Editor's Note: September is Prostate Cancer Awareness Month. In partnership with the Prostate Cancer Foundation, Modern Car Care presents the following article as an educational service to our readers.
Prostate cancer. One out of every six American men will be diagnosed with it in their lifetime. For men who have a family history of the disease or who are African-American, the odds are one out of 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 U.S. 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 may be the most misunderstood and least talked about type of cancer.
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 exempts them from having to pay attention to their physical ills or seeing their doctors for annual checkups. The same pressure often leads men 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, M.D., 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 go the battle alone. It’s ironic. By doing so they are actually shirking their roles as protectors and providers for their families and partners.”
Because the very patients who are afflicted by prostate cancer often prefer not to talk about it, questions about the prostate and the cancers that can affect it are 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, 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 a small gland, about the size and shape of a walnut, found only in men as it is an important part of the male reproductive and sexual anatomy. It 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 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.
More than One Prostate Cancer
Prostate cancer is not one disease. This is 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 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, over treatment often occurs to ensure that a patient’s cancer doesn’t progress into advanced, metastasis disease. Many of our funded research projects are focused on identifying cancer-specific biomarkers that will deliver better diagnostics, treatment decisions tools and progression and response measurements.”
To Screen or Not to Screen
Due to concerns of over treatment and raising unnecessary anxiety, there has been increased debate over the importance of annual screenings for prostate cancer using the PSA (prostate-specific antigen) 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 treatment of prostate cancer.
In a follow up commentary, Patrick C. Walsh, M.D., of Johns Hopkins Medical Institutions wrote: “What is the take home message? If you are the kind of person who doesn’t wear a seat belt nor goes regularly to the dentist or your family doctor for a check-up 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 55-69 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 few seconds of swallowed pride during the DRE exam can provide more peace of mind by eliminating the question of whether or not you