Prostate Cancer: Aware and Confused
By Michael Kaufman
September, in case you didn’t know, is National Prostate Cancer Awareness Month. Maybe you haven’t heard of it because no one has come up with a clever symbol like the pink ribbon used to highlight breast cancer awareness. Neither breast cancer nor prostate cancer is anything to joke about but somehow this reminds me of an old joke about a mohel, whose job is to perform ritual circumcisions, who rents a storefront to drum up business. He puts a sign bearing his name and profession in the window. Then he decorates the rest of the window with herring.
“So,” asks the first person who enters, “why do you have herring hanging in the window?”
“What should I have in the window?”
Perhaps there is a bit of subconscious irony at play in thinking of the joke: The prostate is attached to bundles of nerves and blood vessels linked to the penis. Ritual circumcision occurs at the beginning of a male baby’s life at the tip of his penis, whereas the prostate gland, located just in front of the rectum, is a matter of concern for the aging adult male.
Be that as it may, prostate cancer is among the most common cancers for men living in the United States and continues to take a devastating toll on thousands of lives each year. After skin cancer, it is the second most common cancer in American men—second only to lung cancer as a cause of cancer deaths. The National Cancer Institute estimates that 238,590 new cases of prostate cancer will be reported in the U.S. in 2013 and that 29,720 men will die of the disease.
Thanks to recent advancements in treatment, however, nearly 100 percent of men are still alive five years after diagnosis of prostate cancer; more than 93 percent are alive 10 years after diagnosis, and approximately 79 percent are alive after 15 years. While those numbers are encouraging, the need for greater awareness remains: Prostate cancer rarely causes symptoms until the disease is far advanced and more difficult to treat. Thus, screening is essential for at least some men aged 40 and above.
Many men are resistant to screening because the physical evaluation begins with a digital rectal exam (DRE). As described in a Johns Hopkins Medicine White Paper on prostate disorders, the DRE, “which involves the insertion of a gloved, lubricated finger into the rectum, is mildly uncomfortable but extremely important.” I don’t know about you but I don’t like having “a gloved, lubricated finger” inserted into my rectum one bit. I waited three years before going to my most recent “annual” physical examination by my internist because my memories of past DREs made my skin crawl.
A couple of years ago the Prostate Cancer Foundation launched a brilliant campaign at the beginning of Prostate Cancer Awareness Month that used humor to try overcome men’s reluctance to undergo the DRE. The campaign, featuring a character named “Branko, the Prostate Czech” was a big success. (Watch the video at www.youtube.com/watch?v=6Wal7b6kXgU)
But the DRE is merely the first step in a dizzying process of diagnostic and potential treatment choices. At each step, starting with the Prostate Specific Antigen (PSA) test, there is widespread disagreement among medical specialists and conflicting sets of guidelines. As noted by the Mayo Clinic, “A number of major professional organizations and government agencies have weighed in on the benefits and risks of PSA testing. The American Cancer Society, the American Urological Association, the American College of Preventive Medicine, the Centers for Disease Control and Prevention, and the U.S. Preventive Services Task Force all recognize the controversy surrounding screening with the PSA test and the lack of firm evidence that screening can prevent deaths from prostate cancer.” The full Mayo Clinic explanation of the risks associated with prostate cancer screening is available at www.mayoclinic.com/health/psa-test/MY00180/DSECTION=risks
In August an international panel of experts at the Prostate Cancer World Congress in Melbourne, Australia, issued a five-point “consensus statement” in an attempt to bring clarity to the confusion that exists with existing guidelines and to offer “reasonable and rational guidance for the early detection of prostate cancer today.” I read the statement. I’m still confused.
Michael can be reached at email@example.com.