confined to the prostate. An advanced stage cancer has spread to nearby tissues, the lymph nodes and/or distant parts of the body.

The Treatment Landscape: There Are More Options Than Ever

Luckily, there are more options than ever before for the treatment of prostate cancer. Gone are the days of one-size-fits-all.

Active Surveillance

For low-risk cancers, many men will opt to give active surveillance (aka watchful waiting), a try. This usually entails consistent monitoring with PSA tests, occasional biopsies, and imaging tests like MRIs, without treatment. The reasoning behind Active Surveillance is to limit treatment that would have side effects for a cancer that is less likely to pose a problem. The research is clear that this is a safe method of management for selected men.

Surgery

A radical prostatectomy—removal of the entire prostate gland—can be done with the traditional open approach, laparoscopic, or robotic approach. Each has advantages and disadvantages. Recovery will typically take several weeks, and the potential side effects can include incontinence and erectile dysfunction; however, rates of erectile dysfunction are getting better with refined techniques.

Radiation Therapy

External beam radiation or brachytherapy (where seeds that give off radiation are implanted into the prostate) are both safe and highly effective. Side effects can include fatigue, urinary irritation, and bowel issues, although typically they are not long-lasting. As with surgery, radiation can also lead to issues with sexual function.

Hormone Therapy

Hormone therapy to reduce testosterone levels can slow and improve outcomes of more advanced prostate cancer. Hormone therapy medications can be combined with other treatments, and may be prescribed for different lengths of time.

Newer Treatments

Focal therapies, such as cryotherapy (freezing) and high-intensity focused ultrasound (HIFU) are prospective treatments being studied for localized cancer who want treatment but do not want the side effects.

The Role of Second Opinions: When and Where

Getting a second opinion for a cancer diagnosis should never be construed as distrust in your doctor; it is a smart step for getting information in whatever way is possible. Most oncologists, if not all, not only recognize this but also encourage second opinions, particularly with complex cases.

A second opinion can be particularly useful when:

• Your cancer is borderline between active surveillance and treatment
• You're trying to choose between surgery and radiation
• Your situation is complicated because of your age, other health conditions, or family history
• You want to confirm that you've explored everything you're considering

Many large cancer centers have programs that are specifically designed to offer second opinions. Many have formalized review processes where multidisciplinary teams discuss each case together.

The Support System: You're Not Alone

One of the most difficult parts of being diagnosed with prostate cancer is how isolating it can feel. It can often feel like men should simply "suck it up" and deal with it alone. It is important to note that both the best medical and emotional outcomes for all men actually occur when men build a strong support system around themselves.

Partners and Family: Navigating Relationships Through Diagnosis

A prostate cancer diagnosis doesn't happen just to you—it happens to everyone who loves you. Partners may be on their own emotional rollercoaster. They could be feeling helpless, scared, angry, or completely overwhelmed with their sudden need to consult medical jargon and decide on treatment. Communicating with each other is essential, even though it can be difficult. You want to shield your family from your fear, while they want to shield you from fear. While this reciprocal support stems from caring intentions, it can unfortunately lead to a wall entering the time in your life when you need connection more than anything.

Some of these practical strategies that many couples find useful are:

• Go to medical appointments together whenever possible
• Take turns being the "note taker" in meetings with the doctor
• Carve out time to have discussions about fears and concerns without trying to "fix" one another
• Attend couples counseling or find support groups for cancer patients and families
• Make decisions about how much to disclose to children, other family members, and friends

The Work Situation: How and What to Disclose

Disclosing a cancer diagnosis to an employer and coworkers is a very individual decision, but it is worth thinking through the implications of this decision before the time comes. I will explain some considerations followed by the legal piece of this topic. The ADA (Americans with Disabilities Act) protects employees with cancer from discrimination and mandates reasonable accommodation. A reasonable accommodation could be making allowances for a flexible schedule while you attend medical appointments, taking time off for treatment, or modifying or changing temporary job responsibilities.

