When men shy away from prostate cancer screening and treatment, the women in their lives often help them face their fears and the facts

 

“Men are funny. A guy will come in for an enlarged prostate issue and he’ll say everything is good, everything is fine,” says Ali Kasraeian, M.D. “But his wife will give me this look, and say, ‘I don’t know what he’s talking about. He gets up 50 times a night. And when he’s in the bathroom, it starts and stops, starts and stops.’ You often get a lot more information from a woman,” explains Dr. Kasraeian, a urologist at Kasraeian Urology in Jacksonville who performs laparoscopic robotic surgery on prostate cancer patients.

            The symptoms the wife described could be due to a benign enlarged prostate or prostate cancer. So giving that information to a doctor sooner rather than later can change a life. But too often, men simply ignore health problems.

            “When these guys start coming in at age 55 for whatever reasons, they sort of open up a Pandora’s Box of medical problems,” explains Dr. Kasraeian. “If men start having problems and they are ignoring them, the woman in their life will notice it, specifically in prostate cancer. Men don’t want to talk about these things, but their wives can get them to address it.”

 

Get His Foot in the Door

Women, in general, are more used to regular health care visits from an early age, when they begin seeing their OB/GYN for a yearly Pap smear exam, say physicians. Women also are more attuned to keeping up with medical screenings, current treatments and information on good health.

            “Women tend to be more proactive, men tend to be more reserved and reluctant to see healthcare providers,” says Marc H. Blasser, M.D., F.A.C.S., with Urology Associates of Northeast Florida, which is affiliated with Orange Park Medical Center. “With prostate cancer screening, one of the reasons men are reluctant to seek help might be their fear of complications from treatment, which may or may not be justified. Erectile dysfunction and incontinence are two big reasons men don’t come in and get checked. The women in the men’s lives can absolutely make the difference there.”

            A man’s prostate naturally grows as he ages. An enlarged prostate, a non-cancerous condition known as benign prostatic hyperplasia, can squeeze the urethra, creating urinary problems. “That goes to the question of screening, because sometimes it’s hard to distinguish a benign hyperplasia from cancer,” says Winston Tan, M.D., Senior Consultant at Mayo Clinic Florida in Hematology/Oncology. “When there’s a question about that, it’s important to get a biopsy, especially if the doctor feels a nodule on the prostate.”

            Dr. Tan says that men can protect the health of their prostate by not being obese and by eating a low-fat, high-vegetable diet, behaviors that lower the incidence of prostate cancer. The drug Finasteride, or Proscar, is a prostate cancer prevention agent for men at high risk. And the vaccine Provenge has shown to improve survival rates for men with late stage prostate cancer.

            The National Cancer Institute lists the following symptoms that may be due to prostate cancer:

• Weak or interrupted flow of urine
• Frequent urination, especially at night
• Trouble urinating
• Pain or burning during urination
• Blood in the urine or semen
• A pain in the back, hips or pelvis that doesn't go away
• Painful ejaculation

 

            One in six men will get prostate cancer, yet the rate of recovery is quite high in relation to other cancers. “Around 80 to 85 percent of patients will be cured, meaning they won’t have to deal with the disease again in their lifetime,” says Dr. Tan. The earlier you catch it, the better the prospects for recovery. So screening is very important.

            “Men just don’t like to be screened,” says Dr. Tan. “They feel that men are strong, and they don’t need to do something uncomfortable, and a digital rectal exam is uncomfortable.”

            Dr. Tan says about a third of the men who see him for prostate health issues only come in because their wives, girlfriends, mothers or sisters have made them do it. Some women may be concerned that their encouragement to seek screening could be seen as nagging.

            “I think the most important thing is the way communication is given,” says Dr. Tan. “As long as women communicate in a proper way with their husbands that it is important to get screened, and people in the community support that with education, that would be a win-win situation, and the husband will get screened.”

            For a white male with no other risk factors, prostate cancer screening should begin at age 50, says Dr. Kasraeian. African Americans have a higher risk of prostate cancer and should start screenings at age 40, as should white males who have family members with prostate cancer or other cancers that share a similar gene, such as breast and colon cancer.

            “Prostate cancer is very family history related, so couples should be talking about that prospect,” says Dr. Kasraeian. He recommends men get both a yearly Prostate Specific Antigen (PSA) lab test and a digital rectal exam. “You have to catch prostate cancer early, and I think knowledge is a key thing,” says Dr. Kasraeian. “And the wives and significant others play a role in keeping up with this information. Their supportive role in getting a man screened is vital.”

 

Help Him Pick Himself Up

Once a screening exam raises a red flag, a urologist may do a biopsy. Dr. Kasraeian says he may do an ultrasonic evaluation of the prostate to get a map of where they’ll do the biopsy. “The pathologists look at it and tell us whether the patient has cancer or not. Depending on what the stage and grade of cancer, we’ll make decisions on treatment.”

