Special Smashwords Edition
Prostate Cancer Reality Check:
How to Avoid Overdiagnosis, Ineffective Treatments,
&
Keep Your Erections
Carole Schroeder RN, PhD
Disclaimer
The information in this book is intended for informational purposes only. Nothing in this book is intended to be a substitute for professional medical advice. Consult with a variety of health professionals for medical advice regarding prostate cancer diagnosis and potential treatments.
PROSTATE CANCER REALITY CHECK: HOW TO AVOID OVERDIAGNOSIS, INEFFECTIVE TREATMENTS & KEEP YOUR ERECTIONS
Special Smashwords Edition
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Copyright © 2011 by Carole Schroeder RN, PhD. All rights reserved, including the right to reproduce this eBook, or portions thereof, in any form. No part of this text may be reproduced, transmitted, downloaded, decompiled, reverse engineered, or stored in or introduced into any information storage and retrieval system, in any form or by any means, whether electronic or mechanical without the express written permission of the author. The scanning, uploading, and distribution of this book via the Internet or via any other means without the permission of the publisher is illegal and punishable by law. Please purchase only authorized electronic editions and do not participate in or encourage electronic piracy of copyrighted materials.
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Contact the author at carolerealitycheck@gmail.com
Visit the author’s website
http://prostaterealitycheck.com
Published by Telemachus Press, LLC at Smashwords
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ISBN# 978-1-937698-09-6 (eBook)
ISBN# 978-1-937698-10-2 (paperback)
2012.01.05
For Lee
& all our sons and daughters
TABLE OF CONTENTS
How to Read This Book (Critically)
Chapter 1 PROSTATE CANCER MYTHS & FACTS
Chapter 2 PROSTATE CANCER FACTS: THE RESEARCH
Over-Diagnosis of Prostate Cancer
Over-Treatment with Ineffective Treatments
Minimizing Complications of Treatment
Hasty, Misinformed Decisions and Regret
Chapter 3 WHEN RESEARCH THREATENS PROFIT
Cancer Care is Enormously Costly—and Profitable
How Commercial Interests Create Controversy to Maintain Profit
The Lost Opportunity for True Cancer Prevention
Chapter 4 FOUR STEPS TO AVOIDING MEDICAL HARM IN PROSTATE CANCER
Chapter 5 STEP #1: COMMIT To NOTHING IMMEDIATELY
Chapter 6 STEP #2: AVOID “ROUTINE” PROSTATE CANCER SCREENING
About “Routine” Screening for Cancer
About “Routine” Screening for Prostate Cancer
Immediate and Delayed Harm of PSA Screening
If You Are Pressured to Have a PSA Test
Chapter 7 STEP #3: AVOID “ROUTINE” PROSTATE CANCER TREATMENT
Seek Several Independent, Unbiased Professional Opinions
Consult a Variety of Health Practitioners—Including Complementary
Ask Critical Questions about Risk and Benefit Statistics
Chapter 8 STEP #4: PRACTICE HEALTH, NOT DISEASE: SAVE YOUR LIFE, SAVE YOUR ERECTIONS
How to Improve Both Erections and Heart Health
Trans fats, Processed Oils, Sugars and Chronic Disease
How to Avoid Health-Destroying Foods
Anti-Cancer: Blaming the Victim instead of the Cause?
Exercise Hard, Nearly Every Day
Happiness and the Immune System
Anti-Cancer: Two Pioneers to Consider
If You Are Diagnosed with Aggressive Prostate Cancer
INTRODUCTION
The most important thing to do about the created “epidemic” of prostate cancer diagnoses is to STOP, do nothing immediately, and get informed about the true facts of prostate cancer. Then quit worrying and start investigating cancer prevention/remission methods in this book.
Prostate cancer is the poster child for over-diagnosis and over-treatment, meaning men are unnecessarily diagnosed and ineffectively treated for a cancer that would never be a problem for most of them.
Granted, if you do not get tested for prostate cancer, you will not be in danger of losing your bladder control or erections from aggressive treatments in the first place. But since American men are highly socialized into getting tested for prostate cancer, it is important to get the facts before the issue comes up.
One in three American men will be diagnosed with prostate cancer, and nearly all of the cancers will be slow growing. But, 75% of slow-growing prostate cancers are treated aggressively—and unnecessarily—with prostatectomy or radiation.1 Aggressive treatments of slow growing prostate cancer only cause harm, because they do not help men survive.
