It’s rare to find the words “prostate cancer” and “breast cancer” in the same sentence. After all, one (prostate cancer) affects only men. The other affects mostly women. But despite their differences, the two diseases actually have a lot in common, particularly in the way those diagnosed with either one evaluate their options and make decisions about treatment.
Read more about prostate cancer here
Jim Morning, who lives in Dover, Delaware, got used to having regular physicals when he was in the Air Force, and after he retired, he continued doing so. For years, Jim’s physician had been monitoring Jim’s PSA levels (a blood test that can indicate the presence of prostate cancer) and everything was fine. But over time, Jim noticed that he was getting up at night to urinate more often than he used to, and he was having trouble completely emptying his bladder. Jim’s doctor ran another PSA test which came back high, and referred Jim to a urologist who did a biopsy. “After the biopsy, he told me to make a follow-up appointment and to bring someone with me,” says Morning, who brought his sister along. “I wasn’t sure why, but I did it anyway—and I’m glad I did.”
It was at that follow-up that the doctor told Jim that he had prostate cancer.
According to Steven Patierno, PhD, Deputy Director of the Duke Cancer Institute, men like Jim Morning are in the minority. “Generally speaking—although this is beginning to change—men are pretty resistant to healthcare,” says he says. “I’ve had guys tell me that they’d have to be on their deathbed before they’d take a day off from work.”
For Jim—and most people—getting diagnosed with cancer is something of a shock. “I don’t think I heard anything after the word ‘cancer,’” he said.” “I had no clue what to do. All I wanted to know is ‘how long do I have?’” Fortunately, Jim’s sister was there and she took careful notes. In the days and weeks after the diagnosis, Jim’s family mobilized and made sure he had the best care possible, getting him into the MD Anderson Cancer Center in Houston. Two sisters and several cousins—all women—went with him and helped him evaluate his options. “When you have sisters, us guys don’t have to make decisions,” he jokes. After going over each possible treatment with MD Anderson’s doctors, Jim and his family decided on a radical prostatectomy (a complete removal of the prostate).
Jim knows how lucky he is to have had regular health screenings and such a supportive family. After his surgery, he started talking with other men who had been diagnosed with prostate cancer. “A lot of these guys are ashamed and they don’t want to talk about it,” he says. “They have no idea what to do. I tell them about me, how I felt. And I try to get them to understand that they’re not out there by themselves.”
He also works with younger men, trying to educate them about prostate cancer. “We start off talking about sports and girls and then I’ll ask whether anyone’s had his prostate checked,” he says. “Usually the answer’s no.”
Duke’s Patierno says that part of the reason men—especially in African American and Hispanic communities—don’t get checked for prostate cancer is the myths that circulate about health. “A lot of guys have this attitude that, ‘you don’t have cancer unless someone tells you that you do,’ and they end up not getting screened because they don’t want to hear about it,” he says. “So they don’t end up getting treated until their symptoms are severe. By then, it’s too late and they die.” That perpetuates the idea that you shouldn’t be seen by a doctor (“Look what happened to Bob. He goes to the doctor and two weeks later he’s dead. If he wouldn’t have gone, he’d still be alive”).
Patierno also says that women are far more educated about and involved in their own healthcare than men are. That may be true overall, but when it comes to breast cancer, being educated and involved doesn’t always mean better outcomes. “Many women behave just like men,” says Judy Seals-Togbo, a women’s health advocate in Memphis, Tennessee. “They put off getting screened, they don’t go to follow-up appointments, and they don’t get help until they develop symptoms.”
Read more about breast cancer here
The reasons behind women’s reluctance to get screened and treated for breast cancer are similar to men’s reasons for not getting any kind of health care: Some say they’re too busy taking care of everyone else and they don’t have time to focus on themselves. Some don’t have insurance. And others have the if-I-don’t-go-to-the-doctor-I-won’t-get-sick attitude. In addition, many women—especially younger ones—want to believe everything their doctor tells them. Judy, who is a breast-cancer survivor herself, personally knew several women in their early 30s who felt there was something wrong in a breast but were told by a doctor that they were too young to have breast cancer and they shouldn’t bother getting screened. Two of them died—of breast cancer—before they turned 35. “This is crazy,” she says. “We need to train women to be more assertive in telling their doctors their symptoms and, if they aren’t satisfied with the answers, to go get a second opinion.”
In addition to her work with women, Seals-Togbo is also very active in men’s health. And she’s seen how breast cancer stigmas affect men as well. “Getting diagnosed with any kind of cancer is confusing and scary. But guys with breast cancer are also embarrassed and ashamed. They’re worried that people will think they’re not ‘real men’ because they have a ‘women’s disease.’” The result? They frequently don’t get treated in time.
Interestingly, getting diagnosed with either prostate or breast cancer brings up yet another problem. How does it get treated? Jim Morning had his family and a team of medical professionals to help him make his choice. And Judy Seals-Togbo, who turned to her gynecologist at the first sign of trouble, got treated early. Both have been cancer-free for years.
But no everyone’s that lucky. Morning told me about men who refuse to consider certain prostate cancer treatments because they’re afraid of the side effects (erectile dysfunction and incontinence are common), and they end up not getting rid of the cancer. And Seals-Togbo told me about a woman she knew who was told by her doctor that she had breast cancer, left the office and went directly to a local mortuary to plan her own funeral. “She had no idea—and the doctor didn’t tell her—that there are a lot of things to try before planning a funeral.”
We tend to think of the people who have cancer as the only ones affected. “A cancer diagnosis is a family diagnosis,” says Patierno. “The impact on the spouse and children is extraordinary. Kids have an especially tough time coping when mom or dad is sick. Young kids may think that they somehow caused the cancer, and older kids may actually have symptoms that are similar to PTSD. The good news is that cancer treatment centers are developing programs to help family members cope.
There’s also good news on the horizon for treating both breast and prostate cancers. One of Patierno’s colleagues at Duke is involved in clinical trials of a new type of chemotherapy for breast cancer. “We inject the drug into the tumor and the antibodies melt the tumor away,” says Patierno. “Women in the trials are getting the same dose of chemo as they would with traditional chemotherapy but there’s a big reduction in side effects—the women aren’t even losing their hair.”
New drugs are also being developed for prostate cancer. One, in particular has been very effective in treating tumors that have been resistant to other treatments. Overall, “we’re getting really good at treating these two diseases,” says Patierno. “But there are 13.8 million cancer survivors in the U.S. and we haven’t done a very good job figuring out how we’re going to provide ongoing care for them.”
For Jim Morning and Judy Seals-Togbo, ongoing care is a nice goal. But what concerns them more right now is making sure that the men and women they work with get the screenings they need to catch their cancers while they’re still treatable, and the education they need to pick the option that will have the best outcome for them and their family.
