Gary Rhule, MD

Written By Gary Rhule, MD

Did you know that black men are at higher risk for prostate cancer, and it’s more likely to be aggressive and advanced when found?

Despite that fact, a good friend recently told me that prostate cancer is “not real,” and it’s another problem that doctors have “made up.”

“Really?” I said, as an elephant sat on my chest, and I lost track counting on my ten fingers and ten toes of the men I knew who were “gone too soon” because they would not talk with their doctor about the best and individual plan of action for them to screen for and detect prostate cancer in its early stages. I say best and individual plan of action because in general, prostate cancer screening should be done in consultation with your doctor/health care provider.

For black men, screening should begin early, starting at age 40, so that it is detected before it is advanced and has spread beyond the prostate gland. In non-black men screening is recommended to start at 50 years old.


I thought about the ten year old boy who poked his nose into the chain link fence at the soccer field hoping his Dad could be there to teach him how to kick a soccer, basket or baseball or play cricket. That will never happen because his father died at age 45 years because he never went for a health checkup, and refused to have the doctor put a lubricated, gloved finger “down there.”

So, my friends, prostate cancer is real. Like few other things in health care, “Prevention is better than cure.” And, like high blood pressure, prostate cancer is a “silent killer.” You won’t know you have it unless you get screened and have regular checkups with your doctor/health care provider.

As it relates to prostate cancer, EARLY DETECTION is the key, even if we can not necessarily prevent it.

What is prostate cancer? Prostate cancer is the most common cancer in men, excluding skin cancer. 1 in 7 men will be diagnosed with prostate cancer during his lifetime.

The risk of prostate cancer is higher in older men; men who are black; men with a family history of prostate cancer or breast cancer; and men with obesity.



  1. Prostate cancer is the most common cancer in men (excluding skin cancer)
  2. Only men have prostates, a small walnut-shaped gland that makes the fluid that feeds and transports the sperm. It sits below the bladder and in front of the rectum. This is why it can be felt with the gloved finger
  3. Prostate cancer may grow slowly but may be aggressive and can spread quickly (especially in black men)
  4. Early detection is possible when it’s still confined to the prostate gland. This increases the chance of successful treatment
  5. This is another silent killer: sometimes you have no symptoms in its early stages. You won’t know you have it unless you have an exam with your health care provider, that is early detection
  6. When it is more advanced it may cause the following problems: trouble urinating; decreased force in the stream of urine; blood in the semen; discomfort in the pelvic area; bone pain; and problems having an erection (erectile dysfunction)
  7. Screening for prostate cancer involves:

1) Digital rectal exam (DRE)—placing a lubricated, gloved finger in the rectum to feel the prostate’s size and texture, for example if it’s hard, nodular, bumpy – this may be a sign of cancer. The finger is used because of the prostate’s location near the rectum

2) A blood test—Prostate Specific Antigen—to determine if the level is high;

If any of these screening tests are abnormal, your doctor may recommend more tests to make the diagnosis. To make the diagnosis, a biopsy (getting a piece of the tissue), an ultrasound or other tests may be done. Talk to your doctor about these tests.

  1. Complications of prostate cancer are that it can spread to your bladder, bloodstream, and bones. When it spreads to the bones it can cause pain and broken bones. Once prostate cancer has spread to other areas of the body, it may still respond to treatment and may be controlled, but it’s unlikely to be cured.
  2. Other complications are: bladder incontinence and problems with an erection. Erectile dysfunction can be a result of prostate cancer or its treatment, including surgery, radiation or hormone treatments. If you end up having this problem, medications, vacuum devices and surgery are available to treat it.
  3. QUESTIONS TO TAKE TO YOUR DOCTOR —print and take these questions to your health care provider to ask about prostate cancer:


  • Do I have prostate cancer?
  • How large is my prostate cancer?
  • Has my prostate cancer spread beyond my prostate?
  • What is my Gleason score?
  • What is my prostate-specific antigen (PSA) level?
  • Will I need more tests?
  • What are my treatment options?
  • Is there one treatment option you think is best for me?
  • Do I need cancer treatment right away, or is it possible to wait and see if the cancer grows?
  • What are the potential side effects of each treatment?
  • What is the chance that my prostate cancer will be cured with treatment?
  • If you had a friend or family member in my situation, what would you recommend?
  • Should I see a specialist? What will that cost, and will my insurance cover it?
  • Are there brochures or other printed material that I can take with me? What websites do you recommend?
  • Ask any other question that comes to mind and make sure that you understand the answer


Want to know more about prostate cancer? Please visit or

If you are in the Greater Hartford area, there are local resources for prostate cancer screening, and diagnosis. Talk to your doctor/health care provider about where you may get this information.

Please remember, this is general information only and may not apply to your individual situation. Please seek the advice and help for your particular situation from your personal health care provider, doctor, counselor, about the individual screening, evaluation, and treatment plan that you should follow.

Gary Rhule, MD, is an author, poet, speaker, and former emergency room doctor. He is the author of Sailing on Broken Pieces: Essential Survival Skills for Recovery from Mental Illness. He is working on a second book. Watch for his monthly column here on a health related topic. To learn more about Gary, please visit,

Prostate Cancer
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Prostate Cancer
Did you know that black men are at higher risk for prostate cancer, and it’s more likely to be aggressive and advanced when found?