Health and Fitness

Only men have prostates, but prostate cancer (PC) often heavily involves women, too, in at least two ways. First, it will probably strike some man they hold dear. Second, getting men to the doctor often requires pressure from the women in their lives. Thus PC affects most people.

PC is the most common cancer in men, and its death rate in men is second only to that of lung cancer (partly because we need lungs, while the prostate is a non-vital gland that does much more harm than good and is thus dispensable.) Every year almost a quarter-million men are diagnosed with PC and about 30,000 die from it, partly due to late detection, statistically speaking. In our prime retirement decades, our 60s and 70s, PC will hit one in seven men. It hits black men a decade earlier and much harder than whites. Every man should begin getting the two PC tests before age 50, 40 for blacks.

The two simple, quick, painless, cheap tests for PC provide a five-year head start in detecting and curing it before symptoms appear, helping to bump its survival rate by almost 50% in just the last generation. Postponing tests until symptoms appear wastes that five-year buffer and significantly risks a needless and sometimes particularly agonizing death. Early detection and treatment often reduces PC from a major threat to their lives to a much lesser threat to the two functions of their . . . their . . . favorite organ. Modern, early PC treatment saves the lives, potence, and bladder and/or bowel control of many thousands of men who often lost one or all of those just a generation ago.

Women already believe most guys are idiots about going to the doctor. Men prove their women right if they don't drag their butts (how appropriate, as that's the subject of one of the tests) and arms (the subject of the other test) in for their annual prostate checkups. Any man near middle age who doesn't is foolish, because only if these tests catch it early is PC one of the most curable major cancers we face. Early detection is by far the best defense against PC.

Ladies, close friends . . . order your man's raggedy fanny to the doc now or risk losing him to a disease that's 97% preventable if caught early. Each test takes about 15 seconds, tops. A needle in the arm, a finger up the wazoo, and they're done. The doc gets the worst end -- literally and figuratively -- of the latter deal, so any guy who can't handle that exam is a certifiable wuss. It's a quick "Wham, bam, thank you, Sam" any real man can easily face . . . figuratively speaking. Odds are significant that if the men you know skip the exams, one of them will get PC after middle age, so he may be a dead wuss if he doesn't bend over for his health's sake long before he nears retirement. Age is the most critical risk factor in PC.

The PSA test is simply another number gleaned from the same blood sample we should give every year for routine medical exams. Men should know PSA's danger thresholds (defined below), and speak up if their PSA red flags appear. My sorry socialized medicine provider didn't, so now I have advanced PC that we can only hope is still curable. The five-year detection buffer the PSA test gives us was cut in half by his incompetence and my ignorance. I hadn't yet researched PSA levels because I trusted my doctor and didn't consider them a cooking magazine topic. I was wrong! If you love any man, are a man, and/or influence any man's diet, PC concerns you, because it strikes many men and is influenced by diet. (An anti-PC diet includes eating more fruits and vegetables, cooked tomato products, fish, and a $15 per year daily multivitamin multimineral for a small Vit E and selenium boost. Eat much less animal fat [especially red meat] and whole dairy. Take no extra zinc or calcium beyond RDAs and no flaxseed supplements. Saw palmetto is not proven to help, and suppresses PSA artificially, thus could hide cancer.)

Prostate Specific Antigen is the body's natural byproduct of prostate problems; if it's elevated, so are the patient's risks. Sure, PSA can generate false alarms, which may trigger more tests, which will cost the patient or his HMO some money. So? Additional tests, each done only as warranted by prior tests, will usually answer a patient's two burning questions incrementally: Do I have PC, and how bad is it?

PSA tests have two red flags to watch out for: a level above 4.0, and an increase of 0.75 per year over three successive annual tests. If either of those red flags appear, find out why. If it's just an enlarged prostate, which most guys get before retirement age, there are several ways to treat that. It can become a major nuisance, but it's seldom the life threat untreated PC will become. If PSA increases by 2.0 in a year, the patient's life expectancy declines significantly even with immediate treatment; don't let it wait that long.

