Is the Medical Profession Failing Men with Prostate Cancer?

Diagnosed at age 57, I was shocked when, in 2011, the U.S. Preventive Services Task Force recommended against routinely screening for prostate cancer in all men.

Even more shocking is how many doctors stopped screening for prostate cancer. A 2016 study published in JAMA Internal Medicine found that prostate-specific antigen (PSA) testing — a blood test used to screen for prostate cancer — decreased from 2010 to 2012. Testing fell from about 36 percent to 16 percent among primary care physician visits and from about 39 percent to 35 percent among urologist visits.

When you read between the lines, only 16 percent of primary care physicians routinely screen for prostate cancer. This leaves 84 percent of men going to their primary doctor without prostate cancer screening.

The odds for screening aren't much better when seeing a urologist. Approximately 35 percent of urologists screen for prostate cancer. This leaves 65 percent of men who visit a urologist untested for prostate cancer.

Here's the prostate cancer trend among younger men:

The number of younger men diagnosed with prostate cancer has increased nearly sixfold in the last 20 years, and the disease is more likely to be aggressive in young men, according to a 2014 analysis by researchers at the University of Michigan's Comprehensive Cancer Center.

Here's the trend for older men:

According to an article in the Cornell Chronicle, investigators examined data from the Surveillance, Epidemiology and End Results Program, a National Cancer Institute database that tracks cancer incidence rates. They found that the decline in PSA screening has significantly altered the way prostate cancer is now seen: 12 percent of men over 75 were diagnosed with metastatic prostate cancer in 2013, compared with 7.8 percent in 2011. And the proportion of men diagnosed with aggressive cancer increased from 69 percent to 72 percent during the same period.

In other words, the number of older men presenting with aggressive prostate cancer has increased.

I understand the good intentions behind the effort to save men from choosing unnecessary and aggressive prostate cancer treatment. No one wants to ruin the quality of a man's life if aggressive treatment of prostate cancer is unnecessary.

It's the underlying assumption I teake issue with. Men are fully capable of making the correct treatment decision based on their diagnosis when someone takes the time to address their previous experiences with cancer and the fear that arises when you hear the dreaded words: “You have prostate cancer."

Upon receiving the news that I had cancer, three words came to mind: pain, suffering, and death. I wasn't capable at the time of diagnosis to make a rational treatment decision. I think that's true for the majority of those who receive a diagnosis of cancer.

Men need time to decompress. They need time to sort out their personal experiences with friends and family they've known with cancer.

Then, they need time to receive their own specific diagnosis without the filters of fear and their past experiences with folks who've died from any form of cancer.

When information, rather than fear, drives a treatment decision, you get more appropriate treatment decisions.

The proof of this is the increase in the number of men choosing active surveillance.

The New York Times reported that 10-15 percent of early-stage prostate cancer patients were treated by active surveillance several years ago. Now, national data from three independent sources show that 40-50 percent of them are making that choice.

In other words, the data suggest that men are capable of making a treatment decision based on their diagnosis, rather than their fear.

It's always heartbreaking when I hear from a son or daughter who's lost their father, or from a partner who's lost the love of their life because they were never screened for prostate cancer.

It’s possible that your primary physician or urologist is among the group of physicians no longer screening for prostate cancer.

I'm not a doctor, which means I don't give medical advice. I'm a prostate cancer patient advocate with strong opinions about the need to resume prostate cancer screening.

Here are my opinions:

•Familiarize yourself with the various tests available to detect prostate cancer. A new urine test may replace the need for a prostate biopsy.

•If prostate cancer runs in your family, I suggest getting your first screening a decade earlier than recommended, at age 30. You are at a higher risk for prostate cancer.

•If you are African-American, get your first screening at age 30. You are at a higher risk for prostate cancer.

•All men should have at least one screening by the time you reach 40.

Men, given where we are with the politics and policies with prostate cancer screening, your life may depend on you taking control of this piece of your medical care.

For your sake and for the sake of those who love you, you can't assume that you don't have prostate cancer because your physician didn't screen or test you.

Note: This article appeared in Prostate Cancer News Today 

Rick Redner and his wife Brenda Redner wrote two award winning books. The first:

I Left My Prostate in San Francisco-Where's Yours?

provides men and couples with information and support before, during and after prostate surgery.

Their second book was written for couples living with erectile dysfunction. After living with erectile dysfunction for four years, Rick chose penile implant surgery. The couple share how implant surgery changed their lives and relationship.

The title of their second award winning  book is:

Everything You Never Wanted to Know About Erectile Dysfunction and Penile Implants.