the prostate and prostate cancer….the rodney dangerfield of cancers and organs

budding urologist with incontinence-author circa 1959

Five reasons the prostate is the “Rodney Dangerfield” of organs…it gets no respect.

“I’m not a sexy guy. I went to a hooker. I dropped my pants. She dropped her price.”- R.D.

The reason why the prostate doesn’t get any respect has a little to do with the very nature of the organ and its disease and a little to do with the mindset of the male.  The perfect storm which is a gland that the male can’t see or feel and a cancer that doesn’t cause symptoms until it is too late is the reason for the tragedy of over 25,000 deaths a year in the United States a year. Look at the following reasons and see if  you see  yourself or that of a loved one who isn’t guilty as well.

  • Unlike a women’s breast that gets all the attention an organ could ever want, the prostate lives a very isolated life. You can’t see it, you can’t feel it, men don’t know what it does, and they sure as heck don’t want a stranger probing around to disturb it or try to feel it.  Men feel unmanly with the very thought of a rectal exam and would just as soon not have the prostate checked. Men are told to self examine their testicles in the shower, and women to do breast exam often, but no one suggests that the male contort himself to examine his prostate. Its very location bespeaks of nature giving it no respect: and why does it have to be located right there where other unpleasant things occur?
  • Then the blood test PSA comes along and further complicates the prostate’s social life. Before the PSA was a test the only way to check on the prostate was a rectal exam. Now with the advent of this simple blood test, men and doctors will often substitute the PSA for the rectal exam. It is an easy sell; not doing a rectal exam makes a doctor’s visit much more pleasant for both the doctor and the patient. Everybody ends up being happy except of course the dejected and unchecked prostate. (One can have prostate cancer with a normal PSA.)
  • Even when the prostate tries to exert itself with prostate cancer it get little attention both because of the prevailing belief that prostate cancer doesn’t kill people and that it often occurs only in older men. Articles in newspapers and on the internet daily state that most men die with prostate cancer and not of it, despite over 200,000 cases diagnosed and 25,000 deaths a year. Society perceives breast cancer much differently, and more seriously, than prostate cancer.  This is reflected nationally by the emotional and financial support that advocates of breast cancer have on loved ones and resultant proceeds from breast cancer fund-raisers.
  • Many patients, but particularly men, will only go to the doctor if they perceive a problem with an organ or if a symptom presents itself. Unlike chest pain indicating a problem with the heart or blood in the urine a problem with the kidneys, early prostate cancer has no symptoms until it is too late to do something. Prostate cancers often originate away from the tube men urinate through; and as a result there will be no urinary symptoms until the prostate cancer has become fairly extensive. Men can have prostate cancer for years without any symptoms. Despite this men will almost always assume there can’t be a problem with their prostate because, “I pee fine.” Once again for the wrong reasons the prostate is left out and not invited to the party-no respect.
  • The final insult to the prostate is what happens to the male if you mess with it. Any treatment of the prostate for prostate cancer is associated, in varying degrees, how a male voids and his ability to get erections. If the hurdles in checking the cancer weren’t enough of a deterrent to early detection of prostate cancer, the idea of what can happen to the male after treatment further complicates the prostates life. It is almost as if it is mad about being ignored throughout its life having angered it and now that something has to be done to treat the cancer; the prostate exacts its revenge in the form leaking urine and sexual dysfunction. These two maladies strike right at the heart of the male ego.


“Hell hath no fury like a prostate scorned.”

A conversation between a urologist and a friend at a party make the above points nicely:

 A urologist was asked by a friend, who was 49, at a party when he should have his prostate checked. The urologist said the blood work and exam could be done in less than five minutes, and he could come by anytime at the end of his work-day through the urologist’s office back door, and have the exam performed for free. The friend said that he was having no symptoms. The urologist said that having no symptoms is irrelevant. The friend then said he had had a colonoscopy and asked if that checked the prostate. The urologist said no, that was a different organ. The friend then said, like most people, “Isn’t prostate cancer a disease of old men?” The urologist said, “No,” and mentioned that Frank Zappa died in his 50s, three years after the diagnosis of prostate cancer, adding, “It can be a painful death.”,  making the point that it would be prudent for him,  at age 49, to be checked. The friend then said, “But Frank Zappa had a bad lifestyle.” The urologist replied that lifestyle was irrelevant, as well, as a risk factor for prostate cancer. In the matter of this two-minute conversation, this college-educated friend had verbalized almost all the half-truths regarding prostate cancer. He confirmed yet again why prostate cancer is often times diagnosed late, and revealed again why the prostate is the Rodney Dangerfield of organs, “It just don’t get no respect.”

When men acknowledge the respect which prostate cancer deserves only then will there be a heightened awareness, early detection and treatment in a more curable phase of prostate cancer.

“With my wife I don’t get no respect. I made a toast on her birthday to ‘the best woman a man ever had.’ The waiter joined me.”-R.D.

Dr. John McHugh is the author of “The Decision: Your prostate biopsy shows cancer. Now what? Medical insight, personal experience and humor by a urologist who has been where you are now. and


6 Replies to “the prostate and prostate cancer….the rodney dangerfield of cancers and organs”

  1. Love the picture and the caption! It really made me giggle. Thanks for putting so much humor into a difficult subject.


  2. John, thanks for sharing your prostate cancer journey. I too have PCa (G3+4)/PSA7.4, and as an engineer I had to research my options before deciding what treatment path to follow. I did something similar to your treatment decision tree, and in the end I opted to enroll in a Phase I Study at UTSouthWestern called Hypo-fractionated SBRT for Prostate Cancer. That took place in Feb 2007. I had 5 fractions at 900 cGy each. I did not baseline my PSA just before treatment (6 months later), and 1 month after treatment, my PSA was close to 15, and very gradually came down but never really nadir’ed. The lowest point as 4.1 a year later, and goes up and down for the next two years. Last month, it went up to 8.7.

    My RadOnc suggested more tests and a pelvic MRI showed an enlarged lymph node at 15mm. There was a paper by Tiguert that says it may not necessarily be metastatic indicator. I am at a cross road now, trying to decide the next step.I know you believe that everyone has make that decision on their own, but my question is about hormone treatment (CAB and stopping testosterone production). My research seemed to indicate that these have been successful in lowering PSA, but the fact is the cancer cells never really die. As soon as you stop, the PSA rises as to the same level if you have not taken any treatment. The mortality years showed little improvement. Have you investigated this at all and what is your conclusions? Thanks.


    1. There is a nuance to homonal therapy. I’ll make the point but as you know I’d get the advice of the radiation therapist, oncologist and urologist you’ve been working with. Here’s the deal on androgen suppression. You are right it is not a cure, its is a lot like taking the oxygen away from a flame converting it to embers…beats it back but does not cure. Here is the nuance however, you are right that it doesn’t cure but it does extend years. Whether you start homonal therapy early, intermittently, or later in the disease ( a higher psa) makes no real difference in survival. So it is better than none at all but the timing doesn’t have a huge impact. I am currently recommending an ” intermittent approach ” to hormonal therapy. I hope this helps and wish you well…. I am always an advocate of finding a doctor you like and trust and let him or her guide your research and serve backboard to bounce ” ideas” off of. Nothing wrong with an office visit for the expressed purpose to discuss the pros and cons of this issue. John


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