ach year some 40,000 American men die of prostate cancer because the disease is not detected early enough. In its most treatable stages, prostate cancer usually has no symptoms, which means regular screening is absolutely crucial. Below, Doctor Daniel Shasha, an Assistant Professor of Radiation Oncology at the Albert Einstein College of Medicine and Doctor Robert Salant, an Associate Professor of Urology at the NYU School of Medicine, offer some information about the importance of prostate cancer screening and the common fears that surround it. This information could truly save your life.
Next to taxes, prostate screening is one of the scariest things for men. One of the first tests a man would get-a digital rectal exam-is probably far scarier for most. Why is that?
ROBERT SALANT, MD: I think it's just the way men are. My patients come in and very often, if they've never had a rectal exam before, they dread that more than anything else. I spend a good deal of my time on the initial visit explaining the potential benefits versus the minimal discomfort of that initial rectal exam.
Give me a sense of how difficult it is to break the barrier.
ROBERT SALANT, MD: Men rarely come in of their own volition. Either they are told to come in because of an abnormal blood test, or, more commonly, they're brought in by their significant others for a screening prostate examination, usually because their wife or partner has read how important it is.
The men who come in very often will do almost anything to avoid a rectal examination. After discussing the way it is done and how relatively innocuous it is, most of them acquiesce and have the examination. Then afterwards, ninety-nine percent say, "It really wasn't all that bad."
What are the excuses you've heard as to why they don't want to have one?
ROBERT SALANT, MD: I've heard every excuse, from "I've had one done years ago when I went into the Army," to "No one's going to do that on me," to "I'd rather be diagnosed with the prostate cancer than have a rectal examination."
So there's a real psychological issue here for men. Men do not want to feel like they're being invaded or in any way violated. So how do you break down that barrier in ten or fifteen minutes, since you can't spend all day holding a counseling session?
ROBERT SALANT, MD: What I do is just explain how it's done. I really try to draw a comparison to other bodily functions. I will sometimes tell them that it is not much more than having a bowel movement, or that it is only slightly uncomfortable. I explain exactly what will be done. I put them in a position that will be as comfortable as possible during the exam, and I tell them the whole thing should take no more than ten or fifteen seconds.
What percentage of prostate cancers can be detected through a digital rectal exam?
ROBERT SALANT, MD: Well, it used to be that about seventy-five to eighty percent were found using rectal examination. The problem was that half the cancers that were found about fifteen or twenty years ago were already advanced cancers, meaning they had moved beyond the level of the prostate, and were incurable.
DANIEL SHASHA, MD: Earlier intervention, resulting from earlier screening, gives us the ability to diagnose more men who otherwise may have presented with those more advanced cancers. It basically brings us patients at an earlier stage-most importantly, at a more curable stage.
The biggest excuse I hear when I do rectal exams is, "But Doctor, I'm asymptomatic." We like driving home the point to our patients that that's precisely the time to try to detect the cancer.
The no-symptom factor is important because men tend to talk as they get older, complaining about their urinary habits. They can't go. They go too much. So if they don't have these symptoms that some of their friends have, they may think they're fine, right?
ROBERT SALANT, MD: Well, what's so important about that is when a man turns 40 and the prostate does start to grow, one of the things it can do is create blockage to the urine flow, which creates those symptoms of having to go more frequently, having to get up at night, having a poor stream, a feeling of having to push to get the urine to come out.
These symptoms, which are related to benign prostate growth, are the types of symptoms that you do not get with cancer. Having a benign prostate growth with these symptoms has nothing to do with prostate cancer whatsoever.
It does not make you more susceptible?
ROBERT SALANT, MD: Absolutely not. There is no relationship between the development of benign prostate growth, and the development of prostate cancer. They can coexist, but they are unrelated to each other.
