Ladies: Check Your Prostates

By Dan Zenka, APR

Okay…you may not have one physically, but if you are married to a man or care about other males in your life, you might as well resign yourself to becoming an advocate for this small and mysterious part of the male anatomy. Men are often their own worst enemy when it comes to their healthcare, making a strong dose of feminine persistence just what the doctor ordered. Here’s an introduction to the number one men’s health issue that might be affecting someone you love.

Prostate cancer affects one of every six American men. For those who are African American or have a family history of the disease, the odds are one in three. As the second most prevalent form of cancer for men after skin cancer, prostate cancer is projected to claim more than 27,000 lives in the United States this year, with an additional 192,000 new cases diagnosed.

In light of these figures and the fact that nearly 2.5 million American men and their families are facing the disease, it is baffling—perhaps unconscionable—that this disease is among the most misunderstood and least talked about types of cancer.

The Paradox of Being Male

Throughout the ages men have been taught that they must be strong, virile hunters, gatherers, and defenders of their families. Over time this societal mandate has ingrained a false sense of invincibility—one that seemingly exempts men from having to pay attention to their physical ills or see their doctors for annual checkups. The same pressure often leads them to feel extremely vulnerable and reluctant to discuss their self-perceived weaknesses when diagnosed with health problems—especially those that lie below the belt.

“When women are diagnosed with breast cancer, they go on the offensive,” explains Jonathan Simons, MD, president and CEO of the Prostate Cancer Foundation (PCF), the world’s leading philanthropic supporter of advanced research for finding a cure. “They open lines of communication with family and friends, they conduct extensive research, and they mobilize with pink ribbons and races. In contrast, too many men shut down and shut up. They are convinced that they can fight the battle alone. It’s ironic. By doing so they are actually shirking their roles as protectors and contributing providers for their families and partners.”

Many men refuse to submit to annual physical exams and screenings. Yes, it’s woefully hypocritical considering the myriad tests, exams, and procedures they expect women to endure to remain healthy moms, sexual mates, and partners. Moreover, the very patients who are afflicted with prostate cancer often prefer not to talk about it, making questions about the prostate and the cancers that can affect it plentiful.

Everything You Should Know but Wouldn’t Ask

Men and their families should not be embarrassed if they do not know what the prostate is, where it is located, or what it does. I cannot remember my high school biology teacher, Brother Patrick—or anyone else—ever discussing the prostate and its function, so I wasn’t too astounded when I learned that in a poll conducted by the PCF a few years ago 60 percent of women responded by saying they knew they had a prostate but couldn’t identify its location. Ding! Wrong answer.

The prostate is an important part of the male reproductive and sexual anatomy. The small gland, about the size and the shape of a walnut, is tucked deep inside the lower extremities beneath the bladder, above the testicles, and in front of the rectum—where it is clearly out of site and out of mind. Its role in life is to create protective seminal fluids that mix with sperm cells and help them along their way. It’s elegantly small, simple, and unobtrusive—until something goes wrong.

Battling Prostate Cancers—Yes, Cancers with an s

Prostate cancer is not one disease. It’s a problem that fuels misconceptions about this cancer and creates understandable confusion when it comes to screening, diagnosis, and treatment. One treatment option doesn’t serve all patients.

“We fund research on more than six molecular and clinical subtypes of prostate cancer,” explains Dr. Simons. “Some are lethal, while others do not require treatment. We do not yet have genomics- and epigenomics-based tests that can distinguish between the two, thus overtreatment often occurs to ensure that a patient’s cancer doesn’t progress into advanced, metastatic disease. Many of our funded research projects are focused on identifying cancer-specific biomarkers that will deliver better diagnostics, treatment decision tools, and progression and response measurements.”

To Screen or Not to Screen

Due to concerns about overtreatment and raising unnecessary anxiety, there has been increased debate over the importance of annual screenings for prostate cancer using the prostate-specific antigen (PSA) test and a digital rectal exam (DRE). This past March the New England Journal of Medicine published two conflicting papers on the value of screening, based on studies conducted in North America and England. Following much analysis, many medical experts agree that the larger (U.K.) study, conducted over a much longer time span supports the idea that early detection and treatment does indeed save lives. The PSA test, even with its limitations, remains an important tool in the diagnosis and the treatment of prostate cancer.

In a follow-up commentary, Patrick C. Walsh, MD, of Johns Hopkins Medical Institutions wrote: “What is the take-home message? If you are the kind of person who doesn’t wear a seatbelt nor goes regularly to the dentist or your family doctor for a checkup and are not worried about dying from prostate cancer, do not undergo PSA testing. On the other hand, if you are a healthy man age 55 to 69 who does not want to die from prostate cancer, the European trial provides conclusive evidence that PSA testing can save your life.

