Prostate Cancer
By: Michael B. Friedland, MD
Date: January 14,
2008
In my practice far fewer men come into the office for physical exams than women. The reason is simple: the rectal exam. We, men, shudder at the thought, dread the idea, and avoid making appointments for physicals as long as possible until it becomes a point of contention at home. And women are of no help to us on this subject. If we voice our apprehensions about going to the doctor, their reply usually includes mention of the countless pap smears they have had, or worse, that they have endured child birth. How can we compete with labor pains? Yet, a rectal exam is the only way to examine the prostate, and prostate cancer is one of the leading concerns when discussing men’s health. If I tell you that the exam takes a maximum of ten seconds, I doubt it would allay your anxieties very much. Therefore, I would like to appeal to your rational side in an attempt to convince you that rectal exams and prostate cancer screening in general are worthwhile.
Prostate
cancer is the leading cancer in men in the
Diet may play a role in prostate cancer risk as well. Over the last twenty years there have been suggestions that diets high in selenium, lycopenes (the anti-oxidant in tomatoes), and vitamin D may be protective against prostate cancer. Conversely, diets high in animal fats may increase the risk. Unfortunately, all of these dietary theories still require further studies before they can reliably be recommended as effective means of preventing prostate cancer.[2]
Since there is little consistent information regarding prostate cancer prevention, the best approach to the disease is to detect it at an early stage. Treatment of early stage prostate cancer provides virtually a 100% five-year survival rate (the percentage of people that will be living five years after the cancer is diagnosed). On the contrary, late detection of prostate cancer, after it has already spread to other parts of the body, carries only a 32 percent five-year survival rate.[3] The screening tests available to detect prostate cancer are the rectal exam and a blood test, called a PSA.
PSA testing has undoubtedly led to the detection of more prostate cancers at an earlier stage. Yet controversy surrounds this test, as prostate cancer is oftentimes very slow growing and treatment of the cancer does not always prolong life. For example, if a 68 year old man, who is treated for a very slow growing prostate cancer that would not threaten his life for at least ten years, subsequently dies of a heart attack at age 72, the detection and treatment of the cancer was irrelevant. Unfortunately, it is impossible to predict ahead of time which cancer will be slow growing and which will grow quickly.
It is this controversy that has led the American Cancer Society to recommend that all men over fifty years old, with at least a ten year life expectancy, consider a rectal exam and PSA blood testing yearly. Men at high risk should begin testing at age 45.[4]
Despite being
the leading cause of cancer in men, there is clearly uncertainty regarding ways
to prevent the disease, as well as appropriate timing of screening. Yet, even with the limitation in our
knowledge, I think most physicians would agree that men should opt for prostate
cancer screening in accordance with the American Cancer Society recommendations
above. Therefore, I hope all men will consider a physical exam this year
and all that it entails. At least have a
discussion with your physician about it, for ignoring prostate cancer is
certainly not in your best interest.
[1] http://transcripts.cnn.com/TRANSCRIPTS/0306/29/sm.16.html
[2] http://www.cancer.gov/cancertopics/pdq/prevention/prostate/Patient/page2
[3] http://www.cancer.org/docroot/CRI/content/CRI_2_2_6x_Prostate_Cancer_Survival_Rates.asp?sitearea=
[4] http://www.webmd.com/prostate-cancer/guide/is-prostate-cancer-screening-still-necessary?page=3
