It seems to me that one of the “side effects” of writing an opinion column such as this is that readers occasionally offer what is commonly known as “constructive criticism.” Unlike negative criticism which attacks the author, the ideas or opinions expressed, or even the manner in which information is presented, constructive criticism gives the author advice about what to improve on. It gives ideas on what to refine, expand, or otherwise enhance so the critic can help the author “construct” a better piece.

While most of these comments are “after the fact’ and can’t easily be acted upon, I recently received some that were not only pertinent but of such a nature that I can address them. It happened this way.

We were sitting around talking after lunch with Paul and his wife Mary Jean when the conversation turned to my recent columns on prostate cancer. Paul commented that I had done a good job of showing how this disease doesn’t necessarily result in death. However, he followed that up with the observation that I hadn’t included two important topics: what are the symptoms of prostate cancer and what are the cancer screening procedures that guys should insist their physicians perform?

Then Mary Jane chimed in with her suggestion that women would also be interested in knowing about prostate cancer symptoms and screening procedures because, after all, it’s the women in a family that usually take care of health matters, particularly when it comes to their husbands.

I was about to reply that there was only so much space in a column so I couldn’t include everything when I got that wife-to-husband look from my Sweetheart-for-Life which essentially said, “OK, so what are you going to do about it?” There wasn’t much choice – they were right, so here’s what they asked for.

First, a bit of male anatomy. The prostate gland surrounds the urethra at its starting point below the bladder. The urethra is the “tube” through which urine exits the bladder on its way out of the body. The prostate is normally the size of a large walnut but can triple in size when diseased. Because the prostate gland is so close to the bladder and urethra, a prostate cancer tumor may press on and constrict the urethra giving rise to some prostate cancer signs.

According to the National Cancer Institute these may include: weak or interrupted (“stop-and-go”) flow of urine; sudden urge to urinate; frequent urination (especially at night); trouble starting the flow of urine; trouble emptying the bladder completely; pain or burning while urinating; blood in the urine or semen; and a pain in the back, hips or pelvis that doesn’t go away. However, these symptoms may be the result of a variety of other causes including infection and benign enlargement of the prostate and therefore are not conclusive evidence of prostate cancer.

And that leads us to the screening procedures I have dubbed “The Three Pokes” – all of which require a physicians’s involvement. The first “poke” is known as the digital rectal exam (DRE) where a physician pokes a gloved and lubricated finger into a man’s rectum to feel the prostate gland for abnormalities such as enlargement or lumps. Guys jokingly refer to this as “the finger wave.”

The second “poke” is that of a needle drawing blood. Prostate cancer can often be found early by testing the amount of prostate-specific antigen (PSA) in a man’s blood. Although this test can be included in routine lab work it must be specifically ordered by a physician. (Note: as part of Prostate Cancer Awareness Month, free PSA testing is currently being offered by both hospitals in this county.

Guys, this opportunity is not to be missed – it may save your life. My friend Mike, a prostate cancer fatality, didn’t have a PSA test until after the cancer had spread.) OK, if the results of these tests are abnormal, the physician may decide to perform further testing – the third “poke.” This procedure consists of a physician inserting an instrument into the rectum to provide ultra-sound examination and to remove samples of prostate tissue for pathological examination (biopsy) to determine if cancer is present. This is the most definitive test for prostate cancer.

Well, there you have it – a response to the constructive criticism by Paul and Mary Jane and I hope it answers their questions. You know, possible symptoms, such as frequent or difficult urination, are considered comical – good for a laugh at the expense of older men. But prostate cancer is no laughing matter.

As I have said before, “ Take the poke. Prostate cancer is no joke.” – and that appears to be an appropriate way to kinda wrap up this year’s Prostate Cancer Awareness Month commentary. At least that’s how it seems to me.

Editor’s note: Free PSA tests are currently available through Oct. 15 at Greene Memorial Hospital and Soin Medical Center.