Men Who Speak Up

Men’s Health Month is the ideal time to discuss a health issue that affects many men annually and has a great impact on their families: prostate cancer. Prostate cancer is the most commonly diagnosed male malignancy within the US, and sadly, the second leading cause of cancer-related death in men within the US. The diagnosis and treatment of prostate disease is a core disease management issue affecting the specialty of Urology.

Throughout my career and in my practice today, I have focused on better understanding appropriate diagnosis and treatment of all patients with prostate cancer, regardless of whether the disease is early stage or advanced. Although prostate cancer can affect men of all ages, more than half of all cases are diagnosed in men over 65 years old. African American men and those with a family history of prostate cancer, especially a father or brother who was diagnosed, are at increased risk.

Following diagnosis, my goal is to discuss with men and their caregivers all appropriate treatment options, including advantages and disadvantages. The stage of prostate cancer is one of the most important factors in determining treatment options and setting expectations for recovery and possible need for additional treatments.

If the cancer metastasizes, or grows outside the prostate gland to nearby tissues or lymph nodes, preventing or slowing the spread of the cancer is a major treatment goal. With more advanced progression, prostate cancer nearly always spreads to the bones and sometimes to internal organs, such as the liver and lungs.  Approximately nine in ten men with advanced prostate cancer (90 percent) develop bone metastases, which has been shown to impair both quality of life and survival.

Most cases of early-stage prostate cancer are discovered by a concerning change in the PSA blood test and typically do not cause symptoms. However, symptoms may emerge in men with advanced prostate cancer, including increased fatigue (even more than when they initiated hormone suppressive therapy), difficulty walking or climbing stairs, unexplained pain or discomfort, troubled sleep and increased ingestion of over the counter pain relievers. These symptoms, as well as worsening pain, can be signs of advancing prostate cancer, often involving spread of the disease to the bones. Studies demonstrate that nearly 80 percent of men with bone metastases suffer from debilitating pain or extreme discomfort.

Not surprisingly, communicating with patients about their “below the belt” health issues can be challenging. When it comes to discussing prostate cancer, a clear physician-patient dialogue is especially important, and having a family member to assist in that discussion is key. Communication becomes even more crucial for patients with advanced prostate cancer or, in other words, patients who cannot be cured by surgery, radiation, or cryotherapy.

Men with advancing prostate cancer who recognize pain or have stopped doing the things they used to do easily should feel empowered to take action and speak up about their symptoms. Unfortunately, these patients may feel embarrassed by complaining, may not want to disappoint their clinician care teams or upset their families, or might fear a change in therapy. Recently, results from the largest-ever survey to be conducted in advanced prostate cancer – which were presented at the American Society of Clinical Oncology (ASCO) meeting earlier this month – revealed that while virtually all of the more than 1,300 respondents (99 percent) said they experienced at least one prostate cancer symptom, more than half (56 percent) were uncertain if the symptom was cancer-related.

The survey also showed that nearly seven in 10 men (68 percent) living with prostate cancer in the US admitted to sometimes ignoring symptoms. These results indicate that work is needed to help men recognize the symptoms of advancing disease and speak up about them – which is what the Men Who Speak Up program, now entering its second year, seeks to achieve. The program not only encourages enhanced communication among the patient, his caregivers, and his treatment team, but also provides suggestions for improving this dialogue. I encourage my patients to be vocal about their health so that I can better understand their specific needs and offer the most precise and appropriate treatment for them.

All men and their families should be on the lookout for the warning signs of advanced prostate cancer. For resources on advanced prostate cancer, talk to your doctor or nurse and visit

Dr. Neal Shore, MD

View posts by Dr. Neal Shore, MD
Neal D. Shore, MD, FACS, is Medical Director for the Carolina Urologic Research Center.
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