The decision is practical, depending on workplace culture, the relationship with your supervisor, and the nature of your job. Some men report feeling pleasantly surprised by colleagues offering support after disclosing their diagnosis. Other men prefer not to disclose their medical information and manage appointments and treatment under the radar.

No matter what you decide to do, here are some things to think through:

• Are you going to want time off for treatment or recovery?
• Will you be accessing sick leave or disability benefits that would require disclosure?
• Do you have coworkers who you trust to help cover work while you attend medical appointments and treatment?
• How confident are you that your diagnosis could become part of the workplace world?

Support Groups: Finding Your Tribe

Support groups often elicits two very different messages; appealing to some men and very horrifying to others. Both are justifiable, but being informed about what contemporary cancer support actually looks like is worth some elaboration before making a snap judgment.

Support groups can look like many things nowadays. Support groups can look like traditional intimate face-to-face support groups, online discussion boards, one-on-one peer mentoring programs, and groups for a variety of ages, stages of disease, or types of contemplated treatments. Some groups may be more medical or practical based, while others may focus on emotional or coping support. Many men testify how important it is to talk to someone who has undergone any of the treatment of prostate cancer. Sometimes they reveal insights that not even the best physicians can explain.

These conversations might cover everything from what to expect during recovery to how to talk to your kids about your diagnosis. If formal support groups don't appeal to you, consider informal connections. Many hospitals and cancer centers can connect you with other patients who are willing to share their experiences. Sometimes a single conversation with someone who has walked this path can be more valuable than hours of internet research.

Prevention and Risk Reduction: What's Within Your Control

While we can't prevent prostate cancer entirely, emerging research suggests that certain lifestyle factors may influence both the risk of developing the disease and its progression if it does occur.

Diet and Nutrition: Separating Science from Hype

The internet is full of claims about "cancer-fighting" foods and "prostate superfoods." While nutrition marketing can be overblown, legitimate research has identified some dietary patterns that may influence prostate cancer risk.

The Mediterranean Diet

This eating pattern, rich in fruits, vegetables, whole grains, fish, and olive oil, has been associated with lower risks of several cancers, including prostate cancer. It's not any single component but rather the overall pattern that seems protective

Lycopene

This antioxidant is present in tomatoes (particularly when cooked), watermelon, and pink grapefruit. Some studies suggest it is promising. However, there is not enough evidence to justify supplementary forms of lycopene—it is much more sensible to consume it in a food source.

Soy Products

Several studies show that men who regularly consume soy products may have reduced risk of prostate cancer. It may also account for some of the difference in rates of prostate cancer seen in patients from Asian backgrounds compared to Western patients. However, a number of factors could be involved including biology.

Red Meat and High-Fat Dairy Products

Some studies show correlations between consuming high amounts of red meat or high-fat dairy products and increased risk of prostate cancer. Although the mechanisms are not known, it may have to do with inflammation, hormone levels, or other factors completely.

What about Supplements

Despite hefty marketing related to the benefits of vitamins and/or minerals, most supplements have not shown consistent benefits for prostate cancer prevention. In fact, some studies suggest that high doses of either vitamin E or selenium for prostate cancer may even increase risk. The best method of obtaining nutrients is by whole foods rather than pills.

Exercise and Physical Activity: The Underutilized Medicine

Physical activity is one of the most consistently beneficial interventions in all of medicine. Prostate health is no different. Exercise is associated with lower risk of prostate cancer, more favorable outcomes for men who do have prostate cancer, and also improved quality of life during and after treatment. Not only do you have to be an extreme athlete or have a gym membership to reap the benefits. Moderate activity such as brisk walking, swimming, cycling, or even gardening can be beneficial to health. The key to health benefit is not in intensity, but rather in Physical activity can help men dealing with fatigue, depression, and loss of muscle mass while on treatment. More than half of cancer treatment centers offer a physical activity program geared to cancer patients.

Managing Stress - Its More Than Relaxation

While chronic stress may not cause cancer, it does influence your immune function, sleep quality, and lifestyle choices that could raise cancer risk. A man with prostate cancer is likely to have a fair amount of stress, which can impact treatment decisions, recovery, and overall quality of life.

