March 29, 2024, was an important day for me. It was the 5th anniversary of my prostatectomy (prostate surgery). I was completing my semiannual visit to my urologist, Dr. Djalma, and received excellent news. My doctor told me that my exam results meant that my semiannual visits could now become annual visits. The medical consensus is that a cancer patient who has been in remission for ten years is cured. I’m halfway there. That and the fact it’s also Men’s Health Awareness Month has inspired me to write this piece.
Prostate cancer is cancer that attacks men and is the second largest cause of cancer death in men. Only lung cancer kills more men. Despite efforts to educate men about prostate cancer, results have been mixed. The Mayo Clinic states that prostate cancer is one of the most common types of cancer. It is cancer that occurs in the prostate (a gland whose primary function is to produce the fluid that nourishes and transports sperm).
Approximately one in eight men will be diagnosed with prostate cancer during their lifetime. There are approximately 200,000 new cases of prostate cancer diagnosed each year, which results in close to 33,000 deaths a year. In its early stages, prostate cancer may not cause signs or early symptoms, but more advanced prostate cancer can cause any of the following symptoms:
Trouble urinating (Incontinence)
Decreased force in stream of urine
Blood in semen
Bone pain
Losing weight without trying
Erectile dysfunction
Any combination of those symptoms could deteriorate one’s quality of life to an unbearable point.
Generally, the risk for prostate cancer increases as you get older, and its occurrence is most likely after 50 years old. Black men have a greater risk of prostate cancer, and it also tends to be more aggressive. One in six Black men will develop prostate cancer and are 2.1 times more likely to die from it. Despite not having definitive reasons for the disparity’s occurrence, several factors contribute to the difference. A correlation has been established between socioeconomic status and increased cancer risk, and worse outcomes. Access to healthcare is critical, and studies have shown that even access for Black men to medical care doesn’t ensure adequate preventative care.
The three most important allies for all men in the battle against prostate cancer are prevention, early detection, and diagnosis. Significant progress has been made in the early detection methods and treatment options, but much of prevention is still mired in scientific mystery. A primary test for detection is the prostate-specific antigen (PSA) blood test. Two elevated PSA blood tests above four ng/ml levels usually result in additional investigation and, in some cases, a biopsy.
My Medical Journey
I received the diagnosis that I had prostate cancer several months before the COVID-19 pandemic. I recently retired and was performing routine medical exams. Fortunately, my career afforded me access to excellent medical care depending on which country I served in, but if I were to be honest, I didn’t always take advantage of it.
Once I hit 40, I started to perform the “dreaded” finger test and never had any indices pointing to prostate problems. It wasn’t until I reached 60 that they told me I had an enlarged prostate. Still, ironically, fortunately, and unfortunately, I didn’t experience any of the symptoms associated with prostate cancer, so doctors at that point recommended changes in diet, medication, and observation.
I was referred to a Urologist, Dr. Djalma, who recommended an extensive series of exams, including several different types of ultrasounds, to determine if there were any prostatic tumors. They would also help determine which parts of the prostate should be biopsied. It’s important to inform you up to this point; I didn’t experience any pain or discomfort; the worst part was the anxiety associated with finding out whether I had cancer. That is often the most challenging part.
Once I completed all my exams and tests, I scheduled a consultation with my Urologist to determine if I had prostate cancer, what stage it was at, and what course of treatments would be recommended. While my wife (Fabiana) and I sat in the waiting room for our appointment, several patients entered the doctor’s office without discerning facial expressions. However, upon leaving, you could tell that the prognosis they received had shaken them. It made me wonder how we would react.
When we entered Dr. Djalma’s office, he meticulously explained the purpose and results of my exams. He explained that the results of my biopsy were positive. Based on the results of my biopsy samples, I received a Gleason score of 7, which is defined as intermediate cancer. In my case, I didn’t have an aggressive case of prostate cancer, but given time, it would likely develop into that and metastasize to other body parts. Gleason’s score of 8 to 10 meant you have what they call high-grade cancer. He discussed the different options for treatment available to include a prostatectomy, which is the removal of the prostate gland.
