I RECENTLY asked a man named Norman Yang if he was chiefly responsible for inventing the test that has transformed the treatment of prostate cancer. Cancer of the prostate gland is astonishingly common. Estimates vary, but a typical assessment is that one out of ten men has the disease in some form by age fifty. In the natural order of things, though, most of those men will never know they have it, because prostate tumors are usually small and symptomless, and because most of the time they grow so slowly that their hosts die for some other reason before the condition causes trouble. The problem is that prostate cancer is so prevalent that the exceptions to the rule represent a lot of people. According to the American Cancer Society, the disease will kill 35,000 men this year -- putting it in the same ballpark as, though a bit behind, breast cancer.
In the past the lack of symptoms which allowed most men with prostate cancer to live undisturbed made timely detection of the bad cases extremely rare. Doctors looked for possible tumors by inserting a rubbergloved finger into a man's rectum and palpating for lumps in his prostate, an undignified and ineffective procedure avoided by patients and physicians alike. The Department of Health and Human Services has estimated that only one out of ten men in the appropriate age group has an annual rectal exam. As a consequence, more than half of all prostate carcinomas were discovered only after they had spread - by which point it was usually too late. Worse, such tumors frequently disperse to the bones, and even in the dark spectrum of untreatable diseases, bone cancer has a particularly grim hue: pain, long and intense, is a primary symptom. Treatments for advanced prostate cancer, which can include removal of the testicles, are not terribly effective.