When we think about managing stress, it can but doesn't have to be your traditional meditation retreat, yoga, etc. (which may be helpful for some men!), but rather may include:

• Regular physical activity
• Reconnecting with friends and family
• Hobbies/interests away from work
• Getting quality sleep
• Moderating alcohol
• Finding a healthy means to identify your emotional struggles

Environmental Factors - What We Do and don't Know

There have been some studies that describe workplace exposure to specific agents as being associated with an increased prostate cancer risk. For example, farmers, painters, or men with pesticide exposure may have an increased risk. However, knowledge of occupational exposures is still developing. Most men do not need to be excessively concerned with occupational exposures, but if you are working in an industry with known cancer exposure - it is incumbent upon you to know and operate according to best safety practices.

Economics and Prostate Health - Understanding Costs and Coverage

The health care cost and health care coverage can place a different level of stress on an already chaotic time. Understanding your insurance coverage, potential out of pocket expenses, along with looking for resources can lessen the financial surprises and help you make the best informed decisions.

Insurance Coverage: What is Typically Covered

Most health insurance policies, including Medicare, typically cover prostate cancer screening, diagnosis, and treatment. However, coverage specifics may vary widely. For example, PSA tests are generally covered as preventive care, but at least one plan has age cutoffs or a system where in order to be covered, you must sign that you had a shared decision-making conversation with your doctor. Unless otherwise stated, treatments for prostate cancer would generally include some combination of surgery, radiation therapy, chemotherapy, or a hospital stay, but you will have co-pays or deductibles to pay in conjunction with the insurance coverage.

For some of the newer treatments/procedures, your insurance might require some sort of qualification in order for them to be authorized ahead of time, or to even be covered in the first place if they are deemed actuarially experimental by the payer. You should review your benefits prior to needing them in case you are in a situation where you are feeling vulnerable after being diagnosed with a new condition (if the condition itself does not create a feeling of vulnerability).

The Cost of Active Surveillance

One cost that tends to be overlooked for the monitoring of active surveillance. One might think that by avoiding treatment would be a good way to save money in the short and long run, and this could be correct, however active surveillance, because you do not receive treatment, means that you end up going to the doctor again, with periodic PSA tests, periodic biopies, and sometimes MRIs. All of these costs might add up, but they do tend to be more than just avoiding treatment.

Financial Assistance Programs

There are patient assistance programs for the expensive cancer medications offered by many pharmaceutical companies. Non-profit organizations will have grants for treatment, travel, and even living expenses while you are undergoing treatment. Many cancer centers will have social workers who can help you find resources and programs that you may have never heard of. The American Cancer Society, CancerCare, and others have updates databases of financial assistance programs. Don't let pride get in the way of exploring these resources you may need.

The Future of Care for Prostate Cancer

Medicine is advancing at an extraordinary pace, including care for prostate cancer. Understanding trends and advances can help you ask better questions and make choices about how care may be different from what it is today.

Precision Medicine: Your Prostate Cancer is Not Just a Prostate Cancer

Influential advances in cancer care will be increasingly precise. Instead of treating all prostate cancers the same way, the trend now is to begin to use genetic testing from either the patient or the tumor itself to inform treatment decisions. Several genomic tests are available now (Oncotype DX Prostate, Prolaris, and Decipher, to name only those that are already out) that will help predict how aggressive a specific cancer will be and how it will respond to different treatments. These tests are becoming more widely available and may change advice on whether to utilize active surveillance or treat dab treatment once initiated.

Immunotherapy: Capitalizing on the Bodies Natural Defenses

Although immunotherapy has transformed treatment choice for many cancers, immunotherapy in prostate cancer is still being determined. Early results are promising for specific forms of advanced prostate cancer, and work is ongoing to apply the advances into other areas.

