“You’re lucky, you have the good cancer.” Too many of our friends have had this said to them by people who mean well but clearly don’t understand what a diagnosis of prostate cancer means to men and their families. Indeed, try telling that to Stan, Tom and Chris, three of our friends who died this past year because of metastatic prostate cancer.

There is no such thing as a “good” cancer. With rare exceptions, few ever have a certainty that they are “cured” and the worry about a potential recurrence is always present. Virtually every diagnosis brings with it life-changing emotions and realities. Side effects are real. Financial concerns are looming. Relationships become altered. Friends disappear. And, no matter how great your support, no matter how many loving friends and family surround you, basically you are alone as you confront your mortality.

We can surely say that we now live in a time where new treatments emerge that prolong life and help ensure a better quality of life as you go forward. And there are more support groups, patient navigators, and cancer centers to help sustain you as you go from diagnosis to treatment to resuming your life. We are grateful for all that. But it is wrong to presume, even for a moment, that cancer, any cancer, is anything but a fearful occurrence in one’s life.

And with prostate cancer there are so many concerns. For example, we are all urged to have a colonoscopy when our age suggests it is time to begin. Starting in the 1970s, women have been exhorted to have mammograms at the appropriate age. But men have had a rockier road.

It took many years for information to begin to appear suggesting to men and their physicians that they should have a baseline PSA test once they were 45 or even earlier if they had a primary family member with prostate cancer. Finally the message was reaching men and PSAs were becoming more routine, when suddenly in 2012 the U.S. Preventive Services Task Force issued a report that essentially said, “Don’t bother. Don’t get a PSA. Don’t even talk to your doctor about it.”

And so, fewer doctors began offering the PSA and fewer men asked their physicians to include it. The reasoning behind the report was that too many men were being needlessly treated — and that was correct. But the solution was education, not ceasing the life-saving test. Finally in 2018, the task force issued new guidelines suggesting that men could at least begin a conversation with their doctors. But it may be too little too late.

A new report issued by Kaiser Permanente points to the fact that since 2012 fewer men were tested, given biopsies or treatment, but “there was also an increase in dangerous cases where the cancer had spread beyond the prostate and had become incurable.”

There is also speculation that, while overall cancer deaths in the United States have declined, prostate cancer deaths would soon increase.  (Approximately 175,000 men in the U.S. are diagnosed with prostate cancer annually, with about  31,000 deaths.) “The current study shows, however, that there is danger in not being screened; some men will develop metastatic cancer who may have otherwise been treated and cured if they were screened appropriately.”

In Maine, there is a statewide all-volunteer nonprofit, the Maine Coalition to Fight Prostate Cancer (www.mcfpc.org), that lists current information, support groups and cancer centers. They also cooperate with One2One Confidential (441-5374 or 855-552-7200, ext. 801), where men can talk with other men who have been on the prostate cancer journey.

The coalition urges men to talk to their doctors and have a baseline screening (PSA blood test accompanied by a digital rectal exam at 45 or earlier if African American or have brothers, a father or uncles who have prostate cancer.)

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