It is Father’s Day weekend. During Mother’s Day, all the attention turns to breast cancer. Now, the attention turns to prostate cancer.
Is this really a threat to most men? How about men who eat a lot of fiber and don’t really think about this? Do men really need to be tested once they turn 40?
If you are a man in the US, your chances of contracting prostate cancer are 1 in 6; your chances of dying from prostate cancer are 1 in 35. If caught early, when the cancer has not spread outside the prostate or adjacent tissue, the 5 year survival rate is nearly 100%. However, if it spreads to other areas in the body, the 5 year survival rate drops to 32%.
Prostate cancer will kill over 28,000 men in the US this year. Do you feel lucky?
[QUOTE=dalej42]
How about men who eat a lot of fiber and don’t really think about this? Do men really need to be tested once they turn 40?
[/QUOTE]
Umm…I’m unaware of any reason why fiber would have an effect on prostate cancer. Perhaps you’re confusing it with colon cancer? 
And while I don’t know of any statistics about prostate cancer, here’s the thing: is it really that much of a hassle to have a finger stuck up yer bum once a year to potentially save your life?
Prostate cancer was largely ignored by the general public for a long time partially because breast cancer advocates have been so vocal for decades. It is the most common cancer of all and the 2nd most deadly in terms of overall deaths in the U.S. behind lung cancer. However, it usually affects older men and prostate cancer tends to be slow growing and very treatable in the early stages. Those treatments however can easily leave a man with total sexual dysfunction and/or incontinence.
The general lack of openness about it follows the stereotypical male/female divide. Most men don’t want to admit that they can’t get it up or they have an issue peeing themselves if that happens. Many men don’t have either dysfunction but there is no way to know in advance. Prostate cancer is so incredibly common that I have often heard the claim that most men will get it if they live long enough. I don’t know if that is technically true but what is true is that more people get prostate cancer than any other cancer yet you don’t here that talked about it that much even among people that you are close to.
It really is that bad yet men tend to not make very good health activists.
One of the big problems with prostate cancer is that its main symptom in the early stages is diffculty in urinating. Which is exactly the same symptom of an enlarged prostate, which tends also to occur in older men (see any number of jokes about middle-aged men having to get up several times in the middle of the night.) By the time a man experiences other symptoms, the cancer has probably spread.
So it’s not just that 1 out of 6 men may get prostate cancer, it’s also that they may dismiss the warning sign as just a normal part of getting older.
My husband was diagnosed the day after he turn 49. He had robot laparoscopic surgery. He is as good as new. Even though it is one of the slower growing cancers, it is nothing to ignore.
Yes it’s a big deal. The only more prevalent cancer in men in the U.S. is skin cancer. A third of all cancer found in men is in the prostate. Right now, there is an ongoing debate in the medical world on how best to diagnose and treat prostate cancer (CaP). The digital rectal exam (DRE) is standard procedure in any physical exam, but it’s not foolproof since it’s limited to what the physician can feel from his entry point. Also, by the time something is detected through DRE the tumor could already have grown to palpable size. There are other newer tests like the PSA test, but this test suffers from significant false negatives as well as false positives (and they’re not cheap). The so-called gold standard is to do a biopsy, but even that’s not foolproof since only a small sample of the prostate is usually tested. Then even if cancer is detected, the problem is to next decide how to treat it or whether to treat it at all. CaP tends to be slow growing, so aggressive treatment may not be necessary. If you do treat it, surgery can lead to undesirable side-effects like impotence and incontinence. Of course, like breast cancer, the key is early detection and treatment. I had a close relative who had CaP and it was detected after the cancer has already metastasized to his bones. The end was very unpleasant. Prostate cancer claimed the lives of some famous men at a relatively young age such as Bill Bixby and Dan Folgelberg. There’s also a long list of famous people (like Rudy Giuliani, Colin Powell, John Kerry, Robert DeNiro) who are survivors.
[QUOTE=bouv]
Umm…I’m unaware of any reason why fiber would have an effect on prostate cancer.
[/QUOTE]
Prostate cancer helped to kill my dad. So yeah, kind of a big deal.
Durn tootin’ it can be a big deal. That is, if you care about living.
Like so many cancers, early detection can make all the difference in the world. I’ve had several friends who got prostate cancer which spread into the bones and rest of the body, and it was not a pretty thing to watch their slow progression toward death.
I’ve had annual exams and PSA tests for many years, and in 2001 (age 74) had sudden increase in the PSA. Doc sent me to a urologist who did a biopsy, and sure enough, had cancer.
I voted to take the “shaped” radiation, which now does not destroy a lot of extra tissue as used to be the case. I went for treatments five days a week for eight weeks.
Very few bad side effects other than tiredness during the last four weeks. Once over, recovered quickly and have been cancer-free since.
Surgery and implanted radioactive “seeds” are other forms of treatment.
Every single male over 40, IMHO, ought to get examined and have a PSA annually. It is a pretty easy and inexpensive way to assure catching anything in the early stage.
Some prostate cancer is fast-growing and very dangerous, other types are quite slow-growing. In many older men who have the slow-growing type, doctors will go with “careful watching and waiting” as many will die of something else befoe the cancer gets them. In any case, it is not something that should be ignored.
[QUOTE=KGS]
Masturbation works, though.
[/QUOTE]
I’m all in.
[QUOTE=KlondikeGeoff]
Every single male over 40, IMHO, ought to get examined and have a PSA annually. It is a pretty easy and inexpensive way to assure catching anything in the early stage.
