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My Retirement Plan: 401K, IRA, and… Prostate Cancer Screening?

As a physician, I probably don’t think about my own health as much as you might guess, but last month I underwent an executive physical (full disclosure: my wife signed me up and my Duke benefits covered it, otherwise I would not be talking about this). Labs, physical, stress test, bone and muscle density testing; nutrition, exercise and stress counseling, the whole gamut.

I won’t bore you with the details, but it occurred to me — we spend a tremendous amount of effort screening, educating and proactively managingrisk factors for heart disease, and for good reason, as cardiovascular events have been the leading cause of death in American men for a long time. However, recently cancer has passed heart disease as the leading cause of death in American men.

Lung, colon, and prostate cancers are the three big contributors to those deaths, and thankfully there is no controversy about what we need to do for two of those cancers: don’t smoke and get a colonoscopy. For me, I don’t smoke and a got my colonoscopy last year (thanks again, honey), but what about prostate cancer? What steps are we proactively taking to discuss the risks of prostate cancer?

You might be surprised to know that the incidence of prostate cancer has been decreasing, but death from prostate cancer? Not so much. Despite our progress in surgery and radiation techniques, as well as new treatments for advanced disease, prostate cancer deaths in the United States have plateaued around 29,000 per year (roughly 2.7 percent of all deaths for men).

Screening for prostate cancer through a digital rectal exam and the prostate-specific antigen (PSA) blood test is simple, easy and cheap, yet nearly half or more American men are not getting this done.

It’s true that screening is not very efficient – roughly 1 in 9 men will develop prostate cancer in their lifetime and of these roughly 1 in 6 will die from this disease. Furthermore, about half of the prostate cancers detected by PSA and rectal exam screening are very unlikely to ever be lethal and do not need immediate treatment. 

It is the other 50% of prostate cancers, the aggressive prostate cancers, that account for the vast majority of the deaths that we urgently need to screen for. Given these low numbers, most primary care physicians are not going to realize the benefits of screening, only the hassles, and complications. Even the aggressive prostate cancer cases they do come across may not become lethal for five to 10 years. 

But, as we age and plan for the “golden” years of retirement, we should think of cancer screening as part of that retirement plan - if we are being proactive about the other major medical (and financial) risks in our lives, from heart disease to colon cancer,  we should also be talking about prostate cancer screening. I did it at age 48, and I didn’t even need my wife to tell me. 

Written by: Daniel J. George, MD, Medical Oncologist, Professor of Medicine, Professor of Surgery, Duke Cancer Institute, Durham, North Carolina

Published Date: September 19th, 2018