Prostate Cancer Isn't a Death Sentence

Most American men are ostriches...

They bury their heads in the sand, even preferring to help out with housework instead of seeing the doctor.

That's according to a 2019 Cleveland Clinic survey of more than 1,000 adult men – 72% of us dudes said they'd rather do chores versus getting regular health checkups.

One of the most common reasons?

Being too embarrassed or uncomfortable... especially with anything related to problems with erectile dysfunction or peeing... both of which can be symptoms of a cancer millions of men will experience... prostate cancer.

If you've been watching or reading the news lately, you probably saw the shocking news that former President Joe Biden was diagnosed with an aggressive form of prostate cancer.

Now I'm not saying he was burying his head in the sand (like an ostrich). After all, even advanced prostate cancer, like in his case, can leave you without really any symptoms.

It was only when Biden recently reported urinary issues to his doctors that, upon testing, doctors discovered his cancer.

Because it's dealing with our "private parts," prostate cancer is a tough topic, especially for older men, to discuss.

But you need to.

According to the American Cancer Society, 1 in 8 men will be diagnosed with prostate cancer at some point in their life. In medical school, we were taught that if all men lived to be 120 years old, every single one would get prostate cancer.

Fortunately, only around 1 in 44 men with prostate cancer actually die from it. Most people die from something else because it's typically  a very slow-growing disease. And by "slow growing," we mean having prostate cancer with a Gleason score of 6 or lower.

A pathologist uses the Gleason score and grading system to score how abnormal your biopsied tissue's cells look under the microscope. It also tells your doctor how aggressive the cancer is and how likely it is to spread, or metastasize.

Gleason scores range from 2 to 10. Back to that Gleason score of 6, that means your prostate cancer is low grade, or has a grade of 2, and least likely to metastasize, or spread, to other parts of your body.

Scores between 8 and 10 mean you have high-grade (i.e., Grade 4 or 5) cancer that's more likely to spread.

As for Biden...

His Gleason score clocked in at 9, putting him in the highest-grade group of 5. His cancer has already spread to the bone.

While Biden's cancer isn't curable, it is the kind that should respond well to hormone-based treatments.

Aside from how well your cancer responds to treatment, your ability to survive prostate cancer also depends on your age and your overall health.

And like most forms of cancer, detecting it early reduces its ability to spread and increases your chance of survival. So don't be shy when it comes to questioning progressive changes in your body. Most men don't notice the symptoms early on, when it's most treatable.

Prostate cancer symptoms are embarrassing and difficult to talk about because we're taught to keep our "private areas" private. But whatever you do, don't ignore your body...

Feelings of embarrassment, fear, and uncertainty won't last once you're meeting your problems head-on... But the ramifications of suffering in silence will persist.

Six common prostate cancer symptoms are:

1. Frequent urination (peeing seven or more times in 24 hours, if you've consumed 68 ounces of fluid throughout the day)
2. Trouble starting or maintaining flow during urination
3. Burning or pain during urination or ejaculation
4. Erectile dysfunction
5. Chronic pain in the lower back, hips, or pelvis
6. Stiffness in the upper legs

If you have these symptoms and risk factors, see your doctor to discuss the possibility of prostate cancer. A simple, and relatively inexpensive, blood test can check for the level of your prostate-specific antigen ("PSA").

For a long time, a digital rectal exam ("DRE") was an easy (but perhaps awkward) way for your doctor to check for prostate cancer.

But if your DRE squeamishness is what's holding you back from talking to your doctor about your prostate cancer risk, according to a 2023 systematic review and meta-analysis, you might be OK skipping the DRE after all...

The study looked at both PSA testing and DREs in a group of more than 85,000 patients – specifically, the positive predictive value (or how likely both tests were to yield accurate results) and the cancer detection rate (or how often the tests get the detection right).

Researchers found that the tests had similar positive predictive values. However, the DRE had a significantly lower cancer detection rate than that of the PSA. What's more, getting both tests didn't significantly improve that detection rate. The researchers concluded, "These findings suggest that DRE could be potentially omitted from screening and early detection in the absence of clinical symptoms and signs."

Both tests are simple and inexpensive.

But be wary of the timing...

Longtime subscribers know I've warned against getting an unnecessary PSA test for years. These tests are notorious for giving false-positive results because benign factors can cause elevated PSA levels. Inflammation, infection, recent ejaculation, and even riding a bike can increase your PSA levels.

So, have a candid conversation with your doctor about your concerns regarding anything that may artificially elevate your PSA. And don't be afraid to ask for a second – or even third – PSA test for comparison a few days later.

Keep an eye on your inbox next week, as we'll cover what to do after a prostate cancer diagnosis.

And if you're worried about overtreatment, make sure to read the latest issue of Retirement Millionaire. I addressed this big problem in the medical industry and how you can protect yourself from becoming a victim of overtreatment. It starts by being your own health care advocate... like asking the right questions. And if you're not a Retirement Millionaire subscriber, click here for a 30-day, risk-free peek.

What We're Reading (and Watching)...

• If you have prostate cancer, here are links to four organizations with resources to help: Prostate Cancer Foundation, Zero Prostate Cancer, Cancer Care, and HealthUnlocked.
• Something different: Finally, some good aviation-related news... nine minutes of heartwarming goodness.

Here's to our health, wealth, and a great retirement,

Dr. David Eifrig and the Health & Wealth Bulletin Research Team
May 22, 2025