[/QUOTE]
Unfortunately, it’s not that simple. I wish it was.
At present, medical science is split on the effectiveness of routine screening for prostate cancer in normal risk populations. The American Cancer Society is for it, as is the American Urological Society, but the U.S. Preventive Services Task Force (USPSTF) concludes that the evidence is insufficient to recommend for or against routine screening for prostate cancer using prostate specific antigen (PSA) testing or digital rectal examination (DRE). The American Academy of Family Medicine likewise does not recommend routine screening. Many more groups are also undecided.
The basic problem is that both the digital rectal exam and the PSA test are not specific enough. They can indicate a “false positive” far in excess of most screening tests.
Also, prostate cancer is often found to regress, and many, many men are found to have small prostate cancers at death, that did not cause them illness or debility. Treating these would have caused degrees of illness and other complications, not warrented by the lack of bad outcome.
That results in lots of procedures done on the 'false positives", which may cause more debility and death than they prevent in actual cancer treatments.
It’s a knotty problem, and all us docs are looking for a better method of screening the general population.
Now, if you’re a member of a high risk ethnic group, or have a first degree male relative with a history of prostate cancer, then it’s a different picture.
[QUOTE=Qadgop the Mercotan]
**
The basic problem is that both the digital rectal exam and the PSA test are not specific enough. They can indicate a “false positive” far in excess of most screening tests. **
[/QUOTE]
Better to be tested or not, in your personal opinion? If there are that many false positives, what to do.
Cartooniverse
[QUOTE=Cartooniverse]
Better to be tested or not, in your personal opinion? If there are that many false positives, what to do.
Cartooniverse
[/QUOTE]
I’m not part of of a high-risk population, so I’ve foregone screening so far. I’m 50.
I was asked by a young nurse if I had ever had a “digital” prostate exam and I was like…“umm how do they do that…with like a digital camera or something?”
And she waved her digits at me and said “no with fingers”.
A digital exam won’t always catch an enlarged prostate, my husbands was twice the normal size, but it still “felt” normal to his Urologist.
His PSA was only slightly higher than normal. While both the digital exam and PSA can be valuable tools in finding prostate cancer, the best thing you can do is not to ignore any prostate symptoms. If you are having problems urinating or have sudden urges to go, get yourself checked.
As I’ve pointed out, the only sure way to detect prostate cancer is through a biopsy. But even that procedure has a significant chance for a false negative. Biopsies aren’t a free lunch either since there is the risk of infection. Still, better to do the biopsy if there are other signs of possible cancer (like high PSA readings, abnormal DRE) and go from there. The worse scenario is to discover prostate cancer that is of the aggressive variety and is no longer localized. One positive note is that there are good options for treatment for any clinical stage of the cancer.
[QUOTE=Qadgop the Mercotan]
**The American Academy of Family Medicine likewise does not recommend routine screening. Many more groups are also undecided.
[/QUOTE]
Naturally, being interested in the subject, I’ve followed the various studies and theories. I have been aware of this recommendation, and really have trouble with this sort of thing, just ignoring possible exams because they are not proved 100 percent accurate.
That is like saying, “I have these severe pains in my chest and down my left arm, but because this does not necessarily indicate a heart attack, I’ll just ignore it.”
For crying out loud, what is the *harm *is getting the DRE and PSA even if they are not 100 percent? Even if a false positive occurs now and then, is it not still better to get checked regularly with the best of the tests we have now? The worst that could happen would be you would get a biopsy that proved negative. Painful, perhaps but not life-threatening.
As is well known, a lot of lab and other medical tests give both false positives and false negatives. This is no reason to never get tested for anything, or ever have a physical exam.
The The American Academy of Family Medicine might just as well not recommend routine visits to a physician because no exam can possibly detect every condition or disease.
[QUOTE=Qadgop the Mercotan]
Now, if you’re a member of a high risk ethnic group, or have a first degree male relative with a history of prostate cancer, then it’s a different picture.
[/QUOTE]
I asked my doctor about it at my last appointment because my mother’s been pestering my brother and me to get examined and despite my dad’s diagnosis he still says I can forgo screening until I turn 50.
[QUOTE=KlondikeGeoff]
For crying out loud, what is the *harm *is getting the DRE and PSA even if they are not 100 percent? Even if a false positive occurs now and then, is it not still better to get checked regularly with the best of the tests we have now? The worst that could happen would be you would get a biopsy that proved negative. Painful, perhaps but not life-threatening.
[/QUOTE]
Because the treatment may be worse than the disease.
Given the high rate of false positives, and also given the high rate at which many cases of prostate cancer never go on to cause morbidity or mortality, more people may be sickened, and more people may die from, the biopsies and subsequent treatments than are saved by treatments for the cancer.
And that’s it, plain and simple.
The first thing I learned in medicine was Primum non nocere. “First, do no harm”.
If, in my career, I screen 10,000 people for prostate cancer, and catch it early enough to save 20 of them, That’d be good, right?
Not if to save those 20 of them, 23 of them also die of complications of biopsy or complications of the treatment.
That’s what the experts are arguing about. We may be harming more people than we help if we screen every male 50 and over with PSA and DRE.
Until it can be conclusively shown that mass screening helps more than it harms, I can’t recommend it.
I do screen high risk populations, like older african-americans, and those with a strong family history.
I also screen patients who have symptoms or signs suggestive prostate trouble.
But age and male gender alone thus far don’t automatically mean one must be screened.