Defense secretary’s diagnosis highlights stigma surrounding prostate cancer

Amna Nawaz:

The diagnosis of Defense Secretary Lloyd Austin's prostate cancer and his initial decision not to disclose it has put that cancer back at the center of some attention.

As John Yang explains, it's one of the most treatable cancers. But for many men, there's still a stigma around it all too often.

John Yang:

Amna, Secretary Austin was one of the estimated 288,000 men diagnosed with prostate cancer in 2023. It's the most common cancer among men after skin cancer, but, according to the American Cancer Society, the five-year survival rate in the United States is 99 percent.

While one in eight of all men will develop the disease in their lifetime, among Black men, it's one in six.

Dr. Jay Raman is professor and chair of the Department of Urology at Penn State Health.

Dr. Raman, we have often heard prostate cancer be described as slow growing. So help us understand where it is, and how often does it spread?

Dr. Jay Raman, Penn State Health:

That's a great question.

I think one of the things we have to understand is that prostate cancer really represents a spectrum of disease. There are certain types of prostate cancer which are slow-growing. They're indolent. You're more likely to die with it than die from it.

But there are other types that are more aggressive, and these require some type of therapy, surgery, radiation, or some combination. But all of these collectively, as you alluded to, result in a cure rate that is excellent if it's found early.

John Yang:

And let's just quickly remind people what the prostate is and what its function is.

Dr. Jay Raman:

So the prostate itself is a small organ. It's about the size of a walnut. It's located deep in the pelvis. And it's really a reproductive organ. It really helps with men having secretions that nutrition — give nutrition to the sperm and allow them to have children.

Later in life, however, we really know the prostate has two real causative factors, one, prostate cancer, the other being an enlarged prostate. And in this case, we're talking about developing prostate cancer in this organ.

John Yang:

Secretary Austin's physicians say his cancer was detected early and as part of a routine health screening.

Are there lessons in that?

Dr. Jay Raman:

Well, I think, for prostate cancer, screening is absolutely critical. And screening really involves identifying problems such as cancer at an early stage and an early phase, when it's not only treatable, but highly curable.

For prostate cancer, we're really talking about checking a blood test called the PSA test, as well as a rectal examination to feel the prostate for lumps and bumps. And an abnormality in either of these could suggest the presence of prostate cancer and at a minimum needs to be pursued further.

John Yang:

Screening, how soon should it begin and how often should it be done?

Dr. Jay Raman:

So for the patient at average risk, so an average man in the United States, we're looking at ages between 45 and 50 years of age to have that initial PSA blood test, as well as that initial rectal examination.

Now, there are certain patients that are at higher risk. Those are patients of Black African American race or Black ancestry, those with a first-degree male relative with prostate cancer, or those with genetic or hereditary mutations. Those patients really need to be screened at an earlier age, about 40 to 45 years, because they're at a higher risk of developing the disease.

John Yang:

Is there a stigma around prostate cancer, the belief that it's an old man's disease that leads to impotence, it leads to incontinence?

Dr. Jay Raman:

Well, I really think about it this way.

If you look at breast cancer in women, it occurs at approximately the same rate as what we see in prostate cancer in men. And women are excellent advocates for their health. You hear a lot about mammography, self-examination, getting checked, getting screened.

I think, for men in general, health problems create a little bit more of a stigma, the sense that, if they feel fine, there might not be a problem. And the reality is, is that diagnosing and checking these conditions early, identifying prostate cancer early allows you to identify it at a point where maybe some of these side effects that you talked about, impotence and incontinence, may be mitigated or minimized.

John Yang:

We also hear women talk a lot about breast cancer, talk about it among themselves to bolster each other, men not so much about prostate cancer.

Is that a hurdle to more screening and more detection, early detection?

Dr. Jay Raman:

Absolutely.

If you look at prostate cancer, it is really an asymptomatic cancer until we reach a late stage or a late grade. And once men start having symptoms, I always say the wheels are starting to come off that wagon and the ability to treat and cure this disease is less.

So I really believe that high-profile cases like this really underscore the importance that anybody can get prostate cancer, those that are in your community, those that perhaps are of higher profile, and the importance is really getting the word out, having these discussions, understanding that one in eight men do develop this disease, and it's important to have these discussions, and so men get checked and screened.

John Yang:

Dr. Jay Raman of Penn State Health, thank you very much.

Dr. Jay Raman:

Thank you.