The American Cancer Society estimates that 30,000 American men will die from prostate cancer this year. That is a pretty high number associated with a disease that many health advocates and professionals deem not to be a fatal affliction.
The incidence of prostate cancer and mortality rate are roughly equal to that of breast cancer, yet last year we spent double the research money, $600 million to$ $300 million, on breast cancer research compared to prostate cancer. Advocacy groups such as Susan E. Komen have been far more effective at mobilizing the public and engaging its partners in fighting this dreaded disease.
The ubiquitous pink ribbons and nationally recognized Race for the Cure are the icons that have come to symbolize this grassroots efforts to save lives.
Prostate cancer, to date, has no such public profile and that has resulted in a lingering general lack of public awareness and misinformation surrounding his malady. We need to change that through education and a persistent effort on the part of health professionals and entities to engage the public. Having a designated month to increase public awareness is only a start.
We read about the deaths of well know figures and celebrities from prostate cancer all too frequently, but that has failed to dent the public consciousness in this arena. Of course, no one wants to hear the word “cancer.’’
In many ways, men themselves are somewhat responsible for this situation. In treating thousands of men over four decades in practice, I have found that many paid little attention to their prostate health. I also discovered that, quite often, they were not provided the right information. Some advocates argue that many men will die with prostate cancer, but not from it.
Tell that to the prolific author Vincent Flynn, the late Vincent Flynn, age 47.
The debate within the health profession has flamed anew with the fight over the value of the Prostate Specific Antigen test, or PSA. This is a simple blood test that cane be done in a few minutes in a doctor’s office or clinic. Critics say the test is of dubious value because it is not necessarily definitive and prostate cancer is not really fatal.
But there is value. An abnormal PSA result is simply a red flag that something is wrong with your prostate: an infection, benign enlargement or cancer. If the PSA number is elevated, a frank discussion is in order with your physician. A biopsy is probably in next in the prescribed protocol. If the biopsy shows cancer, treatment would continue.
Depending on age and health status, a variety of options are available up to surgery to remove the prostate. The American Urology Association guidelines have recently been modified to have testing begin at age 55 and end at 70. Those with a family history of prostate cancer, and African Americans who have a much higher incidence rate, should begin testing at age 45.
Critics of the PSA testing ignore an immutable fact. Since the advent of the PSA, the death rate for prostate cancer has dropped 20 percent. In April, a report published in The Lancet by the European Association of Urology concluded that the PSA does, indeed, save lives.
Once cancer is detected, the response need not be radical surgery but various forms of radiation, depending on grade and location of the disease. Active surveillance, or constant monitoring, is being touted by many as the treatment of choice. Recent evidence suggests that African Americans may not be the best option, given their higher incidence rate and their metabolic makeup.
If you fall into one of the categories where a PSA test makes sense, take the next step. The time is well spent, the procedure is non-invasive, and it just might save a life. In the meantime, savor the month of September, and think a little bit more about your own health, or your husband, your father, or your brother. They might be too pre-occupied.
Dr. Jeffrey Rabuffo of Higganum practiced as a urologist in Middlesex County for four decades.