Talking points with your doctor
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People frequently ask us what they “should do” about prevention, testing and treatments for cancer.
Because no two men, or their families, are alike there really is no single best answer. In fact, we think it would be a huge disservice to you to suggest simplistic answers to complex questions. We hope we can help you to reach your own conclusions by empowering you with the facts and perspectives to talk with your doctors about decisions that make the most sense for you.
How much attention are you giving to your health?
- There are many diseases, especially cancer, where there may be no symptoms.
- Feeling great is a poor excuse for not doing annual physical exams. You have a right to know what is going on with your body.
- Unfortunately, the “do nothing” case can result in an entirely avoidable premature death. Don’t leave your loved ones too soon.
- Too many men tend to ignore their health. “Doctor Mom” helps get some of us to do what we should, but too frequently, left on our own, we men don’t do enough.
- Make sure the doctor is listening to you, respecting your preferences and needs and that you are jointly deciding what to do. Many treatment choices can lead to irrevocable quality of life issues, so you need to be informed about the risks and decide what is most important to you. Please adopt “If it is about me, it includes me” when talking with your doctor. You will have to live with the consequences!
What tests do you discuss with your doctor at your annual physical exam? Mark Moyad (Footnote 1) MD, MPH, a nationally known urologist at the University of Michigan, recommends the following tests:
- Cholesterol level tests: total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol, and triglycerides.
- Blood pressure test.
- Blood glucose level test to check for diabetes.
- Prostate Specific Antigen (PSA) test and a Digital Rectal Exam (DRE) for initial prostate cancer detection, and possibly twelve other tests for more detailed assessments. (Please avoid lovemaking, bicycle riding and DREs three days before the blood draw for the PSA test.)
- Prostate cancer screening is not for everyone. Men with a life expectancy less than 5 years, men who are frail and could not endure a treatment for prostate cancer, and men who have other significant health issues are not good candidates for testing.
- Prostate cancer testing is recommended to begin at 35 for those men who have a father, brother or uncle that was diagnosed, or if a mother, sister or aunt was diagnosed with breast cancer, or if they are African American. All other men are encouraged to get a baseline PSA starting at 40.
What are you doing to help improve your physical health? Dr. Mark Moyad recommends the following:
- Stop smoking.
- Maintain a healthy weight, preferably a body mass index lower than 25.
- Keep your waist measurement to 39 inches or less and your waist to hip ratio below 0.90.
- Increase your exercise to 30 minutes per day. This modest level will decrease prostate cancer progression, depression, and erectile dysfunction by 25% to 50%. This level of exercise will reduce the risk of heart disease and osteoporosis by 40% to 50% and dementia and colon cancer by 30% to 40%.
- Engage in weight lifting to reduce the effects of aging and to lower your risk of diabetes.
- Eat more fruits, vegetables, legumes, seeds, fiber and fish.
What are you doing to minimize stress, anxiety, fear, anger, frustration, and depression?
- There is growing evidence that a lifestyle heavy with stress, anxiety, and depression substantially increases the risk of cancer and these can spur the progression of cancer for those already afflicted.
- Managing a cancer diagnosis and contending with medical and emotional issues is virtually impossible to do by yourself. Prostate cancer is a difficult disease; please don’t make it worse by trying to do everything alone. There is a band of brothers at the Maine Coalition who stand ready to help through support groups and One-2-One personal conversations. Please give us a call.
What is the Coalition’s stance on screening relative to the United States Preventive Services Task Force Recommendation and the latest American Urological Association guidelines?
- The Maine Coalition believes the USPSTF, which also came out against breast and cervical cancer screening, has placed millions of people at risk. Stopping screening may reduce some overtreatment, but at the needless cost of many patients later discovering their cancer is too advanced to cure. When there are tests that help assess your own unique health status, why would you want to play Russian Roulette? You have a right to know what is going on in your body.
- There is a 14 year study in Goteborg Sweden that clearly indicates there is almost a 50% reduction in mortality when men are screened. This study found that only 293 men needed to be screened and 12 diagnosed to save one life.
- The USPSTF and AUA only looked at the immediate past. Had they looked back to the early 1960s when there was no testing they would have seen nearly 80% of men died from metastatic disease. Had they looked forward they would see 12 new prostate cancer tests: Prostate Health Index, 4Kscore, Prostarix, Prolaris, Genomic Prostate Score, ProstaVysion, Metamark Biopsy Test, Progensa PCA3, Prostate Core Mitomic Test, ConfirmMDx, Decipher and Nadia ProsVue. The PSA controversy is actually an argument about an old test and old methodology and is increasingly less relevant because the current standard of care now involves these newer tests.
- The arguments surrounding PSA testing are the wrong topic to debate. The issue should be about over-treatment and what to do about this. Unfortunately, while approximately 20% of the men diagnosed with prostate cancer die from this disease, currently nearly 90% of men elect to do a procedure, many of them unnecessary. The Coalition has been advocating Active Surveillance since 2009 for those men whose doctors tell them their disease is not aggressive. Active surveillance entails periodic testing but no procedures that will result in erectile dysfunction or incontinence. The USPSTF sadly missed a huge opportunity to advocate in favor of active surveillance to minimize the harms that result from overtreatment.
The Maine Coalition to Fight Prostate Cancer doesn’t offer medical advice but it does try to help everyone deal with the dual journeys of cancer, the emotional journey as well as the medical journey.
Footnote 1. Dr. Mark A. Moyad, MD, MPH, Jenkin/Pokempner Director of Preventive & Alternative Medicine, University of Michigan Medical Center, Department of Urology, Ann Arbor, MI. Moyad, Mark A., Promoting Wellness for Prostate Cancer Patients, Third Edition.