Q&A: Charles Holzner

A: Because the treatment involves impotence and dribbling. Even radiation has a high degree of impotence later on and you can get complications. Radiation of the bladder can cause a lot of problems, and radiation of the rectum can cause a lot of problems. And in surgery about 30% of the men end up impotent or incontinent. So the treatment is kind of not ideal.

Q: But what's the trade-off? Isn't there a major risk in not getting treated?

A: Well, that's the issue. Only a small percentage of people who get prostate cancer die from it. Probably only on the order of 3% or 4% of people who are diagnosed with it will actually die from the disease. The vast majority, over 95% of them, will actually die from old age, and you're sort of taking a gamble. Most of the time it's asymptomatic until it starts spreading to the bones.

Q: So why even encourage prostate cancer screenings then?

A: Well, you don't know who is going to die from it. It's a big gray area of what to do. That's why I said when this prostate cancer test came out 18 years ago it opened up a Pandora's box of, "What are we going to do with this test?"

Q: Even the CDC has determined that there is not enough evidence to support recommending the screenings for men under 75 and actually discourages it for men above that age. Why is that?

A: It's a big unknown because there's no test that's available now that will tell you, you will die from this disease.

Q: You're saying that although there is screening available, the procedures may be useless because some may not be at risk of death. But some could be at risk, so why don't you recommend the screenings for everyone?

A: You present the facts. Most guys know about the disease, and most guys are smart enough to make the determination of whether they want treatment or not. Some people can't stand to live with the idea they have prostate cancer and are doing nothing about it. Other people are perfectly comfortable saying, "Well, I have prostate cancer, but there's a 95% chance I'm not going to die from it."

Q: Do you think a fear of impotence, or maybe a greater concern for sexual activity than cancer, contributes to men's decisions?