If there is a single leading reason why middle-age men dread going to the doctor, it is the prostate examination. Routinely recommended for those 50 and over, the procedure calls for a physician to insert a gloved finger into the rectum to probe the chestnut-size prostate gland, which is near the bladder and produces some of the fluids in semen. But however uncomfortable and embarrassing the exam may be, it could be a lifesaver. The rate of prostate cancer in the U.S. has been steadily rising over the past several years. It strikes 1 in 11 American males and kills more than 30,000 annually. Prostate cancer ranks second only to lung cancer as the most deadly malignancy in men.
No one knows why the disease is spreading. The aging of the American population only partly explains the increase. No one knows why the cancer develops less often in Asians than in Americans or Europeans. Perhaps a low- fat diet plays a role in prevention. No one knows why black Americans suffer and die from prostate cancer more frequently than do white Americans.
But doctors are hopeful that they can force the death rate back down -- through earlier and better detection and treatment. The effort begins this week and next, as the Schering-Plough pharmaceutical company, based in New Jersey, sponsors free prostate screenings all over the U.S. An estimated half a million American men will allow themselves to be poked, prodded and bled in hopes of being reassured of their good health or of spotting trouble before it gets serious. In addition to the rectal exam, men can undergo a new blood test that measures levels of a protein called prostate-specific antigen. If present in large quantities, PSA may signal malignancy. The goal is to detect cancer while it is still confined to the prostate and therefore more likely to be curable. Men can call the American Cancer Society at 800-ACS-2345 for a listing of local screening sites.
As worthy as the goal may be, however, the effectiveness and value of the mass screening are matters of dispute within the medical community. One-third of the tumors picked up by the rectal exam are already inoperable. Yet the PSA blood test is also far from infallible. It misses at least 20% of malignancies and can often give an indication of cancer where none exists. Furthermore, prostate cancers are not all the same; many grow so slowly that they do not need to be treated at all. A man could easily die of something else before his prostate condition proved fatal. If millions of men 50 and older take the blood test, some doctors fear that a great deal of unnecessary treatment will take place.
Whatever the merits of this particular type of mass screening, there are strong reasons to believe that early and accurate detection of prostate cancer can prolong life. When the disease has not spread beyond the prostate, 95% of men survive for at least five years. For half the men in whom the cancer has metastasized, life expectancy is two to three years. Moreover, techniques for surgically removing the prostate -- the standard treatment for the cancer -- have improved dramatically. Just a few years ago, the operation usually caused impotence and incontinence because it damaged nerves in the area. But by using a nerve-sparing operation developed by Dr. Patrick Walsh at the Johns Hopkins Hospital, doctors can prevent those side effects in most patients.