THE MAN'S CANCER

THREE YEARS AFTER HIS TRIUMPH IN THE GULF WAR, GENERAL H. Norman Schwarzkopf was feeling invincible. But in March 1994, uncomfortable with nagging tendinitis in one knee, he stopped by the MacDill Air Force Base Hospital in Tampa, Florida. While there, he decided to visit the base urologist for an exam. "I feel something not quite right," the doctor said, after making a routine rectal exam. "But if it's cancer, I can tell 90% of the time, and I don't think so."

Schwarzkopf, then 59, had reason to feel confident. He had recently undergone a PSA (prostate-specific antigen) test and registered a count of only 1.8, well below the level considered indicative of cancer. But to play it safe, the urologist performed an ultrasound exam ("It looks like a stone," he reassured the general), took a biopsy of the prostate gland and sent it off to a pathologist. Schwarzkopf left the hospital relaxed and optimistic. But a week later, the doctor called, paused and then said, "I don't know how to tell you this, but you have prostate cancer."

Shaken, and like most men woefully uninformed about prostate cancer, Schwarzkopf began devouring books and medical-journal articles. He overcame his squeamishness and started talking to friends and experts about this disease that seems to strike at the very core of masculinity. "For me, it was like war," he says. "First thing you do is learn about the enemy."

Schwarzkopf had little idea how formidable that enemy is. The American Cancer Society estimates that in 1996, 317,000 Americans will be told they have prostate cancer, more than the 184,000 new cases of breast cancer and nearly a quarter of all non-skin cancers expected this year. That figure represents a staggering increase over last year's 244,000 new prostate-cancer cases and the fewer than 85,000 recorded as recently as 1985. The acs predicts that deaths from prostate cancer in the U.S. will reach 41,400 this year, a number fast approaching the annual breast-cancer toll of 44,300. Says Dr. Nelson Stone, a urologist at Manhattan's Mt. Sinai Medical Center: "It sounds like an epidemic to me."

In a way, it is. The life-span of Americans is increasing, and because the disease most often strikes men who are in their 60s or 70s, more of them are now afflicted. When the baby-boom generation matures, the number will balloon. "As men live longer and do not succumb to heart disease and stroke, more will die from prostate cancer," says Dr. William Catalona, a urologist at Washington University in St. Louis, Missouri. "And it is not a nice death."

By far the biggest factor in the sharp rise of prostate-cancer diagnoses is the increasingly widespread use of the controversial PSA test, which in many cases can detect the disease early in its course, long before the tumor becomes palpable. By making early detection and treatment possible, the test could eventually reduce the number of prostate-cancer deaths. Paradoxically, it could also lead to a rise in premature or even unnecessary treatments.