Guys always hear about how important prostate screenings are. If you had the chance to sit down one-on-one with them, how would you explain, in layman's terms, why a checkup is needed, what it could help and what it could prevent?
Dahut: I think screening should really be personalized and adaptive. As information develops over time, screening information should change. We know prostate cancer is a very common malignancy in men—it's the most common non-skin cancer malignancy in men—and folks have heard that many men who develop prostate cancer will be cured with treatment or won't need active therapy. Despite that, about 32,000 to 33,000 men die, per year, of prostate cancer. This continues to be a significant problem.
There was a time when you had a prostate cancer diagnosis where you felt fine after diagnosis but much worse from the treatment, because of side effects. We have more information now. First of all, we do know genetics can play a significant role in your risk of prostate cancer and also in your risk of having a more aggressive prostate cancer. When we say "more aggressive prostate cancer," we're talking about the kind of cancer that can escape the prostate to go to other parts of the body—lymph nodes, bone, liver, brain, lungs, too—can cause symptoms and, unfortunately, in far too many men, death.
I think it's important to know about your family history. Does your brother have prostate cancer, does your dad, is it uncles all on one side of the family? And it's also important to know, are there genes in your family that might put you at greater risk for prostate cancer?
I think a lot of men don't know about the breast cancer gene, the BRCA gene, particularly BRCA2, and that having the gene as a man puts you at about a five times greater risk of having prostate cancer. If you do develop prostate cancer, it's a much more aggressive prostate cancer.
If you knew you had that gene in your family or you knew there's a lot of breast cancer, ovarian cancer in your family, it would be important you were aware because your risk of cancer is likely higher. I think screening would then become more important for you.
Ultimately, [you should have] a sense of your own personalized risk. Looking at your race, if you're a Black man, your risk is going to be higher; if you have a family history, your risk of prostate cancer is higher, and detecting it earlier can lead to a better outcome. Or it may mean we just watch you very closely and if the cancer starts to progress, intervene in a way that your overall outcome should not be greatly different.