In truth, there are no “good” cancers, as they all cause emotional upheavals and most have financial and lifestyle implications.

The American Cancer Society and the Maine Coalition to Fight Prostate Cancer recommend a baseline PSA blood test at age 40 if a man has two close relatives (e.g., father or brother) who have experienced prostate cancer; age 45 if he has one close relative diagnosed with it, and age 50 if he is at average risk. Because of their elevated risk of prostate cancer, Black men should get a baseline PSA screening at age 40. Image Point Fr/Shutterstock

Happily, fatality rates for many cancers have declined as new and more effective medications have been developed and are available. But even though there are incredible advances in the treatment of prostate cancer, the number of deaths continues to escalate.

Six years ago, there were approximately 26,700 prostate cancer fatalities in the United States. For this year, 2023, it is anticipated that 34,700 men will die of prostate cancer.

Why haven’t prostate cancer deaths been reduced? The answer is complicated by many factors, one of which is that men do not seem to ask their physicians about the simple PSA (prostate-specific antigen blood test). And, because of a 2012 downgrading of the test by the U.S. Preventive Services Task Force (where not one member was a urologist), many physicians stopped offering the information to men. And men didn’t ask.

Many of us understood that within a few years, fatalities would rise – and that is exactly what has happened. When prostate cancer is caught before it has spread, the five-year survival rate approaches 100%. But if the cancer has metastasized, the survival rate can plummet to 32%.

Guidelines have now begun to return to more realistic areas, with the American Cancer Society and the Maine Coalition to Fight Prostate Cancer (a statewide all-volunteer nonprofit) recommending a baseline PSA at age 40 if a man has two close relatives (e.g., father or brother) who have experienced prostate cancer; age 45 if he has one close relative diagnosed with the disease, and age 50 if he is at average risk. But these are only suggestions, and a recent Wall Street Journal article indicated that other factors come into play and sometimes an even earlier baseline test may be appropriate.

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The important factor is that men need to talk to their health care provider and inform themselves about prostate cancer. Interestingly, in addition to, sadly, being too often called the “good cancer,” it also is considered by many to be a disease of old age. The reality is that about 60% of men are diagnosed at age 65 or older, but that clearly means that almost 40% are diagnosed at a younger age. Black Americans need to be even more rigorous as they consider baseline testing.

Men who work as firefighters or in manufacturing or roles that expose them to more questionable chemicals may want to pay close attention to their PSA blood tests. Only lung cancer kills more American men than prostate cancer, and only skin cancers are diagnosed more than prostate cancer. ACS states that 1 in 8 men will be diagnosed with prostate cancer in his lifetime. Prostate cancer fatalities did indeed decline from 2007 to 2014, but since then they have risen about 3% per year, with a 5% increase per year for the diagnosis of advanced prostate cancer.

Digital rectal exams are also important, but having an enlarged prostate or raised PSA numbers may certainly not indicate the presence of cancer. There are other possibilities that would need to be explored. And, if diagnosed, men need not rush to action. Overtreatment can bring many unwanted side effects. In today’s world, there are many options, including active surveillance if warranted. The key to fighting prostate cancer is for men to step up, inform themselves and have conversations with their health care provider.

Neither the American Cancer Society nor the Maine Coalition to Fight Prostate Cancer offers medical advice, but they have many free services, and the coalition’s website lists support groups and One2One Confidential, where men can be paired with a volunteer of similar ages. All services are free.

September is Prostate Cancer Awareness Month. Use it to your advantage.

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