Thus the title of this book, Prostate Cancer Reality Check, because most men would be better off without PSA tests and expensive, erection-destroying medical/surgical treatments for prostate cancer. But American men are misinformed and scared, and end up agreeing to screening and aggressive treatments.
While about 3% of men die of prostate cancer (about 29,000 in 2008), 97% die of something else. Death from prostate cancer usually occurs late in life (median age 80 years). But most American men are “routinely” screened for prostate cancer (PSA test or DRE, digital rectal exam), and most are aggressively treated if cancer is found.
Screening does not differentiate between prostate cancer that will never be a problem in a man’s lifetime and rare but dangerous prostate cancer. Screening forces men down the costly, frightening, and life-changing road to prostate biopsies, Gleason scores, radical surgery and/or radiation treatments, impotence, and incontinence.
Aggressive treatments have not been shown to prolong survival significantly, but they have been shown to destroy men’s lives and health. Many men lose their ability to have erections sufficient for intercourse (>60%) and/or to control urine and bowels (30%).
All of this can be avoided if men STOP and think hard about the facts—and refuse to accept the medical hype we all hear from commercial medical industries profiting from widespread fear of prostate cancer.
Why Read This Book
Read this book to prevent medical harm—and to help you avoid problems with prostate cancer or other chronic diseases in the process.
Simply reading this book could save you months of anxiety, confusion, time, money, pain, and hasty decisions you may later regret. It could also help you retain your ability to have satisfying intercourse and avoid unnecessary and ineffective medical treatments.
I wrote this book because too many men and their partners are being harmed—not helped—by the aggressive approach to prostate cancer in the United States.
My husband and I were almost one of the “too many” couples harmed unnecessarily. Several years ago my then-fiancé Lee was diagnosed with “moderate” prostate cancer (Gleason 7). We were told by two urologists (surgeons who specialize in genital/urinary problems) to choose between radiation and surgery, for they were “similar in outcome.” But they were unable to cite evidence showing Lee would survive longer by having radiation or surgery. This made no sense to me at all.
As a PhD-prepared nurse and researcher, I know how important it is to be informed and to critically investigate medical recommendations about cancer, particularly for slow-growing prostate cancer. Lee and I spent many anxious months searching for research data about prostate cancer and its treatments, hoping to find the one that would help Lee “survive.” It was a frustrating task for several reasons:
• Most of the prostate cancer studies contradicted each other. We often read that any treatment of prostate cancer was “controversial” or that there was “little agreement” about treatments. I could also find no clear, convincing evidence that the treatments improved survival rates much at all.
• Treatment did not seem worth it. When studies did show “improved survival” from early diagnosis or treatment, the number of men who actually benefitted was shockingly low (about one in 50). Instead, it seemed that a huge number of men were being treated with invasive, costly, life-altering, and dangerous surgery and radiation, with little long-term improvement in survival.
• The five-year survival lie. The urologists said to Lee, “We can cure you!” When we asked what they meant by “cure,” they told us it meant Lee would still be alive in five years; yet almost 100% of men diagnosed with prostate cancer live for five years, treated or not. In fact, most of these men die of something else.
• The European mortality problem. More worrisome, in Europe, where prostate cancer is rarely diagnosed and treated only when symptoms occur, mortality (survival) outcomes are no worse than in the U.S., where we diagnose and aggressively treat most men who have prostate cancer.
• The “hurry-up-and-cut-it-out” crowd. To add to the confusion and pressure to make a decision, the people around us—close colleagues, friends, acquaintances, and family—all urged Lee to get radiation or surgery (“Cut it out!”) IMMEDIATELY, despite being told about the lack of benefit we were finding.
What was going on?
Why didn’t anyone seem to know about the lack of evidence that early diagnosis of prostate cancer and/or treatment helped? Family, friends, and the surgeon all acted as if “cutting the cancer out” was merely a routine procedure. After 40 years of working in a failed health care system, I believe that nothing in medicine is routine.
Caving in to the pressure, Lee scheduled a radical prostatectomy because he thought he needed to do something right away. But the more he studied the literature, the less inclined he was to try a permanent treatment like surgery, particularly because we could not find that surgery prolonged men’s lives. What we did find, however, was plenty of evidence about complications resulting from surgery and/or radiation—about 60% of patients have permanent impotence as well as a high risk of bladder and bowel damage.
But slowly, over time, we began to understand that widely held social and medical myths about prostate cancer were driving the intense pressure to “do something” quickly about a prostate cancer diagnosis.
