October as Breast Cancer Awareness Month celebrated its 31st anniversary this year. From legislation on screening and breast cancer prevention initiatives to the countless people who have become more aware and vigilant in the fight against the disease, most would agree that a positive push for women’s health has been championed by this cause.
In contrast, November as the month of “Movember” and the movement to raise awareness for men’s prostate, testicular and mental health is celebrating its 12th anniversary this month. From a group of 30 men with mustaches has come a 5-million strong force of influence in the discussion on men’s health, especially as it relates to screening and early detection/intervention.
Screening for prostate cancer saves lives. I’ve seen it in my patients and in the practices of my colleagues. In recent years, there has been some controversy over prostate or PSA screening and the notion of “watchful waiting” in the early diagnosis of prostate cancer. Proponents of a “wait and see” approach cite seemingly unnecessary medical testing and treatment alongside inflated health care costs for men diagnosed with prostate cancer when some research has suggested that they’ll likely die from something other than prostate cancer.
Recently, this topic and controversy were catapulted into the spotlight once again when well-known comedic actor Ben Stiller revealed he had been diagnosed with prostate cancer at the relatively young age of 48. Guess how he found out? A PSA test. And he credits that very test with saving his life.
Research and clinical study is an interesting niche of medicine. It deals, as it should, in probability and statistics – evidence and concrete “proof” over feelings. It has its place in what we physicians do, certainly. But as a urologist who treats people and not numbers on a spreadsheet, I can offer no comfort to every man who may have or has just been diagnosed with prostate cancer if I tell him I “think” he’s okay if we just “watch” it. You see, cancer doesn’t take the same exact path in every person it affects. An initially slow-growing cancer can become aggressive quickly and with no advanced warning it is doing so. And not every patient is comfortable with just sitting back and waiting out their cancer diagnosis.
To be sure, watchful waiting is appropriate and sound medical advice for some patients, but not for all. The decision to screen and treat should be one that is guided by an expert urologist with open communication with his or her patient at every step along the way. While they may not be perfect, PSA tests and subsequent biopsies absolutely have their place in men’s health initiatives. Will some of them result in the need to do further study to ensure an accurate diagnosis? Of course, they will. But to blanket-label these life-saving screenings as useless or unnecessary is dangerous and I worry about the perception it creates of men’s and public health as a result. As we enter this month where we celebrate Movember and the male wellness movement, I applaud Mr. Stiller for bringing a strong voice to this necessary conversation. I hope it gives gentlemen the motivation they may have needed to pay a visit to their doctor.
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