The term used for prostate cancer surgery is the somewhat frightening term ‘radical prostatectomy.” There are two main ways to conduct this surgery. There is an “open prostatectomy,” where the surgeon operates through a single long incision to remove the prostate and nearby tissues. The second surgical method is laparoscopic prostatectomy, where the surgeon makes several smaller incisions and uses long, thin surgical tools to remove the prostate and nearby tissues. The former is performed manually by the surgeon, and the latter is usually performed robotically, with surgeons performing the surgery while controlling robotic arms.
One of the more daunting decision points when making treatment choices for prostate cancer is the fear of erectile dysfunction, especially when it involves surgical remedies. As irrational as it may sound, it becomes a competition between the heartbeat and the hard-on. There is a general belief that any prostate surgery would lead to irreversible erectile dysfunction, but that is not the case. Dr. Djalma explained that that perception is misguided and not supported by science. Surgeons who perform the two procedures described above can often avoid damaging the nerves that control erections. Of course, some of the other considerations are age and the ability to maintain an erection before surgery. A return does take time; it can take a few months to 2 or more years.
Dr. Djalma sat reviewing and rearranging paperwork while Fabiana and I discussed the options. I have never been much of a gambler but have been very good at assessing situational odds. I felt that because I was one notch away from the high-grade cancer group and it had not metastasized, it would be wise to consider a prostatectomy. Some things become priorities as you age that are usually not considered much when you are young, your mortality and quality of life. Before I said anything to Fabiana, I saw a look on her face that I interpreted as an “I’m not planning to be a widow” look, ha-ha. This reaffirmed my decision. I do not believe I would be here today without the love and support of my wife, Fabiana.
I elected to have a robotic prostatectomy performed in January 2019, and the medical technology is fantastic. I checked into the hospital in the evening, went through preparation for surgery, and was in the operating room before 5:00 am. After general anesthesia took its course, the next thing I remembered was opening my eyes and seeing Fabiana standing over my hospital bed, asking how I felt. I wasn’t an in-patient for long. It was just long enough for me to discover that Jello could taste like a five-course meal after hours of fasting. After several rounds of walking through the hospital halls to get back on my feet, I was released that afternoon.
I did leave the hospital with a couple of parting gifts. One of those gifts was a catheter that I renamed my “piss purse” and some adult diapers that, for those of you that are old enough, made me remember the cartoon Baby Huey. The best gift I received was a clean financial record.
Now that I have retired outside of the United States, I do an exercise from time to time: to compare the cost of purchases and services in the United States and here in Brazil—robotic prostatectomy costs between $30,000 and 40,000 in the U.S. The cost of my operation here, including the hospital stay, was $4,000. Cost is a considerable obstacle (2 out of 5 Americans have medical debt), especially for lifesaving medical care. Having access to healthcare is different from gaining access to healthcare.
My recuperation period was approximately one month, and Nurse Fabbie was on duty 24/7, ensuring I followed my daily regimen and recovered. Shortly after I discarded my catheter and diapers, the world changed because of the COVID-19 pandemic. Although I was now a cancer patient, Concerns about the pandemic began to take precedence. In a matter of months, I joined two of the most vulnerable groups regarding COVID-19: senior citizens and cancer patients.
Men and Medical Care
There is a long-standing stereotype that men don’t go to the doctor and that women utilize healthcare services much more than men. Data collected by the Centers for Disease Control and Prevention (CDC) establish that this is more than a stereotype. A study conducted by the Cleveland Clinic found that approximately 60 percent of men don’t see a doctor annually. In contrast, women see a doctor 33 percent more and are 100 percent more likely to conduct annual medical examinations. Medical experts believe statistics like these contribute to the life expectancy gap of 5 years between men and women.
According to the CDC, these are recent health statistics for men in the U.S.
Mens Health
(Data are for the U.S.)
Health status
- Percent of men age 18 and older in fair or poor health: 13.8% (2022)
Source: Interactive Summary Health Statistics for Adults: National Health Interview Survey, 2019-2022
Alcohol use
- Percent of men age 18 and older who had five or more drinks in 1 day at least once in the past year: 30.9%
Physical activity
- Percent of men age 18 and older who met the 2018 federal physical activity guidelines for aerobic and muscle-strengthening activity: 28.3%
Source: Physical Activity Among Adults Ages 18 and Over: United States, 2020
Smoking
- Percent of men age 18 and older who currently smoke cigarettes: 13.2% (2022)
Source: Interactive Summary Health Statistics for Adults: National Health Interview Survey, 2019-2022
Obesity
- Percent of men age 20 and older with obesity: 41.6% (2017-March 2020)
Hypertension
- Percent of men age 18 and older with hypertension (measured high blood pressure and/or taking antihypertensive medication): 50.5% (2017-March 2020)
Health insurance coverage
- Percent of males younger than age 65 without health insurance coverage: 11.5%
Mortality
- Number of deaths (all ages): 1,719,250
- Deaths per 100,000 population: 1,040.2
Source: National Vital Statistics System – Mortality Data (2022) via CDC WONDER
Leading causes of death
- Heart disease
- Cancer
- Accidents (unintentional injuries)
At a minimum, this data is an alert, if not an alarm.
