Prostate Exams Save Lives
November is men’s cancer awareness month. Doctors and health officials around the country are encouraging Brazilian men to use this time to overcome the common fears associated with prostate examinations. A recently published article investigated the reasons why patients avoid the prostate exam when screening for prostate cancer. The study was performed by doctors from the Instituto Curitiba de Saúde and Hospital São Vicente de Curitiba, and it was published by an international urologic journal in Spain.
Prostate cancer is the most common form of noncutaneous cancer in men and the second leading cause of male cancer mortality. In Brazil it is estimated that one out of six men develop prostate cancer during their lifetime. The prostate exam is an important tool during prostate cancer screening, and should be done annually beginning at age 45 for all men, and at age 40 for those with one or more first-degree relatives with prostate cancer.
Although measurement of the PSA in a blood sample is effective in prostate cancer screening, use of the PSA without a prostate exam is not recommended because 25 percent of men with prostate cancer have a normal PSA level.
Using 450 volunteers enrolled in a prostate cancer educational program, investigators found that 8.2 percent of men refused to have a prostate exam for several reasons. A significant number of men thought that only those with symptoms or with an abnormal PSA should undergo the prostate exam. Misconceptions about prostate cancer were identified.
Men must be made aware that they could have prostate cancer and still have no symptoms, feel well, and seem normal to others; and that the prostate exam is in fact most important in patients with a normal PSA because it can identify prostate cancer, which would be overlooked by a low PSA level.
The most surprising fact discovered by this volunteer study was that nearly half of all patients rejecting a prostate exam reported they believe the prostate exam is a reason for shame. Although they rationally understand that prostate cancer screening is important, they believed that undergoing the prostate exam is not an acceptable behavior for men because of cultural myths.
As the leading author of this investigation, I want to stress that men have no reason whatsoever to feel this way. “The prostate exam is a fast procedure as important as PSA that may detect and allow treatment for small and localized prostate cancers, which have the highest chance of cure, and the lowest risk of complications,” this investigation concluded.
It was also shown that after men undergo the prostate exam for the first time, refusal rates decline for future prostate cancer screening. This demonstrates that patients’ expectations and anxieties can be overcome after the first exam.
Dr. Frederico Ramalho Romero