Knowing Lee’s health, happiness, bladder and bowel control, sexuality, and maybe even his life were at stake, we decided to slow down, commit to nothing, and search for the truth about prostate cancer. This book is the result of that long search (and several years of subsequent research) into prostate cancer.
Lee cancelled his scheduled prostatectomy and sought out diverse, independent opinions on what he should do (see “What Lee Did” at the end of this book).
For the next several months, I used my 40 years of clinical nursing and medical research experience to find independent and unbiased facts about prostate cancer diagnosis and treatments.
Lee continued to read the many books on prostate cancer written by professionals and lay people, and we both talked to many men who had been treated for prostate cancer. In addition, I talked to women whose partners were diagnosed or treated for prostate cancer.
We were shocked at what we discovered and are sure you will be too as you read this book.
Being diagnosed with any cancer is devastating. Prostate cancer diagnosis is particularly devastating to men because of the serious and life-altering effects and complications of treatment. Prostate cancer is the second leading cause of cancer deaths in men, with about 29,000 men dying of it in 2008 (out of about 1.2 million male deaths). The lifetime risk of dying of prostate cancer is only about 3%, with 97% of men dying of something else.
The most common treatments for prostate cancer (surgery, radiation, and hormone treatment) often cause sexual impotence (erectile dysfunction, ED) and permanent problems with incontinence (inability to control bladder and/or bowel). The treatments can cause other problems or, in rare cases, even death (about 1-5%). Prostate biopsies put men at risk for deadly infections.
These complications could be acceptable if men were benefitting from prostate cancer screening, early diagnosis, and treatment, meaning they survived longer because of the treatment. But very little long-term benefit in mortality has been shown by our aggressive approach to prostate cancer in the United States.
No one should be unnecessarily diagnosed, or worse, unnecessarily treated for cancer. The psychological harm of unnecessary cancer diagnosis can be huge. Only about one in 50 men who are diagnosed with prostate cancer and treated aggressively with prostatectomy are helped—the rest are treated unnecessarily. This means that men’s chances of being harmed by prostate cancer diagnosis and treatment are much more likely than being helped by them.
Because of fear, misinformation, and our for-profit system, which floods us with frightening, hard-to-understand statistics, most men get screened for prostate cancer sometime after they reach their 50s. Prostate cancer is the most common cancer in men: about one in three men over the age of 50 have histological (meaning atypical cells can be seen on a pathology slide), recognizable prostate cancer. One in three men is a huge and profitable market, and as the 2010 fight for health reform showed, the medical care industry is not about to give that market up easily (prostate cancer costs the U.S. about 9.9 billion a year,2 according to the National Cancer Institute). So men are bombarded with constant advertisements, medical news, and “public service” announcements about the importance of being screened for prostate cancer.
Most American men with prostate cancer undergo unnecessary and harmful tests and treatments that have not been shown to prolong long-term survival. Although government graphs show “survival” increasing since the 1970s, these figures do not account for the epidemic of unnecessary early diagnosis that resulted from the creation of the PSA test in the 70s. Little real change has occurred in mortality over the last 40 years, despite aggressive treatments.
As discussed in Chapter 2, “Prostate Cancer Facts,” several large studies have been published over the last few years that demonstrate conclusively that most men are being harmed by prostate cancer diagnosis.
In 2008 and 2009, three studies were published that show how screening for prostate cancer does not help. In March 2008, a government-sponsored, scientific review of prostate cancer was published in a leading medical journal. The review found the most common treatments for prostate cancer to be similar in outcome to doing nothing.3 Moreover, men who are treated for aggressive prostate cancer have similar outcomes to men who are not treated. In March 2009, two other large controlled studies were published (one in the U.S. and one in Europe) that confirmed men are grossly over-diagnosed and unnecessarily treated for prostate cancer in the United States.4 5
More recently, the highly respected British Medical Journal published a major 2011 study by Sandblom, et al., showing that early detection of prostate cancer through screening does not help men survive prostate cancer.6 The authors studied men for 20 years and conclude that risk of over-detection and (unnecessary) over-treatment is significant when men are screened with PSA tests or rectal exams. From the conclusion of the 2011 Sandblom study:
After 20 years of follow-up, the rate of death from prostate cancer did not differ significantly between men in the screening group and those in the control group.
