The 5280 Guide to: The 5 Biggest Health Risks for Men

From heart health to prostate cancer screening to that most common of Colorado maladies—the adventure-sports accident (yes, it’s true!)—we examine the latest research, treatments, and controversies in men’s health.

April 2011

Prostate Cancer

What are the risks—and benefits—of early preventive screening for someone with a family history of prostate cancer? One man wants to know.

I have what might be politely termed the burden of knowledge when it comes to prostate cancer. Seventeen years ago, at the age of 47, my father was diagnosed, through routine screening, with an aggressive form of the disease. He sought the opinions of three physicians, all of whom advised him to have his prostate removed. And so my dad underwent the surgery, avoided chemotherapy and radiation, and last month turned a very healthy, cancer-free 65 years old.

My relationship with cancer, however, doesn’t end with my prostate. The incidence of cancer in my family is, in the words of one characteristically understated physician, “interesting.” I might call it terrifying. Paternal grandfather: fatal colon cancer. Paternal grandmother: fatal breast cancer. Father: prostate cancer and colon cancer survivor. Brother: acute leukemia survivor. For the past 15 years or so, I’ve joked that cancer for me was a matter of when, not if. I used to warn my then-fiancée, now wife, about what she was getting into. It was a transparent, and somewhat clumsy, defense mechanism to deal with the existential fear of thinking—in some way, intuitively knowing—that someday I’d be diagnosed with the big C.

Now, with two young sons, and having just turned 37, the time has come for me to put the jokes aside and to think responsibly about my health, specifically about that walnut-size gland down there. Among men, prostate cancer is the second most common form of cancer, after melanoma. But, that statistic notwithstanding, screening for, and the treatment of, prostate cancer is something of a health riddle: According to the American Cancer Society, one in six men will be diagnosed with the disease, but only one in 36 men will die from it.

Put simply, men who are diagnosed with prostate cancer are six times more likely to die with the slow-growing disease than from it. And that brings us to the controversial PSA screening test, and whether taking it makes sense for someone like me. PSA is an acronym for prostate-specific antigen, a substance produced by the prostate. If a man’s PSA is high, that does not necessarily mean cancer. It may mean nothing—PSA levels can be affected by any number of variables, including a benign enlarged prostate, recent ejaculation, or riding a bike. But an elevated PSA may mean something, and the next step would be either another PSA test or a prostate biopsy, which would reveal whether cancer is present.

Getting the simple blood test seems like a no-brainer for someone with a first-degree relative who’s had the disease (which increases my risk of developing prostate cancer by 20 percent). But, of course, it’s not quite so simple. The PSA test is notorious for producing false positive results, and there’s debate within the medical community about whether PSA screening actually saves lives. Further diagnostics and treatments—in some cases, overtreatment—in turn can lead to awful side effects. Biopsies can result in infection, difficulty urinating, and bleeding.

But the real issue for many men comes from the potential side effects of prostate removal: incontinence and impotence. When I was younger, I thought I’d rather be dead than have erectile dysfunction. In the Coen brothers’ cult hit The Big Lebowski, one character asks Jeff “The Dude” Lebowski what makes a man: “Is it being prepared to do the right thing, whatever the cost? Isn’t that what makes a man?” The Dude, played by Jeff Bridges, deadpans, “Sure, that and a pair of testicles.” I always bought into that notion—as juvenile as it may be, there’s a bit of truth there. So for years, that mind-set, coupled with the vagaries of the PSA test, was reason enough to not want to know what might be wrong with me.

And yet…my wife. My boys. I want to be around to spend time with all of them for a long time to come, no matter what. Maybe prostate cancer will hit me when I’m young. Maybe when I’m old. Or maybe not at all. But as someone who makes a living asking questions, I now think I’d like to know what’s coming my way. And, if I’ve learned anything from my father, it’s that preventive screening can work.

So I made an appointment with the Urology Center of Colorado. Dr. Mark Jones recommended a digital rectal exam, and we had a discussion about doing a PSA test. I decided to go for it. I may even undergo genetic testing to see what secrets my DNA holds. Will I find mutations that mean I have a higher risk of developing prostate cancer? Will I find something else entirely? And what will it all mean for my boys, who share my genetic material? There are so many questions. Now it’s time to start finding some answers.