Written by: Dr. Ibrahim
September is National Prostate Cancer Awareness month! But the truth is, this deadly disease deserves attention all year long.
Here are the facts:
● Prostate cancer is the most common cancer in men (after skin cancers).
● Prostate cancer kills more men than any other cancer (other than lung cancer).
This makes prostate cancer a widespread and very deadly disease!
Prostate cancer often has no symptoms. Men can’t readily exam their prostate. When we compare this to breast cancer, a self-exam is possible for women. Therefore, the only hope is a proper prostate screening. The statistics for breast and prostate cancer are nearly identical. There is much public awareness surrounding screening, biopsies, and treatment of breast cancer. This awareness needs to be as strong for men and prostate cancer.
The studies have shown that there is only one way to guarantee someone won’t get prostate cancer, and that is castration before puberty. Other more realistic ways to decrease the risk, but not prevent, are the following:
● Healthy lifestyle
● Not smoking
● Physical fitness
● Healthy eating
But these do not prevent its occurrence.
Have I got your attention? Good! Now please share these facts with your primary care provider.
I am a Duke University Board-certified Urologist. My specialty training was in oncology, specifically prostate cancer. I speak to this subject with authority. There is a misperception amongst primary care providers that prostate cancer is slow-growing and a non-life-threatening problem. This was once the way they once viewed breast cancer. Prostate cancer needs the attention and public education that breast cancer has received. My views may differ what you might “google,” but whoever went to Google Medical School? No one!
What should you expect, then, from your primary care provider (PCP) for a proper prostate cancer screening:
● A digital rectal exam (DRE) at each yearly physical
● PSA, prostate-specific antigen, lab
● Screening should start by the age of 50 years old
● In some instances, such a strong family history, or those of African descent, screening should start as early as 40 years old. All men with either an abnormal DRE or a PSA should then undergo a prostate biopsy.
So, you may ask: What about the risks of screening, the false-positives, and false-negative results? What about finding cancer in a man who may not “need” to be treated? I heard that some treatments may be worse than the disease.
This kind of thinking ignores the first two facts that are indisputable!
● Prostate cancer kills more men than any other cancer other than lung cancer.
● Prostate cancer is the most common cancer in men.
The “risk” of a PSA is a blood draw! It is illogical to assume that getting a PSA is a “risk” equivalent to unnecessary surgery. That’s like saying getting a mammogram is a risk because it may lead to unnecessary excision. Screening means early detection. Elevated PSA does not always mean prostate cancer. Elevated PSA does mean that you need a full evaluation by a urologist.
There are standardized approaches to the evaluation of an elevated PSA. If a prostate biopsy is necessary, in most cases it is conclusive. Early diagnosis is key. Routine screening starting at age 50 is recommended so that you do not have a small cancer that is left undiagnosed and untreated. The trend is a decrease in breast cancer mortality as compared to prostate mortality—the reason for this is public awareness education and increased screening for breast cancer.
Again, screening is necessary as early diagnosis is the key! If diagnosed early, there is nearly a 100% survival rate. If diagnosed after the disease has spread, or metastasized, it’s nearly always fatal!
And the argument that a “biopsy of the prostate may lead to treating men who don’t need to be treated for prostate cancer” is like saying, “you have a very high likelihood of having an unexploded grenade near your rectum, but we aren’t going to look and see if you do!” Ludicrous!
If a man’s PSA increases in a manner that is worrisome for prostate cancer, or his DRE is abnormal, doesn’t he deserve to know if he has prostate cancer? Don’t allow that grenade, with the pin pulled, to remain in your body! The patient should decide if he wants to investigate further or to treat this deadly cancer. Don’t let your PCP decide for you!
If you have a biopsy positive prostate cancer, then further evaluation and staging is necessary for treatment decisions to be made by you and your urologist.
Are the treatments dangerous?
Not as dangerous as undetected cancer and delay in the treatment of early cancer. Treatments can cure men who have an organ-confined disease, early diagnosis, nearly always!
● Surgical removal of the prostate
● Radiation of the prostate
Treatment options have pros and cons that will need to be discussed with your doctor.
Men, know that prostate cancer carries the same risk of breast cancer without the possibility of self-screening. Insist that your primary care provider screens appropriately. Make Prostate cancer awareness month a year-long awareness for both patients and their doctors!