They continue:
Before undergoing prostate-specific antigen testing, asymptomatic men should be informed about the potential hazards of treatment with curative intent in case prostate cancer is diagnosed. These include erectile dysfunction, urinary incontinence, and bowel problems. The discomfort associated with prostate biopsy and the psychological effects of false positive results should also be considered.
As most of us know, the treatments for prostate cancer can ruin men's lives—and I get upset when the treatment is unnecessary and ineffective yet continues due to huge profits for the medical industry.
Prostate cancer has been studied for many years, and the evidence continues to accumulate that we are harming men more than helping them:
1. In nearly all screened cases, prostate cancer is slow growing and will not be a problem in a man’s lifetime—but 75% of men with early prostate cancer are aggressively treated, and the treatment can destroy lives.
2. Screening does not discriminate between slow-growing and rare but aggressive prostate cancer.
3. Screening leads to unnecessary and potentially dangerous biopsies and aggressive and ineffective treatments.
4. Aggressive surgery and radiation have not been shown to significantly improve mortality.
5. Most men with prostate cancer will die of something else, usually heart disease.
6. Men who do die of prostate cancer are usually elderly (median age 80).
We are all confused by prostate cancer because the creation of controversy is fast at work in the prostate cancer industry. Many research studies funded by various for-profit and government entities are published in an attempt to refute studies like Sandblom's. The Sandblom study could hurt the nearly $10 billion prostate cancer industry, which is based on testing, imaging, drugs, and treatments. Be prepared to be confused by headlines exclaiming this study is wrong, contaminated, biased, and invalid—headlines designed to confuse and scare the public into submitting to mass screening and aggressive, highly profitable treatments for prostate cancer.
Regarding psychological harm, Lee and I were devastated by his diagnosis of prostate cancer, mainly because we did not understand the real facts.
The financial harm of unnecessary diagnosis and treatment are huge, with the average cost of prostate cancer medical treatment over five years amounting to more than $40,000. This is cause for concern because the one-year cost of a radical prostatectomy is around $12,000, meaning men have to continually revisit the medical system due to complications of treatment or recurrence of prostate cancer. I sure don't want my husband to spend the rest of his life in a medical waiting room unnecessarily, and I bet you would like to avoid that fate, too.
This book can help. I hope to prevent other couples from experiencing what Lee and I narrowly escaped: medical harm. Aggressive treatments not only do not help but result in loss of erections and sexuality, impaired bowel and bladder control, psychological problems and depression, constant medical visits, and possible financial ruin (the cost of medical care is the number-one reason for bankruptcy in the U.S.).
As an academic, a health professional, and the wife of a man with prostate cancer, I want to make the information we found accessible to the public.
Who Should Read This Book
This book will be helpful to anyone concerned about health and prostate cancer. It will be particularly helpful to men who are:
• Feeling confused about all the contradictory information about prostate cancer.
• Considering whether to be tested for prostate cancer.
• Trying to decide what to do about an abnormal PSA test result.
• Worrying about the common effects of treatment for prostate cancer (impotence and incontinence).
• Dealing with a diagnosis of prostate cancer and trying to decide what to do.
• Wanting to keep and/or improve their erections and sexuality.
This book will also be very helpful for men who:
• Have already been treated for prostate cancer but want to improve their natural abilities to fight the cancer.
• Want to increase their chances of prostate cancer remission.
• Want to improve their chances of avoiding prostate cancer in the first place.
Ideally, men will read this book BEFORE getting tested or treated for prostate cancer. It will also be helpful to any man wanting to improve his chances of living a long and healthy life, with or without prostate cancer.
How To Read This Book (Critically)
This book takes a very critical look at our overly aggressive approach to prostate cancer in the U.S. It is important to critically evaluate everything you read about prostate cancer, this book included. Commercial medical interests have largely taken control of our medical care system, and corporate profit determines much of what the public knows about cancer in general and prostate cancer in particular.
Reading this book critically should be easy since it goes against everything the media, some medical associations, and “public health announcements” have taught us about cancer and prostate cancer.
This book is divided into two major sections:
Part I, The Problem, discusses the epidemic of over-diagnosis and over-treatment of prostate cancer. It also explains why so many men continue to be harmed by our aggressive approach to prostate cancer—despite clear evidence it does not work.
Chapter 1, Prostate Cancer Myths and Facts, lists several widely believed myths about prostate cancer. These myths drive popular and, sometimes, professional understandings of prostate cancer. Actual prostate cancer facts are listed after each myth.
