Fifty years ago, men were dying and no one knew why.
Prostate cancer is often slow-growing and can progress without symptoms for long periods of time. So for centuries, by the time someone discovered the cancer, it had often already spread — to the lymph nodes, bones, to any number of other organs. It didn’t help, either, that prostate cancer and its less threatening counterpart, BPH, share many of the same symptoms — weak urine stream, blood in the urine, frequent urination — making the cancer nearly impossible to diagnose on indicators alone.
By the middle of the last century, the dreaded digital rectal exam (DRE) — one of the most notorious and joked-about examinations in the history of medicine — had been developed as a way for doctors to physically feel for potential abnormalities. If you’re not familiar with the specifics of the DRE, “digital” refers to fingers and ... you can figure out the rest on your own.
Though this test made it easier for doctors to locate tumors that had grown in specific areas of the gland, it wasn’t without serious limitations. A doctor could use the DRE to feel for abnormalities on the prostate, but only on one side of it. If a tumor was growing on a side not accessible through the rectum, it would be missed entirely and left to spread unchecked. Relying on touch to identify growths on a man’s prostate was a helpful step forward, but the DRE was still a rudimentary technique. It allowed doctors to detect that something was there, but didn’t do much beyond that to determine what, precisely, that something was. That’s important, because there are several different kinds of prostate cancers and not all of them are considered dangerous or worth biopsying.
Also, not loving the idea of a doctor inserting a finger into their respective rectums, a large percentage of men dreaded or permanently put off having the test.
An estimate from the U.S. Department of Health and Human Services says that only 1 in 10 men who should be receiving a rectal exam actually get it.
During his residency in the mid- to late 1980s, Roehrborn saw a patient at least once a week who was brought in on a stretcher, paralyzed. It wasn’t because the patient had broken his back; it was because he had prostate cancer, and it had spread, eating into his spine, collapsing it, and compressing the nerves.
“Coming in paralyzed from a prostate cancer metastasis to the spine was actually a common first diagnosis in my residency,” Roehrborn says. “You would put your finger in the rectum and there was a stone right on the prostate. You’d put two and two together, do a bone scan, and see the guy is loaded with metastasis.”
Since prostate cancer forms on a hidden organ and can be confused for a benign and fairly common condition, it’s hard to predict who’s at risk. A man’s behavior seems to have little effect on whether he’ll develop it, with no studies showing strong links between the cancer and eating certain kinds of food, smoking, or drinking alcohol. And for the most common types of prostate cancer, family history doesn’t seem to play much of a role, either.
But still, if prostate cancer is caught while it’s still local — when it hasn’t spread to other parts of the body — survival rates are nearly 100 percent. Doctors knew there had to be a better way. A way to detect the tumor faster, more definitively, and less invasively.