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Men: it's time to talk prostate with your doctor

Date Posted: November 10 2006

Prostate cancer is one of the most prevalent forms of cancer among American men, especially African-Americans. By age 75, 50 to 75 percent of American men will have cancerous changes in their prostate.

About 80 percent of men diagnosed with prostate cancer are over age 65, and one-third of all American men over age 50 have microscopic signs of prostate cancer. The cancer will be diagnosed in more than 200,000 American men this year, and about 29,000 men will die from the disease.

Those are a few facts about the cancer, from the American Cancer Society and the National Cancer Institute. They also point out that it is a slow-acting, treatable cancer.

But first, it has to be found.

Three men who learned of prostate cancer in their body this year are members of IBEW Local 252 in Ann Arbor. This year, all three were diagnosed or being treated for the cancer.

"They're all in their fifties, and I realized in talking to them how important it is for guys to get an annual physical and talk to their doctor about getting a PSA test," said IBEW Local 252 Business Manager Greg Stephens, who suggested this article to our readers. "So I thought this would be a good reminder to spread the word."

One of those members, Jim Burns, 54, a business agent with IBEW Local 252 for the last six years, was diagnosed with prostate cancer about 18 months ago and subsequently had his prostate removed.

"It is so important to get an annual physical and have a PSA test," he said. "Especially if you have a history of it in your family. They say if you have a family history of prostate cancer, you either got it and you don't know it, or you're going to get it."

Burns' father died three years ago at age 75 of prostate cancer, only eight months after the cancer was diagnosed. Burns said he has always had regular physicals, and had been especially aware of the risk of prostate cancer since his dad died.

He said about the time his father died, a routine physical with blood test showed his PSA to be borderline for prostate cancer. But despite that number and his family history, Burns' general practitioner at the time didn't press him to get checked out further. Burns said he blames that doctor and himself for not asking more questions and getting follow-up testing.

Eighteen months later, getting treated by a different doctor in that practice, Burns said his PSA test number nearly quadrupled. Further testing confirmed the presence of cancer. There are several treatment options for prostate cancer, and from the advice of his urologist Burns chose to have his prostate completely removed.

Follow-up blood testing on Burns revealed a 0.17 PSA number - very low, but which indicates that minute amounts of cancer may have spread to surrounding tissues. So Burns was scheduled to go in for four to five weeks of low-level radiation treatment this fall to eliminate any remaining cancer.

"It was caught pretty early and I felt that this wasn't a big deal," Burns said. "I have always had the attitude that I would get over it and beat it, and it hasn't phased me at all."

Early detection is vital. According to the American Cancer Society, health care professionals should offer the PSA blood test and digital rectal exam annually, beginning at age 50. Men at high risk, such as African Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65), should begin testing at age 45.

Men at even higher risk (because they have several first-degree relatives who had prostate cancer at an early age) could begin testing at age 40.

But PSA screening is not a perfect process. Since the use of early detection tests for prostate cancer became fairly common (about 1990), the American Cancer Society points out, the prostate cancer death rate has dropped. "But it has not been proven that this is a direct result of screening," the ACS said.

There are potential problems with the current screening methods. Neither the PSA test nor the digital rectal exam is 100% accurate. Uncertain or false test results could cause confusion and anxiety. Some men might have a prostate biopsy (which carries its own small risks, along with discomfort) when cancer is not present, while others might get a false sense of security from normal test results when cancer is actually present.

Still, place Rick Kett in the category of believers in the PSA test. The prostate cancer survivor received an urgent call from his doctor's office last February after he had a routine physical and blood test. Upon learning he had cancer, he also chose to have his prostate removed.

"There are a lot of treatment options," said Kett, 58. "The worst option is doing nothing at all. I think one of the most important things I can tell people from the experience I've had is to take control of their own medical business. A lot of men who read your article are going to get prostate cancer. These are macho, tough construction workers out there who think that they don't need to see a doctor every year, or they don't question the results of tests or don't even ask for tests like the PSA.

"If they don't want to do it for themselves, I hope they get checked out for the sake of their wives and their families. There are so many sexual, family, lifestyle and life and death issues that are involved with prostate cancer."

The American Cancer Society concludes: "Until more information is available, whether you have the tests is something for you and your doctor to decide. Things to take into account are your age and health. If you are young and develop prostate cancer, it will probably shorten your life if it is not caught early. If you are older or in poor health, then prostate cancer may never become a major problem because it is generally a slow-growing cancer.

"Health care professionals should give men the chance to openly discuss the benefits and risks of testing at yearly checkups. Men should actively take part in the decision by learning about prostate cancer and the pros and cons of early detection and treatment of prostate cancer."