It’s a legendary truth. Most men hate going to the doctor. And why get a checkup
anyway? One good reason is because men have a prostate. The prostate is a walnut-sized
gland below the bladder and in front of the rectum. This gland surrounds part of
the urethra, the tube that carries urine from the bladder to the outside of the
Why focus on the prostate?
- Because prostate cancer is the most common cancer affecting men in the U.S.
- Because if caught early, it’s one of the most treatable cancers.
- Because early prostate cancer often has no symptoms.
- Because checking his prostate could save a man’s life.
Why aren’t men standing in line to get their prostates checked? One reason
is the widespread existence of some myths that either scare a man to death or lead
him to believe he can safely ignore his prostate.
The most common myth is that prostate cancer is an “old man’s disease,”
which is a half truth. Certainly, a man’s chance of getting prostate cancer
increases dramatically with age. That doesn’t mean men under 70 don’t
need to get screened. My friend’s healthy 47-year-old husband just got diagnosed,
and is very glad he didn’t put off his doctor’s appointment as he was
tempted to do. In his words, “That appointment found my prostate cancer, and
the treatments have saved my life.”
Two other myths are frightening, but false. One is that if a man has symptoms, he
has prostate cancer. Absolutely not true. Benign prostate hyperplasia (enlarged
prostate) is very common, very treatable, and is not cancer.
The other terrifying myth is that if a man gets diagnosed with prostate cancer,
he’s going to die. In reality, about 90 percent of the 186,320 men diagnosed
annually are treated successfully, according to the American
Cancer Society (ACS). In the words of oncologist Clayton D.K. Chong, M.D.,
“Men who catch their prostate cancer early before it has had a chance to spread
are usually treated successfully.”
Another myth is that prostate cancer treatments remove all sexual function and bladder
control. While these effects are possible to some degree, they are by no means a
certainty. New nerve-sparing and robotic surgeries produce fewer side effects and
faster healing than previous methods.
The same good news applies to new radiation techniques like implanting tiny radioactive
seeds to radiate a tumor, and “mapping” tumor size, shape and location
so external radiation can be delivered only where it’s needed. Both techniques
spare surrounding tissue, meaning side effects are generally minimal and temporary.
Besides, as John L. Lederer, M.D., of Pacific Radiation Oncology, Inc., points out,
“A man with a prostate tumor is not going to escape side effects by refusing
treatment. He’ll have side effects from the tumor he has neglected. With treatment,
a man can better predict what will happen. He has some control. If he refuses treatment,
he has given all his power to the tumor.”
How Do You Screen for Prostate Cancer?
Most men are familiar with one test, the digital rectal exam, or DRE. In this test,
the doctor feels the prostate gland to see if it’s enlarged or abnormal in
any way. The other commonly administered test, usually used in conjunction with
the DRE, is a blood test that measures a man’s PSA, or prostate specific antigen,
which is an enzyme in the blood.
If the prostate begins to make too much PSA, it could be a sign of an enlarged prostate,
inflammation or possibly cancer. So a rise in PSA could signal the need for a doctor
to investigate further. “The PSA test used with the digital rectal exam is
the best screening technique we have,” says Lederer.
Since every man’s PSA will change over time, the rate of change is often more
important than any single PSA score. That’s why low-risk men older than 50
should be tested annually, which is generally a covered HMSA health plan benefit
once every calendar year. If you are in a higher-risk group, including men with
a family history of prostate cancer or African-American men, talk to your physician
about PSA testing.
Signs and Symptoms
The following symptoms should not send a man into panic mode, but they should send
him to his doctor. It may not be cancer, but if it is, the earlier it is discovered,
the better chance of treating it successfully. He should call for an appointment
if he has:
- Pelvic pain.
- Painful ejaculations.
- Frequent need to urinate.
- Blood in the urine.
- Weak or interrupted urine stream.
- Loss of weight or appetite.
The odds of getting prostate cancer are lessened if certain daily practices are
adopted. The first important habit is eating a low-fat diet. Yes, that means less
Portuguese sausage, bacon and SPAM. If you’re reading this and rolling your
eyes, remember how much you weighed in high school? Reducing fat in your diet will
help cut fat from your middle. It’s also helpful to eat more fruits and vegetables.
Frequent exercise is also important. That doesn’t mean you have to run 10
miles or bench press 200 pounds. Set a goal that is achievable, like walking with
a buddy, your wife, or a significant other. An appointment with an exercise partner
works like a business appointment – you both have to show up.
The most obvious recommendation is to quit smoking. Period.
HMSA’s Ready, Set, Quit! Program can help (952-4400 on O‘ahu
or 1 (888) 225-4122 on the Neighbor Islands).
What about the man who has symptoms and is worried, or someone who has already been
diagnosed with prostate cancer? He may feel alone in his situation, but he’s
not. He can call the Hawaii Prostate Cancer Coalition (HPCC) Hotline or the ACS
and talk to another man who has gone through the same thing. He can find out about
screening, support groups and other resources for men living with and living after
The HPCC hotline number on O‘ahu is (808) 487-3295. The toll-free number
for the Neighbor Islands is 1 (877) 626-4722. The ACS number on O‘ahu
is (808) 595-7544; call for Neighbor Island phone numbers.
Shatter the Silence
Unlike women who run races, raise money for research, advocate mammograms, and talk
about breast cancer in every public forum they can find, men remain largely silent
about prostate cancer. Consequently, although prostate cancer is about as common
as breast cancer, prostate cancer awareness among men is much lower than breast
cancer awareness among women.
Ten years ago, prostate cancer got a lot of attention when former Hawai‘i
congressman Sen. Spark Matsunaga was diagnosed with it. Since then, awareness of
the disease has faded. Chong asks, “Why do we have to wait for someone famous
to die? Isn’t each of us worth the effort to raise men’s awareness to
fight this disease?”
If men want their life expectancy to be as long as it is for women, they have to
step up to the plate, according to Chong. “Men need to form groups to encourage
screening for prostate cancer, plan events to raise awareness, and raise money for
research,” he says. “They need to get organized and speak up. We men
are worth it.”