It’s Important to Treat Fear Before Treating Prostate Cancer

It’s Important to Treat Fear Before Treating Prostate Cancer
According to the American Cancer Society prostate cancer is the third leading cause of cancer death in American men, behind only lung cancer and colorectal cancer. About one man in 39 will die of prostate cancer. In addition, the number of younger men diagnosed with prostate cancer has increased nearly six-fold in the past 20 years.

Knowledge is power when living with prostate cancer.

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Rick Redner received his master’s degree in social work from Michigan State University. He has spent many years working as a medical and psychiatric social worker He is the author of the award winning book I Left My Prostate in San Francisco-Where's Yours? His second book Everything You Never Wanted to Know About Erectile Dysfunction and Penile Implants won the Beverly Hills International Book Awards in Men's Health in 2016. Additionally, the book was a winner in the 2017 IAN Book of the Year Awards.

6 comments

  1. Chris O'Neill says:

    “The unspoken assumption here is the best way to prevent men from making bad treatment decisions is to keep them in the dark about prostate cancer.”

    How wrong can you be. No-one is suggesting men should be kept in the dark about about prostate cancer. In fact, men being kept in the dark about prostate cancer is one of the reasons that PSA screening has been such a large scale disaster. This is because usually men who have been given PSA screening are told little or nothing about prostate cancer and often they are not even told they are getting PSA screening – until the day their doctor tells them they need to see a urologist because they have a high PSA level and a few short weeks later they are given a biopsy which the urologist tells them shows they have CANCER!

    This is nothing less than an ambush. An ambush that happens because men are kept in the dark about prostate cancer and PSA screening. Men are kept in the dark by not being told that PSA has never been shown to lead to a net saving of lives compared with usual care anywhere. And neither are men told that a reduction in disease specific mortality has only ever been demonstrated in two countries and is highly inconsistent with every other country. The understanding of these issues can take years, not the few weeks between high PSA results and biopsy results when the only advice may be from financially conflicted urologists.

    So men ARE being kept in the dark about prostate cancer in a very serious way but not in the way your statement implies they are.

  2. Chris O'Neill says:

    “There’s a good reason and explanation why men tend to over-treat their cancer.. That emotion is FEAR.”

    You failed to mention a much more important reason why men are over-treated by their urologists for prostate cancer. That reason is the financial conflict of interest of the urologist who is advising them to use his services.

    “When I was diagnosed with prostate cancer, I was convinced I was given a death sentence. The idea that I could survive prostate cancer never occurred to me.”

    Yes. You had certainly been kept in the dark by all the medical professionals advising you. That was shameful of them.

    “The second session takes place after a Gleason Score and other test results are available.”

    This is simply far, far too late. Very few men would be capable of coming to a good understanding of what PSA/biopsy results mean when they are under the pressure of a prostate cancer diagnosis, especially if the urologist simply (and shamefully) asks them WHEN (not if) they want their prostatectomy. Men should be given information based on the Cochran Review of PSA screening trials before they even start PSA screening. Men should be at least 55 years old when and if that happens. That’s more than old enough to have had enough time to learn about prostate cancer and PSA screening.

  3. Mary says:

    “The unspoken assumption here is the best way to prevent men from making bad treatment decisions is to keep them in the dark about prostate cancer.”
    Yes!! You have hit the nail on the head. This is exactly what happened to my husband. Five years ago, the GP decided to stop screening all men. He didn’t mention the option of screening to allow for an informed decision. My husband had 2 physicals in the ensuing years and was assured that he was in good health.
    When symptoms of PCa begin, it is often too late and this is what happened to my husband.
    The tragedy of recurrence and death by PCa due to not being detected early is vastly understated in PSA screening discussions. Do policy analysts think that men actually enjoy living life on testosterone blockers? Do they know about the excruciating pain of dying from cancer in the bones-the most common cause of death of PCa? What about the effect on the family? A very good man well deserving of a nice retirement is denied, a loving wife left a lonely widow decades before statistics would predict and the worst part is lost legacy- grandchildren who will never know their grandfather.

    Screening guidelines focus on infection from biopsy and the possibility of unnecessary surgery. My husband would gladly trade his diagnosis in for 100 infections and 100 unnecessary surgeries. All of these events are only temporary.

    I believe that the decision to stop screening (head-in-the-sand medicine) will go down as one of the stupidest actions ever taken in medicine.

    • Rick Redner says:

      Very sorry for your loss. What happened to you was awful and unnecessary. I fear your tragedy must be repeated with tens of thousands of couples before it reaches a statistically significant level. Until then, policy makers will continue to insist the Task Force recommendations are saving men from unnecessary treatment. It’s maddening and tragic this is the status quo. The good news is new research is beginning to emerge:
      https://goo.gl/JkJ4oY
      I hope it won’t be too long before policy makers understand what they’ve done.

      • Chris O'Neill says:

        “The good news is new research is beginning to emerge:
        https://goo.gl/JkJ4oY

        The vast majority of the increase in metastatic prostate cancer in 55-69 year olds in that study occurred by 2010 which was long before the USPSTF made its recommendation regarding PSA screening for 55-69 year olds in 2012. Thus the large increase in metastatic prostate cancer among 55-69 year olds before 2010 could not possibly have had anything to with reductions in PSA screening among that age group that occurred years later.

        The sad fact is that large variations in metastatic prostate cancer and prostate cancer mortality occur whether changes in PSA screening occur or not.

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