September is Prostate Cancer Awareness Month, and it has me thinking about a pattern I've seen as a family physician for more than fifteen years.

Many men don't use primary care regularly. And when they do come in, some concerns, especially those involving urinary symptoms, sexual function, or prostate cancer risk, can be difficult to say out loud. 

I’m also the father of a teenage boy and I’ve been thinking a lot about how I talk with him about difficult things: how to acknowledge fear, name an insecurity, or say something that may be embarrassing. In short, how to be vulnerable. 

These two parts of my life are connected. Some men don't outgrow the instinct to minimize what's happening in their bodies or avoid uncomfortable topics. They just get a little better at hiding it. 

Ask any clinician working on the front lines of primary care. A man might talk about a sore knee before finally mentioning he gets up four times a night to urinate. He might ask about cholesterol and then, hand on the doorknob, add, “Oh, I peed a little blood a few weeks back. Probably nothing.”

What sounds like an afterthought may be the real reason he came in. It may have taken him weeks or months to say it out loud. But speaking up is only the beginning.

Vulnerability isn’t a one-way act. It creates responsibility for the person who receives it and for the healthcare system around them.

Why timing matters

The American Cancer Society estimates that 333,830 men will receive a prostate cancer diagnosis in 2026, and 36,320 will die from the disease. One in eight men will receive a prostate cancer diagnosis during his lifetime.

Since 2014, new cases have increased about 3% each year. Advanced-stage diagnoses are increasing fastest, which means the conversation still starts too late for many men.

That burden is not shared equally: compared with White men, Black men are 67% more likely to be diagnosed with prostate cancer and more than twice as likely to die from it. The mortality gap likely reflects, in part, unequal access to high-quality treatment; in equal-access healthcare systems, Black men have equivalent or better prostate-cancer-specific survival.

Where the healthcare system breaks down

When a man discloses blood in the urine, difficulty urinating, new sexual symptoms, or persistent pelvic pain, our job is to turn that disclosure into a clinical plan.

That means asking the next question, determining the appropriate evaluation, arranging a referral when needed, reviewing the results, and managing what comes next.

This is where our system too often breaks down. 

A test can be ordered without being completed. A referral can be placed without an appointment ever being scheduled. An abnormal result can sit in an inbox without anyone reading it, recognizing its urgency, or taking the next step. 

For a patient, these are not separate administrative steps. They are one episode of care that needs clinical ownership, management, and oversight from start to finish.

Primary care clinicians try to do this work in brief visits packed with competing priorities, and through hours spent reviewing results, answering messages, coordinating referrals, and completing documentation. One study found that physicians spend nearly half of their workday on electronic health records and desk work. Our financial reimbursement system compounds the tension. Fee-for-service medicine pays for the visit, not the relationship between visits.

What staying involved looks like

I keep thinking about a patient we recently cared for at Color, a man in his sixties with a strong family history of cancer. He told his primary care doctor that he was interested in prostate cancer screening, but those concerns met a wall and a refusal to pursue testing. There was no further inquiry into risk factors. No test. No plan. No follow-up. 

He found Color through his employer and completed an online cancer risk assessment. Color sent him an at-home PSA test with information about its benefits and risks. He chose to complete the test. When his PSA level came back elevated, Color’s clinical team acted. We proactively connected with the patient, arranged an in-person urology evaluation, scheduled imaging, and stayed involved throughout the diagnostic workup.

A biopsy confirmed high-risk, localized prostate cancer, and he started treatment soon after. He has completed radiation and continues hormone therapy. Color’s clinical team remains involved in his care and manages his side effects with him.

A single test did not produce that result. The difference was a care model that managed the care, gave him a place to start and remained responsible when something looked wrong.

It was never just “get screened”

Awareness months are often compressed into a single directive: get screened. That’s an important message for many cancers. For men at the right age and risk, PSA testing can find prostate cancer early, often before symptoms appear. But it's incomplete in two ways.

First, screening is not one-size-fits-all. The American Cancer Society recommends that men receive information about the benefits, risks, and uncertainties before deciding whether to screen. Age and personal risk shape when screening becomes relevant. And the risks are concrete: PSA can flag slow-growing disease that never would have caused harm, leading to biopsies and treatment, with real side effects, for cancer that didn't need treating. A man deserves to see both sides before he decides.

Second, screening is only one moment in a long arc. Cancer care spans risk assessment, suggests screening when appropriate, acts on abnormal results, and remains involved through diagnosis, treatment, and survivorship. Every handoff in between is a place where a man can be lost. 

That’s the model we’re building at Color: one clinical team that owns every one of those handoffs.

A healthcare system worthy of that honesty

As a physician, I know that we can’t place the entire burden on patients. We have to build a healthcare system worthy of that honesty.

So, to any man reading this: that symptom you have been sitting on, the family history you have never mentioned, or the health concern that keeps nagging you, please tell someone. It’s not oversharing. 

And to those of us on the other side of that disclosure: recognize what it may have taken for him to reach out and say it. Then act on it, own the follow-up, and make sure the next step happens.

Vulnerability can open the door to earlier care, but only if someone is there to receive it.