Silence Aiding and Abetting Prostate Cancer : Health: The new technology used to fight the disease that attacks one man in 11 cannot help if the victims refuse to speak up early enough.
Cancer of the prostate, the small gland that produces a constituent of semen, now attacks one man in 11. It recently overtook lung cancer as American men’s most commonly diagnosed malignancy and is the second most rapidly increasing cancer diagnosis.
Each year, the United States records more than 100,000 new cases and almost 30,000 deaths, rates that are near the high end of the worldwide scale. Black Americans, for unknown reasons, have the highest rate in the world. And thousands more men die “with” the disease but officially “of” other causes, according to Dr. Donald S. Coffey, director of urological research at Johns Hopkins Hospital in Baltimore.
But unlike those stricken by other epidemics, prostate cancer’s victims have until now maintained a Gary Cooper-style silence. The disease closely parallels breast cancer in incidence and mortality but gets much less public attention. In the past 15 years, women have built an infrastructure of breast-cancer support services, but not many men even share their prostate stories with friends.
Research funding for prostate cancer lags far behind diseases with more vocal advocates. Only $13.2 million in government spending a year goes to prostate research, contrasted with $77 million for breast cancer and at least $750 million for AIDS. Squeamishness, along with a persistent lack of detection and treatment, have long allowed men to keep the whole subject “in the closet.”
Prostate cancer’s image problem starts with the method of diagnosis. The chestnut-shaped gland, 1 1/2 inches long and weighing an ounce, straddles the urethra just below the bladder. Doctors generally examine the prostate gland with a very low-tech probe: a finger inside the rectum, feeling for the hard nodule of a tumor. A new, high-tech ultrasound method uses a probe attached to a machine, but the same orifice. Added to the embarrassment and discomfort has been the psychological stress of knowing that treating a tumor--if one were found--could mean castration.
And if the cancer “gets away”--spreading to nearby lymph nodes, the spinal cord and column, or other organs--what follows is often a painful, lingering death. A combination of early, improved testing and better treatment methods offers a good chance for both survival and continued virility.
With a disease that often lacks symptoms until it’s quite advanced, the key word is early. This means regular--preferably annual--checkups. It also means men have to recognize certain warning signs--changes in urinary habits or lasting pain in the thighs, back or pelvis--as danger signs demanding immediate action.
Young men may be oblivious to these indications, says Coffey, because “a lot of people think it’s an older person’s disease.” But a fifth of patients are under 65, he observes. Men in their 30s and even in their 20s have developed the disease.
Women routinely submit to pelvic exams and mammograms, hardly known for being dignified or comfortable. And most women are willing to accept the mutilation of mastectomy or the loss of reproductive power through hysterectomy if it’s necessary to save their lives.
The difference in attitude may well lie in men’s and women’s very different experiences with their bodies. A woman is much more accustomed to, and much less threatened by, medical intervention in her sexual zone.
But for most men, such genital tinkering at best a suspicious deal. “Anything related to the sexual organ is verboten, “ says Lloyd Ney, who started a national self-help organization after overcoming prostate cancer.
Only about a third of susceptible over-50s undergo the digital test annually, according to one survey; a third have yet to have their first. A relative handful have had an ultrasound scan. To beat the disease, men have to overcome this fatal resistance.
The question is, how can men be convinced to get preventive care? When a national magazine publicized the telephone number for a prostate information clearinghouse, “more than 50% of the 800 calls we received were from wives, daughters or mothers,” says Ney. “As the health provider in the family, a woman nurses the children through their illnesses. She’s more aware of the necessity of medical attention as a preventive.”
Indeed, if men won’t rouse themselves, women must, suggested the late Rose Kushner, founder of the National Breast Cancer Advisory Center and a member of the National Cancer Advisory Committee, appointed by the President. “She told me, ‘Men (who have prostate cancer) are stupid and stubborn and they won’t acknowledge the fact that they should do something about it,’ ” Ney recalls.
“She said, ‘If there’s anything I can do, I’ll be glad to do it, because we women have a vested interest in our fathers, sons, nephews, etc., and we have to take care of men if they’re not going to take care of themselves.’ ”
New technology, no matter how promising, is only a partial answer. It cannot save men whose silence makes them accomplices in their own suffering and death.
