Arnold Palmer recently passed away, leaving an enormous legacy of golf achievements. He won 92 championships, 62 on the PGA tour starting with the Canadian Open in 1855 at age 26. He also won 18 times in foreign championships and 12 times on the senior tour.
As part of his legend, Arnold's army began at the Masters Championship at Augusta when cofounders Clifford Roberts and Bob Jones gave free tournament tickets to any soldier in uniform. Many soldiers showed up and were seen on television and in photographs. In my family, my dad was part of Arnie's army of fans, and Palmer helped make golf our family sport.
But a less well-known part of Arnold's history was his role in promoting prostate cancer control. At age 67 in 1997, Arnold had a PSA screening test for prostate cancer. His PSA had been rising for 2-3 years and had resulted in 2 prior normal prostate biopsies. But this time, his third biopsy showed him to have prostate cancer. He went to Mayo clinic where the doctors discussed the treatment options. Wanting the highest chance for cure, Arnold opted for surgery to remove his prostate. The findings showed enough risk for possible recurrence that he then received 7 weeks of radiation therapy. Remarkably, only 6 weeks later, after physical therapy, Arnold was back on the golf course competing in tournaments.
Although he did not win another golf tournament, he won the admiration of his army and all Americans by becoming a lifelong spokesperson for prostate cancer control. He advocated prostate cancer screening with PSA. Regarding screening, and in keeping with current recommendations, he felt that men's lives would be better if they just talked to their doctor about it. "That's health and living", he said, and felt that being healthy is the "good life".
Arnold also formed the Arnold Palmer Prostate Center in Palm Springs at the Eisenhower Lucy Curie Cancer Center, and then supported the Arnold Palmer Pavilion at U. Pittsburgh Medical Center and Latrobe Area Hospital. Because of his advocacy, many more men have been cured of prostate cancer and are survivors.
Prostate cancer is the most common cancer in men. Over their life, one of every 7 men will get prostate cancer. This year 180,000 men will be diagnosed with this cancer, and 26,000 men will die of it. Because of early diagnosis and excellent treatment options including surgery, radiation therapy or hormonal therapy, there is a 99% chance of 5 year survival from this cancer. In America today, there are 2.8 million prostate cancer survivors.
Prevention to avoid getting prostate cancer includes exercise, avoiding obesity, eating a healthy diet including 5 helpings of fruits or vegetables. Also, this cancer may be prevented by taking certain medicines such as finasteride, dutasteride, aspirin, and even statins which can prevent not only heart disease, but also prostate cancer with a 40 % reduction of prostate cancer deaths.
A controversial issue is whether men at low to average risk of prostate cancer should have PSA screening. Currently, the US Preventive Services Task Force and American Academy of Family Physicians have recommended against PSA screening, since biopsy most often finds prostate cancers that would not become fatal (but are sometimes over-treated), and PSA screening often results in uncomfortable biopsies that show no cancer. This recommendation has resulted in a 28% reduction of PSA testing. Unfortunately, there has also been a 23% reduction in diagnosis of high risk prostate cancers which would have required immediate surgery or radiation for cure. This may result in more prostate cancer deaths.
On the other hand, the American Cancer Society and American Urological Association recommend that for men at average risk of prostate cancer, men between ages 50 and 70 should discuss PSA screening with their physician. However, men at higher risk for prostate cancer should be sure to get PSA screening annually. A recent clinical trial showed that if your PSA is above average (higher that 0.7 to 0.96 depending on age), your chances of getting prostate cancer are 7 to 13 times higher and you should consider getting annual PSA screening.
Here are my tips for you:
• Know if you are at higher risk of prostate cancer by discussing this with your physician. This includes men with a family history of prostate cancer, obesity, heavy alcohol intake, little exercise, poor diet, above average PSA (see above), and African American men. If your doctor is uncertain or does not know, get a second opinion about risk and screening. For advice on getting a second opinion, see my website and book Surviving American Medicine.
• If you are at higher risk of prostate cancer, consider PSA screening starting at age 40. If you are at average risk of prostate cancer, discuss PSA screening with your doctor starting at age 50.
• If you have symptoms of prostate disease including either difficulty urinating, blood in the urine, urinating at night, urinary dribbling, pelvic pain, or difficulty with erections, get a urology consultation and include a diagnostic PSA test regardless of age.
• Take steps to prevent prostate cancer with good diet (less red meat, at least 5 helpings of fruits or vegetables daily), exercise, and avoiding obesity. Discuss cancer-preventing medicine with your doctor. Get advice on aspirin, finasteride or dutasteride, and statins. If your doctor does not know, get a second opinion.
• If you are diagnosed with prostate cancer STOP before you agree to treatment. Get advice from a urologist, radiation oncologist and/or medical oncologist to see if you have high risk or low risk prostate cancer. For low risk prostate cancer (most are low risk), be sure to discuss delaying treatment and use watchful waiting or active surveillance instead. If you have high risk prostate cancer, be sure to get therapy immediately. Distinguishing between low risk and high risk prostate cancer may require getting a pathology second opinion on the biopsy that was already done.
Arnold Palmer recommended taking control, and getting on with your life. He urged PSA screening for prostate cancer when appropriate and choosing the best therapy. Follow his advice so you can keep on having fun on the golf course, or in whatever activity you enjoy, and continue leading the "good life."
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