Chapter 2, Prostate Cancer Facts: The Research, provides research-based evidence that screening for prostate cancer does not save lives and that men are grossly over-diagnosed and over-treated for prostate cancer in the U.S. Included are links to research that could dispel the myths that keep men willing to undergo unnecessary and ineffective treatments.
To help people decide for themselves, I provide Internet links to the online research studies discussed. If the research is not available online, I include the citation so people can get the article from a health professional or a medical library. (Later in the book, I explain how to interpret misleading statistics and the type of information to demand regarding prostate cancer). When available, I also provide a link to an easily understood media article that discusses the study.
Chapter 3, When Research Threatens Profit, outlines how scientifically valid (but commercially unprofitable) research results are discredited and labeled “controversial.” This chapter also explains how politics and profit have escalated the incidence of cancer to epidemic proportions. Tragically, this process has marginalized real cancer prevention efforts—efforts that could prevent getting cancer in the first place.
—
Part II, The Solution, shows how to safely (and sanely) avoid being drawn unnecessarily into the medical care system and how to safely navigate the prostate cancer medical industry. Part II also describes how to practice health, not disease, and shows how to improve health and happiness by following an anti-cancer lifestyle.
Chapter 4, Four Steps to Avoiding Medical Harm in Prostate Cancer, explains the steps to safely navigate the commercial prostate cancer industry and improve health (and erections!) in the process.
Chapters 5-8 explain each step in detail, emphasizing how to slow down and avoid being unnecessarily drawn into the medical care system.
In the Appendix, I provide some basic information regarding cancer as a chronic and systemic disease as well as information about rare but aggressive prostate cancer.
I also include a section called To PSA or Not to PSA?
A section called Frequently Asked Questions (FAQs) answers the questions most commonly asked about prostate cancer.
A section called What Lee Did outlines my husband’s decisions on treatment of his prostate cancer and his anti-cancer lifestyle changes.
A final section lists Resources for further information on prostate cancer and health.
This prostate cancer book has two major aims:
1. First, to prevent medical harm. Men who are over-diagnosed with prostate cancer are rarely helped by aggressive treatments—they are usually harmed. This book teaches men how to safely navigate our cancer care system and avoid medical harm.
2. Second, to help turn the threat of a frightening diagnosis of prostate cancer into improved overall health, fitness, and happiness (and yes, even improved erections). This book teaches men how to do something about the threat of cancer right now, rather than waiting until they develop health problems.
REFERENCES
1 Shao, Y, Albertsen, P, Roberts, et al. Risk profiles and treatment patterns among men diagnosed as having prostate cancer and a prostate-specific antigen level below 4.0 ng/ml. Archives of Internal Medicine. 2010;170(14):1256-1261.
http://archinte.ama-assn.org/cgi/content/abstract/170/14/1256
2 National Cancer Institute. U.S. National Institutes of Health. Benchmarks. The financial burden of cancer. April 2010.
http://benchmarks.cancer.gov/2010/04/the-financial-burden-of-cancer/
3 Wilt, T, MacDonald, R, Rutks, I, Shamliyan, T, Taylor, B, Kane, R. Systematic review: Comparative effectiveness and harm of treatments for clinically localized prostate cancer, Annals of Internal Medicine. 2008;148(6).
http://www.annals.org/content/148/6/435.full.pdf+html
4 Andriole, G, Grubb, L, Buys, S, et al., of the Prostate, Lung, Colon, Ovarian (PLCO) Project Team. Mortality results from a randomized prostate cancer screening study. New England Journal of Medicine. 2009; 360:1310-1319.
http://content.nejm.org/cgi/content/full/NEJMoa0810696
5 Schroder, F, Hugossen, J, Roobol, M, Tammela, T, et al. Screening and prostate cancer mortality in a randomized European study. New England Journal of Medicine. 2009; 360:1320-1328.
http://content.nejm.org/cgi/content/full/NEJMoa0810084?EX
6 Sandblom, G, Varenhorst, E, Rosell, J, Lofman, O, Carlsson, P. Randomized prostate cancer screening trial: 20-year follow-up. British Medical Journal. 2011; Online first; 342: d1539.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3069219
PART I
Chapter 1
“Early diagnosis with a PSA test will save my life.”
FACT: Early diagnosis does not save lives; it puts men as risk for unnecessary and ineffective treatments. Most diagnosed men would live a normal life, never knowing they had prostate cancer.
“I need to be treated immediately.”
