Prostates and The Fickle Finger Of Fate

1

As a urologist, I perform a lot of male screening for prostate cancer.  Most men (except perhaps for us Citadel graduates) know that this consists of a rectal exam and a blood test, the PSA (prostate specific antigen).  What is not generally known is that the blood test does not take the place of the rectal exam.

 I tell my male patients that the rectal exam is one way to know that A) there is a God and B) that He has a sense of humor, sticking the prostate where He did, and making us do what it is we do in order to evaluate it.

 Believe it or not, much has changed regarding the DRE (digital rectal exam) over the forty years of my practice of medicine.  In the 70s and 80s,  it was not unusual for an Air Force doctor like myself to have a patient say that the only way he would submit to a DRE was if we called his commanding officer and received an order from him that the patient bend over the table.  And that is what we did.

 Now, men have become somewhat more relaxed about it.  It is not unusual to hear a joke from the patient during the exam:

  1. Hey doc, I am missing a green sock.  If you find one up there, it’s mine.
  2. Hey doc, while you are that far in, do you mind scratching my brain?
  3. Hey doc, are you sure that you’re using your finger?
  4. Hey doc, the last person to do this to me was an IRS agent.
  5. Hey doc, there is nothing left up there.  Trust me, my ex- wife’s divorce attorney checked.
  6. One that came from a fellow physician while I was examining him:  hey Dennis, do you ever go home and say to your kids ‘Guess what I did all day?’

The endeavor can rapidly become grim when my examining finger feels something that I know will turn out, on biopsy, to be a cancer.   That, after all, is the purpose of the DRE and blood test: to find a cancer at its early, and therefore curable, stage.  Even though the majority of patients that I now see get diagnosed while still in the curable stage (in the 1970s, the vast majority were beyond cure), the patient is about to learn that there is a threat to his survival.  The exam that previously was the source of humor immediately takes on a sinister character.

The youngest patient I ever diagnosed with prostate cancer was 35.  The incidence of prostate cancer is increasing and the age of onset is becoming ever younger.  Risk increases if the patient is African American or if they have a primary family member who already has been diagnosed with prostate cancer.

All we can do is spread the word about getting the DRE and blood test.  We have a national prostate cancer awareness month, but we are woefully behind the groups that push for more research and public education about breast cancer.  Even though the incidence in the USA of breast cancer and prostate cancer is about the same (and the mortality rate about the same) breast cancer gets more than double the amount of money for research and public education.

 This is not sexism.  Women are more effective, articulate, and comfortable with public activism.  Virtually all male professional sports teams feature athletes wearing pink: pink shoes, pink patch, pink towel.  The female professional sports teams do the same.  Where is the blue shoe or patch or towel that would signal prostate cancer awareness activism?

Left to their own, men will not rise to this challenge.  Somewhere on the Y chromosome is a gene that prompts men to ignore their health.  It is the same gene that makes men go back home after a lengthy discussion with me about some medical issue and tell their wives that the doctor didn’t say a thing. (I am persuaded that an additional reason that God created Eve was so doctors would have someone rational with whom to speak).

Prostate cancer awareness will not be universally spread until the same women who are triumphing in breast cancer awareness also take up the banner of prostate cancer.   In addition to their advocacy for themselves and their female friends, they would add advocacy for their fathers, brothers, husbands, and children.

 Prostate cancer awareness is proceeding at a snail’s pace.  What is not proceeding at all is the awareness that it will take women raising the banner of prostate cancer advocacy in order for it to go further.  I am grateful that many African American churches have begun to sponsor prostate cancer screenings because their congregation is at higher risk for this cancer.  Nevertheless, more often than not, I examine a patient who was encouraged, or ‘ordered’ by his wife or sister or daughter, to ‘get his butt in there and get tested.’  Lord bless the ladies!

 Until then, we must often resort to sports metaphors to motivate men.  Example: if you were a member of a football team and victory would require you to expose yourself to pain, injury or risk- to ‘take one for the team’- you would do it.  In this health case, the team that you are sacrificing for, you are ‘taking one’ for, consists of you wife and children.  So, come in to your doctor for a DRE and blood test; take one for your team.

 – Dennis Garvin