As a urologist and a physician who has dedicated his life to men’s health issues, I am amazed at the response I get when I tell someone that every year more men are diagnosed with prostate cancer than women are diagnosed with breast cancer. The response I usually get is: How come I didn't know that? The reason is that women have been incredibly successful at raising awareness of breast cancer. Just turn on a football game on Sunday and see the wash of pink. Pink socks, pink shoes and pink mouth guards. Even the footballs themselves have the breast cancer logo with the pink ribbon.
The high profile of breast cancer relative to prostate cancer translates into a huge discrepancy in research on the two diseases. For example, in 2010, the National Institutes of Health spent almost $4.5 billion on breast cancer and its Women’s Health Initiative. For prostate cancer? Only $331 million. How much for the Men’s Health Initiative, you wonder? Zero. There is no Men’s Health Initiative, despite the fact that the life expectancy of a man is 5 years less than for a woman and that men die of ischemic heart disease at a rate 50% higher than women.
If all this is not enough to get your blood boiling, recently the United States Preventive Services Task force advised healthy men not to get a PSA blood test to screen for prostate cancer. What a mistake. (To read more about this, click here.) Men are already in denial of health issues – we certainly don’t need another reason for men not to go to the doctor.
Prostate cancer is the second leading cause of cancer in men, second only to lung cancer. One out of every 6 men with prostate cancer will die of the disease. Prostate cancer death rates have dropped significantly from 1995 to now. The main reason: PSA testing and earlier detection.
Today we have a much better understanding of the strengths and limitations of the PSA test. In addition to detecting prostate cancer, we now realize that the PSA test is great for detecting benign (non-cancerous) prostate disorders, such as prostate infections (prostatitis) and benign prostate enlargement or BPH. These non-cancerous conditions affect many more men than does prostate cancer. Before proceeding with a biopsy looking for cancer, the goal of PSA testing should be to rule out prostatitis and BPH first. Understanding and implementing this approach makes the PSA test much more effective.
When we do biopsy the prostate and the result is cancer, in over 50% of cases, the grade of the cancer is typically low. In these men, we begin an active surveillance program that usually avoids the need for surgery or other invasive treatments. For many men with low grade prostate cancer, surgery and other forms of treatment may be avoided by diligent, increased surveillance.
Now, it's important to remember that 20 years ago when I was a resident (before PSA testing was an option) most of the men we saw in the clinics where dying of metastatic disease from late stage prostate cancer. These men had diffuse bone metastasis with severe pain. Today, PSA testing has allowed us to greatly reduce the diagnosis of "late" stage prostate cancer. While late-stage prostate cancer remains incurable, modern treatments have prolonged and improved the lives of many of these men.
Lastly, PSA screening is especially worthwhile for men who have relatives that have died from prostate cancer, and African Americans, who have a higher chance dying of prostate cancer. For those men who have high grade cancer that are detected early by PSA, and there are many of those, the PSA test is a lifesaver.
Finally, we men need to learn how to help themselves. Let’s take a page from the breast cancer advocates and insist that the spotlight finally shine on men and their health issues. Perhaps next year the NFL can teach us to take care of our own health!