Advanced Imaging: An Advanced Approach to Detect & Control Progress

Imaging technology in our society continues to become increasingly sophisticated. PSMA PET scans, which can detect very small amounts of prostate cancer throughout the body, are going to become more available, and are anomalously advancing imaging. These scans can assist with initial staging, identifying recurrence following treatment, and quality of monitoring while on treatment.

Artificial Intelligence: Supporting Human Decisions

Artificial Intelligence (AI) is starting to assist with everything from reviewing biopsy slides to evaluating MRIs and predicting treatment effects. AI is not going to replace doctors but might help them to confirm a diagnosis or treatment recommendation.

The Human Moment: What to do if it resonates with you

If you have read this and feel a knot in your stomach, as some of it hits a little too close to home, then here is your plan of action.

Don't Panic. The odds still favor that it is a benign, treatable problem.

Write it down. For a week, keep a small diary. Note how many times you go at night. Write down if you felt urgency or had any pain. Note it down objectively. This is very good information for your doctor.

Make the Call. Call and get an appointment with a primary care doctor or urologist. This is the hardest and most important step. Be completely honest and direct. You do not have to be embarrassed. Simply say, "I have been having some changes in urination, and I want to get it checked out." Doctors hear this every single day. You are not going to shock them.

Have the Conversation. Your doctor will probably start by talking about your symptoms, your risk factors, and your general health. Your healthcare provider may conduct a Digital Rectal Exam (DRE), which is a quick and physical examination of the prostate. They may also order a PSA blood test. This would be an opportunity for you to discuss any questions or concerns you may have about the pros and cons of further testing. The distance from experiencing a symptom, to seeing a doctor, to having a definitive diagnosis, is a journey you take with your doctor, focusing on evidence and staying calm.

The Bigger Picture: Masculinity, Health and Changing Conversations

There is something larger at play in men's reluctance to seek out medical assistance, and that deserves recognition. Traditional masculine ideals still often involve values of stoicism, self-reliance, and physical toughness. These can be values we applaud, but they can also become barriers to health when they prevent men from pursuing care, or acknowledging that they can be vulnerable.

The conversation around masculinity and health is beginning to change. More men are understanding that taking care of their health, including prostate health, does not demonstrate weakness, it demonstrates responsibility to yourself and those who count on you. Male athletes talk openly about their mental health. Celebrities talk about receiving a cancer diagnosis. Social media has created spaces for men to talk about experiences their fathers and grandfathers may have kept to themselves. These conversations, when they happen, happen gradually and unevenly, but changing the narrative is happening.

If you find yourself thinking about seeking help for medical care, try to think about it differently. Going to your doctor is not giving up—it's gathering intelligence. Getting screened is not admitting fear—it's taking ownership. Talking to your family about your health concerns, is not burdening them—it's letting them be part of something important that you are doing.

Living Forward: Life After a Diagnosis

Whether your journey related to your prostate, concludes with you receiving reassurance that everything is normal, an understanding that you have BPH that is managed with medication, or the news that you have cancer that will require treatment, life goes on. You will potentially have been changed as a result, but you do not have to be defined by that change.

Many men report that having to deal with prostate issues, even cancer changes your perspective on what matters. Relationships matter more to you. You have a different perspective on time and its value. Health is no longer something to take for granted, but something you work to take care of. I do not suggest this is romanticizing a difficult experience. I simply recognize that people are pretty adaptable. While you may spend days or weeks in disbelief after symptoms or your diagnosis, you will soon be engaged in solving practical challenges. Treatment becomes routine within a week or two. Side effects, if they happen, become part of a new routine, and new normal becomes something you adapt to.

No one said the goal is to return to the exact person you were before the symptoms appeared—that is neither possible, or desirable. Rather, the goal to continue the journey of life, forward, with the person you are becoming, influenced by this story, but not limited by it.

In the end, perusing prostate health is not about making a cancer fear, it is ultimately about taking ownership of your wellness. It is ultimately about your quality of life - sleeping through the night, a road trip with appropriate bathroom breaks, and living your life without discomfort and worry. Those little whispers from your body are just its way of talking to you. The most powerful thing you can do is learn to listen.