The reason why the prostate doesn’t get any respect has a little to do with the very nature of the organ and its disease and a little to do with the mindset of the male. The perfect storm which is a gland that the male can’t see or feel and a cancer that doesn’t cause symptoms until it is too late is the reason for the tragedy of over 25,000 deaths a year in the United States a year. Look at the following reasons and see if a loved one, or maybe even you, isn’t guilty as well.
• Unlike a woman’s breast that gets all the attention an organ could ever want, the prostate lives a very isolated life. You can’t see it, you can’t feel it, men don’t know what it does, and they sure as heck don’t want a stranger probing around to disturb it or try to feel it. Men feel unmanly with the very thought of a rectal exam and would just as soon not have the prostate checked. Men are told to self examine their testicles in the shower, and women to do breast exams often, but no one suggests that the male contort himself to examine his prostate. Its very location bespeaks of nature giving it no respect; why does it have to be located right there where other unpleasant things occur?
• Then the blood test PSA comes along and further complicates the prostate’s social life. Before the PSA was a test the only way to check on the prostate was a rectal exam. Now with the advent of this simple blood test, men and doctors will often substitute the PSA for the rectal exam. It is an easy sell; not doing a rectal exam makes a doctor’s visit much more pleasant for both the doctor and the patient. Everybody ends up being happy except of course the dejected and unchecked prostate. (One can have prostate cancer with a normal PSA.)
• Even when the prostate tries to exert itself with prostate cancer it get little attention both because of the prevailing belief that prostate cancer doesn’t kill people and that it often occurs only in older men. Articles in newspapers and on the Internet daily state that most men die with prostate cancer and not of it, despite over 200,000 cases diagnosed and 25,000 deaths a year. Society perceives breast cancer much differently, and more seriously, than prostate cancer. This is reflected nationally by the emotional and financial support that advocates of breast cancer offer loved ones and resultant proceeds from breast cancer fundraisers.
• Many patients, but particularly men, will only go to the doctor if they perceive a problem with an organ or if a symptom presents itself. Unlike chest pain indicating a problem with the heart or blood in the urine indicating a problem with the kidneys, early prostate cancer has no symptoms until it is too late to do something. Prostate cancers often originate away from the tube men urinate through; as a result there will be no urinary symptoms until the prostate cancer has become fairly extensive. Men can have prostate cancer for years without any symptoms. Despite this men will almost always assume there can’t be a problem with their prostate because, “I pee fine.” Once again, for the wrong reasons, the prostate is left out and not invited to the party — it gets no respect.
• The final insult to the prostate is what happens to the male if you mess with it. Any treatment of the prostate for cancer is associated, in varying degrees, with how a male voids and his ability to get erections. If the hurdles in checking the cancer weren’t enough of a deterrent to early detection of prostate cancer, the idea of what can happen to the male after treatment further complicates the prostate’s life. It is almost as if it is mad about being ignored throughout its life. Now that something has to be done to treat the cancer; the angry prostate exacts its revenge in the form of leaking urine and sexual dysfunction. These two maladies strike right at the heart of the male ego.
A conversation between a urologist and a friend at a party make the above points nicely:
A urologist at a party was asked by a friend, who was 49, when he should have his prostate checked. The urologist said the blood work and exam could be done in less than five minutes, and he could come by anytime at the end of his work day through the urologist’s office back door, and have the exam performed for free. The friend said that he was having no symptoms. The urologist said that having no symptoms is irrelevant. The friend then said he had had a colonoscopy and asked if that checked the prostate. The urologist said no, that was a different organ. The friend then said, like most people, “Isn’t prostate cancer a disease of old men?” The urologist said, “No,” and mentioned that Frank Zappa died in his 50s, three years after the diagnosis of prostate cancer, adding, “It can be a painful death.” He was making the point that it would be prudent for his friend, at age 49, to be checked. The friend then said, “But Frank Zappa had a bad lifestyle.” The urologist replied that lifestyle was irrelevant as a risk factor for prostate cancer. In the matter of this two-minute conversation, this college-educated friend had verbalized almost all the half-truths regarding prostate cancer. He confirmed yet again why prostate cancer is often diagnosed late, and revealed again why the prostate is the Rodney Dangerfield of organs: “It just don’t get no respect.”
When men acknowledge the respect which prostate cancer deserves, there will be a heightened awareness, early detection, and treatment in a more curable phase of prostate cancer.
Dr. John McHugh is the author of “The Decision: Your prostate biopsy shows cancer. Now what?” which offers medical insight, personal experience, and humor by a urologist who has been where you are now. Visit him online at theprostatedecision.com and Theprostatedecision.wordpress.com.