The Truth about Prostate Cancer

Martin Ware sat on the edge of the exam table, dressed only in his underwear, barely covered by a paper thin examination gown. “I hope we get this over with soon,” he thought. Martin was worried.

Dr. Doren breezed into the room, a patient chart in his hand and a smile on his face. “Good morning, Martin. How are we doing today?” The doctor’s eyes took in the stiff posture and the worried facial expression of his patient.

“I’m a little worried about what’s going to happen today.” Martin fidgeted on the end of the table.

Dr. Doren sat down on the little roll around stool and crossed his legs. “What about?” he asked.

“I’ve been reading in the papers about prostate cancer and I know you had them draw my PSA last week.” Martin was talking rapidly, anxiously. “And I saw that some doctors want to do digital exams every year and some don’t think you need to. And my friends said that I was in for it today. And I just wondered . . . what would happen.”

Dr. Doren gazed up at the ceiling for a long moment. “Well, let’s start at the beginning,” he began. “First of all, you are here for a yearly physical exam – an exam of all of you, not just your prostate. So my concern is for your total health–body and mind and spirit. I’ll be talking with you about many areas of your life. Your prostate isn’t even among the top three subjects.”

“Second, you are uniquely you. While there are guidelines for investigation and treatment of many diseases, I have to take into account your unique factors – your family history, your propensity to disease, your other risk factors – in deciding what questions to ask, what specific physical exams to do, and what lab tests to order.” Dr. Doren stared at him seriously. “Don’t make medical decisions based on newspaper articles and discussions with your friends, Martin. If you are concerned, come talk to me.”

Martin shrugged his shoulders to relieve the tension. So far, nothing he had heard had removed his worries.

Dr. Doren continued, “Now so far as prostate cancer is concerned – this is a disease of older men, men over 60 or 70. You are . . .” He flipped to the front of the chart he held in his hands. “You are 52,” he said looking up. “Your chances of getting prostate cancer are very small.” Dr. Doren paused and held up his hand. “But let’s ask. Did your father or your brother have prostate cancer?”

“No,” Martin answered.

“Did your mother or any of her relatives have breast or ovarian cancer?”

Martin thought about it. “No.”

“And you aren’t African-American. So you aren’t in any of the high risk groups. And your chances of prostate cancer are very small indeed. Feel better yet?”

“A little,” Martin said with a small laugh.

Dr. Doren again checked the chart. “I did a rectal exam and an initial PSA on you two years ago – when you turned 50. Your prostate was normal size then and your PSA was 1.3. The PSA we drew last week is 1.5. So there is no need to go any further. No rectal exam today.”

Martin laughed out loud. “Okay, now I’m not worried.”

But Dr. Doren was still straight-faced. “However, if your PSA had been over 2, we would be doing a rectal exam. And if it had been over 3, I would be sending you to a urologist. It’s not the PSA number so much as it is how fast the number is climbing. When the PSA climbs rapidly, it’s worrisome. But,” he smiled, “that’s not your numbers and that’s not your situation.”

Shaking his head, Dr. Doren mumbled to himself, “Lab tests and exams should not be stopped blindly or done arbitrarily by some non-personalized guideline.”

Dr. Doren looked up. “Now as to your cholesterol levels – we have some talking to do.”

Martin took in a deep breath and listened.