More recently, the American Urological Association revised its screening guidelines to recommend that all men receive a baseline screening at age 40 and then determine with their physician how often subsequent screening should occur, based on family history and individual health factors.

As for the issue of undue anxiety, there is a stronger argument that a vial of blood and a few seconds of swallowed pride during the DRE exam can provide more peace of mind by eliminating the question Could I have cancer? and the consequence of catching it after it has progressed to an advanced, more life-threatening stage. Personally, I like knowing that early detection and treatment provide a five-year survival rate greater than 95 percent. If I hadn’t already started my own schedule of annual screenings, I’d be calling my doctor today.

PSA Testing: One Step at a Time

The PSA test is a diagnostic beginning, not an end. Its biggest limitation is that it is not cancer-specific. I have heard it best explained as a smoke alarm that can alert us to potential problems in the prostate, but it cannot distinguish between a full-blown fire fueled by cancer or one of several other medical conditions, such as an enlarged prostate or prostatitis, that can be creating smoke. This data, combined with the DRE that provides a tactile assessment for the presence of tumor growth, gives physicians information that may lead them to recommend a needle biopsy to determine if cancer cells are present in the prostate.

Becoming Number Six

Patients whose biopsies come back positive for prostate cancer join the one in six American men who will be diagnosed with prostate cancer each year. But it isn’t a foregone conclusion that they need to join the 27,000 men who die annually from the disease. It is prudent at this stage to remember that some prostate cancers are lethal and require aggressive treatment, whereas others most likely do not require treatment. Patients with the second classification of cancer will die with, not from, prostate cancer. But, as referenced earlier, we cannot yet differentiate between the two.

At the point of diagnosis, men (and their partners) need to be active participants in the treatment plan. Personal research is needed along with in-depth consultation with a known and trusted physician. Together, the pros and cons of various treatment options can be thoroughly weighed and selected based on each individual’s medical status. Depending on the specific treatment selected, a detailed follow-up plan will also be outlined (see “Common Treatment Options for Prostate Cancer”).

It’s Time for Men to Step Up

In a recent campaign, Kaiser Permanente ran a series of print and broadcast ads proclaiming, “I have cancer. It doesn’t have me.”There is both wisdom and inspiration in the statement. While there is still much progress to be made in eliminating prostate cancer, we now know that early detection and treatment can drastically improve outcomes—in fact the death rate from prostate cancer is now nearly 40 percent lower than what was once predicted. Moreover, scientific studies are beginning to underscore the importance of nutrition and exercise in preventing certain cancers and improving survivorship. Treatments are now less invasive and better tolerated by patients, and new therapies are close at hand.

The time is long overdue for men (prompted by the women who love them, if needed) to move beyond their traditional behaviors, make prostate cancer something to talk about, and proactively develop their personal programs for protecting their prostate health.

For more information on prostate cancer symptoms, treatments, prevention, and the latest advances in research, visit www.pcf.org.

A Woman’s Guide to Prostate Cancer

  • Understand and make prostate cancer something to talk about; share what you know with your partner, family, and friends.
  • Know your partner’s family history and share it with sons and relatives.
  • Recommend diets low in fat, carbohydrates, and processed sugars in combination with regular exercise.
  • Be sure your partner talks to his doctor about a baseline screening (PSA and DRE) at age 40 and develops a schedule of subsequent screening based on his medical history.

Common Treatment Options for Prostate Cancer

  • Active surveillance. For those men diagnosed with slow-growing cancers, immediate treatment might not be recommended because of the possible side effects of other treatments. Recent studies have shown that men over 65 with low-grade cancers can do well with this approach.
  • Surgery. Because prostate cancer grows through a number of small tumors scattered throughout the prostate, the entire prostate plus some surrounding tissue must be removed. Depending on how much tissue outside the prostate must be removed, side effects can include incontinence and erectile dysfunction. Fortunately, improvements made in nerve-sparing technologies are lessening the impact of these side effects.
  • Radiation therapy. Oncologists can kill prostate cancer cells by delivering high doses of X-rays to the prostate via external beam radiation or intensity-modulated radiation therapy. Or, in a treatment called brachytherapy, small radioactive pellets can be injected into the prostate. Over the course of a year, the radioactive matter degrades, leaving harness pellets inside the prostate.
  • Proton therapy. For many patients proton therapy offers a new treatment option without the side effects of radiation. This treatment is relatively new and costly, however, limiting patient access.
  • Hormonal therapy. In advanced, metastatic cases of prostate cancer, testosterone can actually fuel the growth of cancer cells. With hormonal therapy patients are treated with drugs to block the effects of testosterone.
  • Chemotherapy. Also utilized in advanced, metastatic cases of prostate cancer, chemotherapy floods a patient’s system with cytotoxic drugs that kill fixed and circulating tumor cells.