If more utilization of the healthcare system and medical resources would lead to better health outcomes, why are we (men) so reluctant to take advantage of them?
The Wall Street Journal published an article titled “Why Men Won’t Go to the Doctor, and How to Change That.” The article stated, ” Compared to women, more men continue to avoid going to the doctor, skip recommended screenings, and practice riskier behavior.” Orlando Health conducted an online survey on why men do not visit their doctors. The leading reason for not visiting their doctors was that they were too busy. For this to be the leading reason we don’t see doctors would be laughable if the consequences were not so dire.
The Cleveland Clinic has also conducted a four-year campaign called MENtion to convince men to visit their doctors. The recent campaign surveyed men and how they approached their medical treatment. This survey also found that the leading reason for men not seeing their doctors was being too busy. The resistance to seeking medical care is so strong that it’s palpable. In an article written on healthline.com, Leah Campbell recounts a story from a firefighter and paramedic who said he’s had male patients initially refuse to be transported to the hospital even while in the middle of an active heart attack.
I believe the leading reason men don’t go to the doctor enough is fear. This fear manifests itself in at least two ways. The first is fear that we will receive a bad diagnosis or outcome. Second, we don’t want to accept anything interfering with our self-image as strong, virile beings. We often believe, no matter the symptoms, this is no big deal. It’ll pass. In many cases, this mindset leads to these symptoms becoming a big deal, and they don’t pass without resulting in severe blows to our quality of life.
At the risk of sounding preachy, we, all men, need to care more about ourselves and our loved ones. Allow me some grace since I’m being self-critical.
Notwithstanding problems with access to medical care, men should commit to an annual physical regardless of whether they are having health issues. Bring that car in for a tune-up and oil change. It’s preventative care. A physical exam is a medical exam performed by a doctor to determine your overall health and wellness. Typical exams include assessing body systems and questioning medical, family, and surgical histories. Your doctor or medical provider will provide the results, raise concerns, and might recommend additional testing or exams. We can do this. Just once a year, guys. It’s an act of self-love and a testament of love to those who love you.
References
- https://www.healthline.com/health-news/why-so-many-men-avoid-doctors
- https://integrishealth.org/resources/on-your-health/2019/june/why-dont-men-see-doctors
- https://www.cdc.gov/nchs/fastats/mens-health.htm
- https://my.clevelandclinic.org/health/diagnostics/17366-physical-examination
- https://www.wsj.com/articles/why-men-wont-go-to-the-doctor-and-how-to-change-that-11556590080
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3104816/
- https://www.cancer.org/cancer/types/prostate-cancer/treating/surgery.html#:~:text=In%20an%20open%20prostatectomy%2C%20the,the%20prostate%20and%20nearby%20tissues.
- https://www.cancer.gov/publications/dictionaries/cancer-terms/def/open-radical-prostatectomy#:~:text=Listen%20to%20pronunciation,gland%20that%20helps%20make%20semen).
- https://prostatecancer.net/diagnosis/understand-test?utm_source=google&utm_medium=cpc&utm_campaign=Prostate-Orgovyx-Patient-Activator-Plus-2024&campaign_id=20708903168&utm_agid=155006922636&utm_adgroup=test-results&utm_term=gleason%20score&device=c&matchtype=e&gad_source=1
- https://zerocancer.org/black-men#:~:text=Black%20and%20African%20American%20men,prostate%20cancer%20than%20white%20men.
- https://www.cancer.org/cancer/types/prostate-cancer/about/new-research.html
- https://www.cancer.org/cancer/types/prostate-cancer/about/key-statistics.html
- https://www.mayoclinic.org/diseases-conditions/prostate-cancer/symptoms-causes/syc-20353087
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