Mark A. Spears

Prostate Cancer: Colonel Don and Early Detectation

By: Mark A. Spears, MD

We didn’t know “Colonel Don” very well as the four of us sat on the deck trading tales. We were talking and laughing as men do when the conversation briefly touched on the need for those of us at or around 40 years of age to get our first rectal exams. Now, Don is a retired army colonel and certainly has patriarchal standing in his family. As our host’s stepfather he was certainly the elder of the group by 30 years or more and his authority seemed implicit. At the time he was not aware that I am a physician.

“Now before you young men laugh and move on to discuss football or politics I need to take this opportunity to educate you.” said Colonel Don. “I am a prostate cancer survivor and I want each of you to get annual physicals with a prostate exam…”

Colonel Don went on to give a brief but well rehearsed tutorial on the early detection of prostate cancer. I remember thinking that this was an unlikely venue for his presentation but as an African American physician, I certainly understood his passion for educating African American males about this disease.

Prostate cancer is the sixth most common cancer in the world. It represents 29% of all cancer diagnoses in U.S. men. African American men are twice as likely to get prostate cancer and they have the highest incidence of prostate cancer in the world. African Americans get more aggressive disease at an earlier age. With these facts in mind it is paramount that the health conversation with African American men includes a discussion of the signs and symptoms of prostate disease and an understanding that annual digital rectal exams (DRE) and prostate specific antigen (PSA) blood testing are valuable tools in and early diagnosis. Late diagnosis of advanced disease more often results in complex treatment regimens and undesirable consequences of treatment such as incontinence and erectile dysfunction. Advanced disease may result in death despite all available modern treatment methods.

Men should be alert to the signs and symptoms of prostate disease. These include difficulty urinating, diminished force of the urinary stream, incomplete bladder emptying, erectile dysfunction and pain or aching in the testicles or groin. It is critical that men aged 40 and beyond feel comfortable discussing this topic during their annual physical examinations. Despite being a source of pre-visit anxiety, the DRE usually requires only a few moments and gives the physician useful clinical information. There is controversy regarding the usefulness of the PSA test but most clinicians believe that the combination of a directed questioning about family history, symptoms, the DRE and PSA gives critical information for early detection. Very few lifestyle modifications have been shown to alter prostate cancer risk although high intake of red meat and dairy appear to increase risk and increased soy intake may be protective. Patients with worrisome findings are usually referred to a urologist where they are likely require a biopsy to confirm the diagnosis. Treatment is beyond the scope of this brief discussion but might include surgery, radiation or hormone therapy.

Colonel Don had the right idea. Physicians can educate patients one at a time but it is important that awareness increase within entire communities. We should all be willing to share information and take advantage of opportunities to educate one another. Colonel Don didn’t teach a young physician any new facts about prostate cancer that day but his candid discussion and willingness to address a major health issue in an unconventional setting gave me insight into effective means of reaching patients beyond the walls of the exam room.