If the doc suspects PC, s/he will probably schedule a biopsy. But never fear; the prostate biopsy is not a needle in the prostate. It's twelve needles in the prostate, one at a time, each precisely aimed by a sonar system up the usual place and fired from the usual place. (That usual place provides pretty good access to the prostate, so get used to it.)

Here's the big surprise about prostate biopsy: it doesn't hurt. If you didn't know the doc was pinging your heiney with sonar and plunging a dozen needles from there into your prostate, you'd never know this was any more than the annual, routine finger check. The ultrasound device is the size of your thumb, so it's no stretch (realize your wife ain't gonna wanna hear you whine about a little stretch, you wimp). And, believe it or not, you will hardly notice the needles, if at all. On a pain scale of 0 to 10, they were not even a 1; one Tylenol and I would have been unable to perceive them.

But they tell a big story. With fairly good reliability the biopsy tells the doc whether and where the patient has PC and how big a threat is it. If PC is already well established, as mine was because my original doctor ignored both of my PSA red flags, it may be time for a full-body bone scan and a pelvic CT to detect any PC spread beyond the prostate. Those tests are real doozies: you lie down on a table in your street clothes, snooze or count ceiling tiles for a while, and walk out the door. Done. While you were snoozing, a machine did all the work without ever touching you or making a sound.

The data from all those tests help your doctor advise treatment, if any, based on statistics from thousands of similar cases. If PC is not overshadowed by something more threatening (e.g., those three heart attacks, your looming 80th birthday), recent studies say treat it. The old plan of watching it progress at a snail's pace is no longer advisable, because 15 years after PC becomes detectable the snail's odds go way up. If you want to still be playing tennis -- or merely watching TV in comfort -- 20 years after that first PSA red flag starts the race, get any necessary tests and get any PC fixed before the snail wins.

Now, as any dog can tell you, getting fixed has its downside. But these days, if the red flags catch and let you cure your PC early, odds are you'll be using your bed for both its intended purposes and the toilet for both its intended purposes, with no mixups and minimal failures, for decades to come. With tests finding PC much earlier and with great improvements in prostate surgery and radiation treatments, the cures are way up and the side effects are way down just since the 1980s. Guys, be real men . . . get both tests regularly. Women, if you want your husbands alive and functioning properly for decades to come, make them get those tests.

If PSA thresholds are exceeded and the biopsy indicates cancer, there's a must-read book for the patient and probably the closest other person in his life. It's the "Guide to Surviving Prostate Cancer" by Dr. Patrick Walsh, a preeminent PC specialist. It is the gold standard PC patient's reference, and is written exceptionally clearly by a professional writer. (Her preface is riveting.) It's crammed so full of practical, useful information on PC - physiology, tests, treatments, and desired and undesired effects -- that it is all but overwhelming the first time through. PC patients will want to study the book because the patient's options are too complex and personal to leave every decision up to doctors. For starting on a less detailed level, "Prostate Cancer for Dummies" is written by another world-class expert in the field, Dr. Paul Lange. I wouldn't want to make the decisions I'm making without having read both books.

But, I tell ya, if my delay has limited my options, I'd rather be windsurfing another 20 years, and the heck with a little thing like how well my little thing works, than thinking with my little thing while the snail wins the real race in 10. More important, if I had known enough to double-check my primary care provider, I may not be considering such a choice in the first place. You now know enough to prevent that and beat the snail, if you start taking action with baseline testing in your 30s.

A closing caveat: we can get PC without elevated PSA . . . the classic false negative. If you are in a high-risk group - over 65, black, have a close relative with PC, or eat lots of animal fat (e.g., the Atkins diet!) -- consult a urologist even if your PSA is fine.

When you ask the web about PC, wear your hip boots. The Prostate Cancer Research Institute is one of hundreds of good sites, but there are thousands of commercial pitches out there, too. If you don't recognize a source, click instead on one you do.

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