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Health > More Health StoriesWinter 2009 IS Magazine3/18/09 IS Online

Understanding Prostate Cancer

By Michael Chapman

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 body.

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.

Healthy Habits

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 prostate cancer.

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.”

Island Scene Online is not intended to replace the advice of health care professionals. Please consult your physician for your personal needs and before making any changes in your lifestyle.
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