Men's Health Archive

Breast cancer isn’t just a woman’s disease. Men can get it, too—about 1% of breast cancer is diagnosed in men. Since few men know that, they often fail to recognize its earliest signs and end up seeing a doctor later in the process than women do. The result: Men face treatment for larger and more advanced tumors, and their cancer is more likely to have spread to other parts of the body. The largest study to date on outcomes in men with breast cancer indicates that the five-year survival rate for women with breast cancer was 83%, compared to 74% for men. Even men diagnosed with early stage breast cancer still fared worse than women, although the gap closed for men and women diagnosed with later-stage disease. Since breast cancer in men isn’t often on doctors’ radar screens, men should be aware and check themselves.

Yesterday’s announcement that men should not get routine PSA tests to check for hidden prostate cancer is sure to spark controversy for months to come. But the U.S. Preventive Services Task Force (USPSTF) made the right decision. On the surface, rejecting the use of a simple blood test that can detect cancer in its early and still-treatable stage sounds foolish. Cynics have been saying it is the handiwork of a group concerned more about health-care rationing and cutting costs than about health. The decision is wise, not foolish, and will improve men’s health, not harm it. The word “cancer” usually brings to mind images of a fast-growing cluster of cells that, without aggressive treatment, will invade other parts of the body, damage health, and potentially kill. That certainly describes many cancers. But not most prostate cancers. Most of the time, prostate cancer is sloth-like. It tends to grow slowly and remain confined to the prostate gland, with many men never knowing during their entire lives that a cancer was present. These slow-growing prostate cancers cause no symptoms and never threaten health or longevity. That means many men with prostate “cancer” never need treatment.

A simple blood test to check seemingly healthy men for hidden prostate cancer does more harm than good and shouldn’t be part of routine medical care. That’s the long-awaited final recommendation from the United States Preventive Services Task Force (USPSTF), published today in Annals of Internal Medicine. About half of men over age 40 get this test as part of a regular checkup. It measures the amount of a protein called prostate-specific antigen, or PSA, in the bloodstream. An above-normal PSA level can signal hidden prostate cancer. But it can also be a sign of prostate infection, an enlarged prostate, and other problems. Hunting for hidden disease in the absence of any outward signs or symptoms is called screening. The task force says that for every 1,000 men who have routine PSA tests, 0 to 1 deaths from prostate cancer will be prevented. But that is offset by 3 serious cardiovascular deaths due to treatment, along with 47 men who will live with treatment-related erectile dysfunction or incontinence.

Smoking is the leading preventable cause of death in the United States. The health hazards of tobacco are enormous; they include heart attack, stroke, dementia, aortic aneurysms, emphysema, asthma and lung infections, and cancers of the mouth, throat, lung, and many other organs. Together, these diseases account for 443,000 preventable deaths in the U.S. annually, to say nothing of incalculable suffering and disability. And if that's not bad enough, smoking also drains our fragile economy of some $193 billion a year.

The dangers of smoking are well known, but it's taken over 50 years for the full extent of the problem to emerge. First, scientists identified cigarette smoking as the villain of the piece. Over the years, they discovered that filtered cigarettes and "low-tar and low-nicotine" brands offer no protection. Little by little, pipes, cigars, and smokeless tobacco products have been added to the hit list, and research has demonstrated that even exposure to secondhand smoke is a major health hazard.

Q. As a retired physician, I particularly appreciate Harvard Men's Health Watch since it's an easy way for me to learn about new developments in medicine. As a 78-year-old man with an enlarged prostate, I'm particularly interested in your fine articles about BPH. But if memory serves me right, we called the condition "benign prostatic hypertrophy" when I was in practice, but now you call it "benign prostatic hyperplasia." What's the difference?

A. Thanks for your kind words.

Medicine is indeed a rapidly changing science, and you are exactly right about the changing name of BPH. For many years, doctors believed that this common condition resulted from an increase in the size of certain cells in the prostate gland. An increase in cell size is called hypertrophy. It's what makes bodybuilders "bulk up"; in that case, resistance training makes muscle cells bigger and stronger, but these bulging biceps don't contain more cells than those of a 100-pound weakling.

Q. I am a 73-year-old man and I've been diagnosed with epididymitis, which has been quite painful — to say the least. I would appreciate your comments about the cause, cure, and any other implications of having this problem.

A. Despite its unfamiliar name, epididymitis is a common problem that is responsible for more than 60,000 visits to American emergency rooms each year. As the "itis" in its name indicates, it's an inflammatory disease, in this case involving the epididymis, a long, narrow tube that is tightly coiled at the upper rear of the testicle. In health, the epididymis transports sperm from the testicle to the vas deferens, a muscular tube that allows sperm to mature as they travel on to the seminal vesicles, which are near the prostate.

A large study from Europe does little to resolve the controversy over whether men should have a simple blood test to look for hidden prostate cancer. In the study, the number of deaths over the course of the 11-year study were the same in men tested for prostate-specific antigen (PSA) and in men who didn’t have the test. Because prostate cancer usually grows very slowly, detecting it in an older man generally isn’t helpful. Some men live with the side effects of treatment—notably impotence and incontinence—for a cancer that would have had no effect on the length or quality of their lives. This study and others suggest that we rethink the widespread use of PSA testing, especially the yearly screening that is common in the United States.

The prostate-specific antigen (PSA) test is the most important issue in men's health. That's because prostate cancer is the most common internal malignancy in American men, and the great majority of the 240,000 new cases expected this year will be diagnosed because of the PSA test.

The PSA is also the most controversial issue in men's health. The debate began as soon as the test was used to screen for prostate cancer in the early 1990s. Advocates of testing pointed out that the test is the best available way to detect prostate cancer in its earliest, most curable form; that makes testing seem like a no-brainer. But critics pointed out that the test has many false-positive results, which raise the alarm about cancer when none is present, as well as many false-negative results, which provide misleading reassurance to men who actually have prostate cancer. In addition, since the test cannot distinguish between the large number of slow-growing prostate cancers that are harmless and the smaller number of aggressive, dangerous tumors, PSA screening may subject many men to difficult treatments that they do not need.

The day before the findings were even released, The New York Times reported on the long-awaited United States Preventive Services Task Force (USPSTF) recommendation on prostate-specific antigen (PSA) testing. The headline announced "U.S. Panel Says No to Prostate Screening for Healthy Men." The public response was immediate, ranging from approval to confusion and even outrage; the CEO of a prominent prostate cancer advocacy group proclaimed that the USPSTF position "condemns tens of thousands of men to die this year and every year going forward."

Now that the report is available to all of us and we've had time to study it and reflect on its message, we should step back and evaluate PSA screening on its merits. It's a complex issue that requires careful consideration; at the end of the process, even men who disagree about the PSA are likely to agree that The New York Times's front page headline was an unfortunate oversimplification, and that we should all use precise, dispassionate language in discussing this contentious issue. Among other things, we'll see that the USPSTF position is evolutionary, not revolutionary, and that it is a recommendation, not an edict. The Task Force cannot take away a man's right to have a PSA test, nor would it want to. Still, the report is important, and it does point out that before a man decides whether or not to have a PSA test, he should fully understand that screening for early prostate cancer may do more harm than good.