AYESHA RASCOE, HOST:
Early last week, after days of speculation over Defense Secretary Lloyd Austin's health, the Pentagon revealed that the 70-year-old had been diagnosed with prostate cancer.
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PAT RYDER: He was admitted to Walter Reed National Military Medical Center and underwent a minimally invasive surgical procedure called a prostatectomy.
RASCOE: That's Maj. Gen. Pat Ryder reading a statement from Walter Reed. Austin experienced complications following that procedure and was readmitted to the hospital. The press, and it turns out the White House, were initially kept in the dark. Prostate cancer is one of the most common forms of cancer for men, and also the most curable if detected and treated early. Dr. Ben Davies is a professor of urology at the University of Pittsburgh School of Medicine, and joins me now to talk about it. Welcome to the program.
BEN DAVIES: Thank you for having me.
RASCOE: So let's start with the basics. What is prostate cancer?
DAVIES: Well, it's really a proliferation of cells in the prostate which can - if left unchecked, in some cases can spread in your body and unfortunately kill about 36,000 men a year.
RASCOE: How prevalent is it?
DAVIES: We probably overdiagnose prostate cancer in some men and overtreat prostate cancer in some men and undertreat prostate cancer in some men. So one major thing that we should talk about is that many prostate cancers do not need to be treated. And that's a source of challenge to communicate to the public when people get diagnosed. So one thing we can do is make sure that people get diagnosed with the correct type of prostate cancer, and it turns out that we can actually do that. We can do what's called smart screening. And smart screening involves checks with a blood test called PSA and then an MRI of your prostate. And if we do that, we do a very good job of selecting out some of the prostate cancers we don't need to see, but do get to diagnose the ones that are helpful to treat.
RASCOE: So how is prostate cancer usually treated?
DAVIES: Yeah, that's what we got a real quick look at this past week with poor Secretary of Defense's terrible complication. By the way, that complication in most series is less than 1%. It's extremely rare. So I hate - I would hate the public to think that that was a common complication. But to get to your question, it's really two ways to treat prostate cancer, I would say. One is with radiation therapy, which works extremely well, and one is with surgical removal, which is what I do for a living. But the two methods are very, very good methods and relatively equal in terms of outcomes.
RASCOE: Can I talk to you about - I mean, obviously you mentioned Secretary Austin, and you are not his doctor. We clear about that. But in general, when a prostate gland is removed surgically, what kind of complications can there be?
DAVIES: In some we would say there are side effects to the having a prostate removed. And then there are complications. Complications are like the poor Secretary of Defense had, having to be readmitted because there's urine spilling into your belly. That's less than 1% - very, very rare. And then there are normal complications of surgery that you could imagine - an infection of a wound, cardiopulmonary problems that can happen with surgery. Again, extremely rare - I would say that having your prostate removed now is akin to having, say, your gallbladder removed. The pure complication rate is extremely low. Now the side effect profile of one - I'm sure your listeners are well aware of - of erectile dysfunction and stress urinary incontinence. Those side effects are real and can happen. And those rates will change with a variety of different factors that influence those rates - surgeon skill, patient factors like patient diseases that they may have and things like that. Those are kind of challenging conversations we have to have with patients every day.
RASCOE: And my understanding is that that exam of the prostate is uncomfortable as well as effects post-treatment can be considered embarrassing for a lot of folks. Do you think there's a certain amount of shame involved that maybe keeps people from getting screened or treated, or even talking about their experiences?
DAVIES: I hesitate to use the word shame, but I think people are hesitant because they're worried about the exam may hurt, and they certainly are worried about the side effects of any treatment. Rectal exam should not be painful, but they certainly can be, and they are uncomfortable. What's important for men to know is that if they don't want to get a digital rectal exam, they can tell their physician, I don't want one. Because it's really the PSA value that is great for prostate cancer screening. Now, if you come to the physician's office and have all kinds of different symptoms, we're definitely going to want to feel your prostate. But people should remember, if that's the reason they're not coming to the urologist or their PCP, they can tell them, I don't want to have the digital rectal exam. They heard it from Dr. Davies, and they do want to get their blood test to be screened and maybe get an MRI if it's abnormal.
RASCOE: That's urologist Ben Davies of the University of Pittsburgh School of Medicine. Thank you so much for joining me.
DAVIES: Thanks for having me. Had a great time. Transcript provided by NPR, Copyright NPR.
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