a partial truism applied with broad strokes resulting in bad decisions about prostate cancer treatment…


   

a little knowledge is a dangerous thing...

Guess what I have at the lake cabin now…a scanner…well what do you think? Clever huh?

From “The Decision:Your prostate biopsy shows cancer. Now what?”   The number one Kindle on Amazon.com for Prostate Cancer

My mother loved to use old adages as aids to imparting advice as life’s learning experiences arose. Although “the pot calling the kettle black,” “it’s going to be too wet to plough,” and “you can lead a horse to water but you can’t make him drink,” were commonly called upon, I believe “a little knowledge is a dangerous thing” was her favorite. She reminded me of the saying so many times that as I got older, she only needed to say, “a little knowledge John” with a sarcastic upward inflection in her voice, and I knew what she meant. In no other disease does this saying ring so true as in prostate cancer and men’s perception of it.

 

Most men know very little about the prostate in terms of what it does, what it looks like, or where it is located in their body. Upon telling my little brother Jeff, who was 46 at the time, that I had prostate cancer, he asked, “Is the prostate like that little tube you took out when you did my vasectomy?” What little men do know or have heard about the prostate is often either incorrect or only partially true. This is where a little knowledge can be a very dangerous thing. Most patients know just enough about the prostate to hurt them. This is true of both the patient who does not have prostate cancer and the one who has researched the disease after his diagnosis. “Most people die with it, instead of because of it” and “It’s a disease of old men,” are common misconceptions prevalent among patients. Although these concepts have some degree of truth, the problem is in the word “most.” It is this thinking that lowers men’s diligence for early detection, and after diagnosis they make decisions based on these partially true perceptions.

 

The fact is that more than 200,000 men per year are diagnosed with prostate cancer, and each year almost 25,000 men die of it. Fifty-year-old men and younger are commonly diagnosed with prostate cancer, often the more aggressive form. The perception that prostate cancer does not kill or is only a concern for the elderly is wrong and hampers men from making a point to be examined. Unlike the breast in a female, the prostate in a male is not amenable to a self-exam. Men also believe, incorrectly, that prostate cancer causes voiding symptoms, and they assume that if they have no symptoms, there is no need to be checked. This too is an impediment to early diagnosis. Most prostate cancers occur well away from the channel in the prostate that men urinate through, so in early prostate cancer, voiding is normal. Symptoms occur late in prostate cancer and are usually indicative of advanced disease. If a man waits until he has symptoms to be checked, he has waited too long. Despite this, men I see frequently tell me that they don’t want to have a rectal exam because they have no voiding symptoms.

 

In addition to all of these factors that delay early detection, the necessity of a rectal exam further complicates the situation. The patient often finds ways to avoid having a rectal exam because it is unpleasant, uncomfortable, and, for many men, embarrassing. It is not unusual for patients to suggest, and I am sure that this is the case with many primary care providers as well, “let’s do that next time” in response to the suggestion of a prostate exam. Both the patient and the physician, through better education, need to do a better job of making sure rectal exams are done; “out of sight, out of mind” cannot rule the day in this regard. So the perfect storm, a combination of misconceptions giving men a false sense of security, an exam they do not want to have done, and leads to a flawed rationalization to skip a prostate evaluation and sets the stage for a missed opportunity for early detection.

 

Although you would have been better off to have had a negative biopsy, the good news for the reader is that you have overcome the previously mentioned hurdles, had the rectal exam and biopsy, and now you know your diagnosis. You have to know that you have prostate cancer in order to treat it. The primary focus of this book is to help guide you through the process to arrive at a decision that is best suited to you. A secondary goal is that, with your new-found knowledge about prostate cancer, the pitfalls related to men’s health, and the importance of early diagnosis, you will be proactive in educating others. My hope is that this book will help you with the issues that you are now facing, and aid in preventing the “a little knowledge is a dangerous thing” mentality from precluding early detection in other men. 

3 Replies to “a partial truism applied with broad strokes resulting in bad decisions about prostate cancer treatment…”

  1. Hi again,
    This is quite difficult to write, but I think it raises an important point that for many reasons is often overlooked or simply ignored. I am a surgeon myself, and like Dr. McHugh I’ve also had my cancerous prostate removed robotically. However, although I had performed dozens of rectal exams throughout my career, I never realized that I didn’t know how to properly do the procedure until undergoing it myself in my urologist’s office. When my own PSA came back elevated, my internist, a man who had been doing rectal exams on me for years and who had always told me mine was negative, sent me for a urological consultation for further work-up and corroboration. That’s when I finally learned what a REAL rectal exam was; meaning just how deeply the doctor’s finger must probe the rectum to truly palpate the prostate gland. Perhaps the way I had learned to do this exam in medical school was too gentle to begin with, or maybe thru the years I had intentionally held back really pushing my finger as far as it would go because I didn’t want this part of the exam to be as unpleasant as most patient’s anticipated. Whatever the reason, it was exactly what my own doctors were doing to me; half-heartedly going through the motions of doing a digital rectal exam but never really going far enough to actually palpate my prostate gland. This is an error I still believe many — not all, of course — internists and family practitioners are guilty of perpetuating, all of them more or less subconsciously relying on the PSA results to correct any possible error in their physical diagnosis. What is your take on this Dr. McHugh?
    Jack Brown

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  2. I cannot emphasize the importance of finding out everything you can about the prostate gland, the methods of diagnosis and finally treatment. You can then have an informed discussion with your treating physician.
    After your initial consultation it is an excellent idea to, then, make a list of all the things you need to ask your physician eg. bladder and sexuality issues, post treatment penile exercises and all the myriad of little things that might worry you and are important to you as an individual.

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