FACT: Prostate cancer is a chronic disease that is usually slow growing. Most men end up dying with prostate cancer, not of prostate cancer. There is rarely a need to rush towards treatment. Do not make hasty, uninformed decisions you will later regret.
“My doctor always knows best.”
FACT: Only you know what decision is best for your life and your body in dealing with prostate cancer. Learn the unbiased facts before making decisions that could affect the rest of your life.
“I must find the best treatment that will save my life.”
FACT: Neither of the aggressive treatments (radiation, prostatectomy) has been found to be much better that the other. They are similar in mortality outcomes to doing nothing at all.
“Complications of prostate treatment are rare.”
FACT: Complications, such as impotence (up to 60-80%) and incontinence problems, are much more common than believed. All treatments impact the ability to have erections and may damage bladder and bowel control. Psychological harm can also be enormous.
“There is nothing I can do on my own to prevent cancer or stop its progression.”
FACT: Cancer is a chronic disease, usually controlled by the body’s natural defenses. Living an “anti-cancer” lifestyle may be the most effective way to prevent cancer or slow its progression.
“If I have prostate cancer, I will never be able to intercourse again.”
FACT: Most men with prostate cancer do not need erection-destroying surgery or radiation. Ability to have erections and to slow cancer growth can be improved by an anti-cancer lifestyle.
As you read, try to keep an open mind, for the information in this book is contrary to what most of us have been taught about cancer and prostate cancer.
Cancer myths have been drilled into us all since childhood, and it may be difficult to let go of them. Know that they can be detrimental to your health, your happiness, and in some cases, your survival.
A cancer diagnosis is laden with fear, anxiety, and misinformation. With about two-thirds of us getting cancer in our lifetimes, we all know people who have had aggressive, painful treatments, or have died long, painful cancer deaths. In 2007, men had about a 16% risk of being diagnosed with prostate cancer and about a 97% chance of dying from something else.
Prostate cancer is usually slow growing, with about 3% of men dying from it in the U.S. But these are only the ones we see and hear about. Men with prostate cancer are usually silent about the disease, so we rarely hear about men living long lives with prostate cancer. Silence sustains the myths and adds to our fears about prostate cancer.
The myths die hard because prostate cancer and its treatments impact all of our powerful notions of masculinity and male sexuality. The treatments are also dreaded by most men (and their partners), for they are painful, embarrassing, and physically and permanently impact a man’s sexual ability.
Treatments, such as surgery (radical prostatectomy), radiation (destroying the prostate with radioactive pellets or beam), and hormone treatment (eliminating testosterone by physical or chemical castration), all have life-altering effects and may have serious complications.
The treatments may make a man impotent or unable to control his bladder or bowels. Hormone treatments may make a man grow breasts, lose sexual desire and ability, and have serious mood swings (in some cases, these effects may be reversible if hormone treatment is stopped).
Consequently, many men do not volunteer this information in casual conversations, and popular understanding about prostate cancer is limited to what we hear from the medical industry. Instead of facts, we know only the myths about cancer and prostate cancer.
When my then-fiancé Lee was diagnosed, we interviewed couples who had been treated for prostate cancer as a way to learn about it. I interviewed the women separately, and Lee talked to the men alone. I consistently heard that sexual relationships were distressing, that treated men could not sustain erections sufficient for intercourse, and that the sexual aspect of their relationships was very stressful (or nonexistent). In contrast, Lee heard from the partners of these same women that sex was okay, that they used penile implants, injections, or nothing to have intercourse—in short, sex was not a problem.
When Lee and I got together after the interviews, we were astonished to compare the different stories of men and their partners. Perhaps women are more willing to discuss sexual problems in their relationships while men are socialized into norms of masculinity that discourage any admission of sexual problems. It’s also possible the men may not have wanted to scare Lee about the impact of treatment for prostate cancer. Given these norms, misinformation continues—misinformation that plays into the profits of the prostate cancer industry.
Moreover, many of us, including nurses and doctors, have blind faith in the status quo. The status quo (or mainstream) management of prostate cancer ruled by the industry is diagnosis and aggressive treatment of even early cancers. But as this book shows, the status quo condemns men to a lifetime of complications and rarely improves mortality rates.
Our for-profit medical care system is a major part of the problem. Prostate cancer, like all cancer, is big business for hospitals, medical supply companies, pharmaceutical companies, research companies, medical specialists, biotechnology companies, medical investors, etc.