Men need to be better informed about prostate disease and how to deal with it. A new book, by a leading New York surgeon, fills a much-needed gap

PROSTATE cancer is far more common in men than breast cancer is in women. Yet the public awareness of the two diseases could not be more different. Women have their mammograms, their ultrasounds, pink-ribbon days, designer T-shirts and celebrity-awareness campaigns. Like breast cancer, cancer of the prostate is treatable if caught early enough. Unlike breast cancer, it is also completely curable. Yet more men in America and in Britain still develop prostate cancer—and more die of it—than any other cancer other than that of the lungs. Why so?

“Dr Peter Scardino's Prostate Book” goes a long way towards repealing the ignorance that even many educated men display about this disease. Dr Scardino has been a prostate specialist for more than 25 years. In that time, he has seen prostatology grow from a field that his own professors discouraged him from entering (it was regarded as a dead end) to one in which real progress has been made and where optimism is the prevailing mood.

Dr Scardino chairs Memorial Sloan-Kettering's prostate cancer department and is one of the best known surgeons in New York. The pioneering nerve-grafting technique that he developed to help men recover their sexual function after prostate surgery was the subject of a long recent article in the New Yorker. Vernon Jordan, managing director of Lazard Freres, American Express's one-time CEO James Robinson, General Norman Schwarzkopf and the former mayor of New York, Rudolph Giuliani, all have reason to thank him.

With the help of Judith Kelman, a punchy author of suspense novels, Dr Scardino has written a detailed and well-presented guide to what this crucial little gland is, what it does and how it can go wrong. The writing is clear. Dr Scardino's attitude is refreshingly open and optimistic, and there is no sign of the patronising tone adopted by so many doctors.

Throughout, the aim is to replace fear with knowledge, which is why he makes such a strong pitch for PSA testing. The PSA (prostate-specific antigen) is generally known to be a marker for prostate cancer. It is not a specific cancer test, but the value of your PSA is related to activity in the prostate gland. The number is very important, though comparisons are not straightforward and your PSA needs to be interpreted in context. This has led to the misguided belief that the test is unreliable, and causes too much worry to be worth bothering with. To Dr Scardino this is the worst kind of ignorance. An abnormal PSA reading, he argues, is like a dashboard warning light. (Motoring analogies are particularly common in the British edition.) It may just be a fuse, but worth checking up on all the same.

This is where the “Prostate Book” comes into its own. Dr Scardino is particularly good on the process of further investigation (from physical examination to taking microscopic sections for histological study) and the array of choices that face a patient with prostate cancer.

At one time, a cancer diagnosis meant major surgery, a future of bowel and urinary problems and the end of an active sex life. This is no longer the case. Many prostate cancers develop so slowly that they can be left alone or treated with far less invasive techniques, such as radiation via conventional external beam therapy or by the implantation of small, radioactive pellets known as “seeds”. Dr Scardino takes the reader carefully through all the alternatives and lays out any possible physical and psychological side effects.

The book is clearly for the patient as consumer. There are repeated calls throughout to check your doctor's credentials and experience. Have your biopsy results checked by another medical centre, Dr Scardino advises. Be sure that you are treated in a centre that deals routinely with prostate disease. Check how often your surgeon does a radical prostatectomy. All of which is sound advice, if awkward for men who live in countries, such as Britain, where there is still little real choice about where they can receive treatment.

Dr Scardino's advice may seem to risk undermining the relationship between a patient and his doctor, but it is no more than a reflection of the pro-active attitude to health that prevails in America. His heart is in the right place: with the patient. The value of his knowledge and experience are beyond measure. Buy his book for every man you know.