            Men may not handle the news well. “With men, it is actually very hard for them to understand that they have cancer,” says Dr. Tan. “We encourage patients to have a second ear when they come for a visit, perhaps their wife or someone they know who can explain to them the treatment choices and the side effects of the treatment.”

            Women can manage all the information and help men make smart decisions on treatment options. Some men become bewildered, traumatized and depressed after learning they have prostate cancer, which clouds their judgment.

            “We have a psychologist on staff who helps a patient cope with the diagnosis,” says Dr. Tan, adding that Mayo Clinic takes a multi-disciplinary team approach to treatment. “The most important factor that affects the patient once diagnosed with prostate cancer is how they feel about the disease and how they are able to resume their usual functions after they get the treatment. We have a program to get the patients back to where they have been after the procedures.”

            Dr. Kasraeian says they always try to bring a man’s wife in on diagnosis consultations, encouraging them to face prostate cancer like a team, just like they might face breast cancer together. “With prostate cancer, it’s not like having your appendix taken out with only one option. You have a myriad of options, from surgery (including what kind of surgery, open or laparoscopic robotic) to radiation therapy and seed implants. There’s a lot of information,” says Dr. Kasraeian, who practices with his father Ahmad H. Kasraeian, M.D. “The support from a woman at that time is a strong factor in how a man deals with prostate cancer.”

            Prostate cancer is categorized in stages and grades, which have a bearing on the type of treatment. Surgical treatment can be radical prostatectomy, which is the removal of the prostate. Other standard radiation treatments are external beam radiation and seed implant treatment, known as brachytherapy. Androgen deprivation therapy is a hormonal treatment option that blocks testosterone. High frequency ultrasound and cryo therapy, which is basically freezing the tumor, are also options for smaller subsets of patients.

            Another option for the treatment of prostate cancer, which is a slow-growing type of cancer, is to merely monitor the patient. “There is a lot of controversy there because of what we call the volubility of the disease,” explains Dr. Tan. “There is a group of prostate cancer that is quite indolent, meaning men have prostate cancer but they die from other conditions, heart disease, stroke, other things.”

 

Operating Under Outdated Assumptions

Most men worry about the terrible two side effects of prostate cancer treatment: incontinence and impotency. But times have changed, and men may be operating under false assumptions, something an informed wife can help correct. “People who get prostate cancer are 50, 60, 70, and they are relying on what they’ve heard in the past,” says Dr. Kasraeian. “They may not know the advances we’ve made in reducing the side effects and treating the cancer.”

            Institutions like Mayo Clinic have patient education programs and are also working to develop new drugs and treatments. “We’re looking at preventing agents, at new drugs that can modify the disease and hopefully prolong the patient’s life,” says Dr. Tan. “We’re looking at how the different procedures and therapies will alter the patient’s quality of life. We are developing an intervention on how to improve the quality of life for our patients.”

            And the terrible two are most often the central quality of life issues. “These very much involve the significant other,” says Dr. Kasraeian. He says the minimally invasive surgical techniques he uses help reduce those issues and result in less blood loss, shorter hospital stays and quicker recovery and return to daily activities.

            “In the procedures we do with robotic and laparoscopic techniques, we’re doing nerve preservations and reconstructions. So we’re getting earlier return of continence, somewhere in the 90 percent range,” says Dr. Kasraeian, who adds that he’s one of the few doctors in the area using these techniques, which have advantages of increased precision, visualization and range of motion. “And in potency, we’re doing a better job of nerve preservation and penile rehabilitation, using medications, vacuum pumps and injections after surgery. With all those combined, we’re doing 60 to 80 percent return to potency two years after surgery.”

            Dr. Blasser focuses on urinary prosthetics, such as an inflatable penile prosthesis and artificial urinary sphincter implants, and often treats other urologist’s patients for urinary and erectile dysfunction. “The penile prosthesis is designed to restore full erectile function and has outstanding success rates of over 90 percent,” says Dr. Blasser. “This changes a couple’s lives incredibly.”

            Urinary problems can also alter a couple’s relationship and benefit from a woman’s initiative, as one of Dr. Blasser’s patients illustrates. “He was wearing five or six adult diapers a day, was homebound, wouldn’t go out because he was embarrassed, his clothing was always wet and he smelled,” relates Dr. Blasser. “He and his wife didn’t have any intimate contact, they slept in different rooms, didn’t go out on dates. Their whole lives were dysfunctional. She felt abandoned, and he was depressed. She got him to come in. We gave him an artificial sphincter, and now he’s 99 percent dry,” says Dr. Blasser, adding that prosthetic options aren’t for every prostate cancer patient. “He’s playing tennis again, he’s taking his wife out on dates, and they’re sleeping together. She says their marriage has been reborn. And it’s because she’s the one who got him to get help.”