Mark Scholz - Invasion of the Prostate Snatchers

15. Now Playing for a Limited Time Only:
The Combidex Follies

22. How Prostate Cancer Can Make You Live Longer:
Getting to the Doctors Office

24.

While writing this book, I have become ever more aware of the vital role played by women in mens healing, and the support of all the loving partners whose lives have been impacted by this disease. May our work help to sustain and encourage you.

RALPH BLUM

I want to dedicate this book to the nearly two hundred thousand men diagnosed with prostate cancer each year. And especially to all my patients over these past sixteen years.

MARK SCHOLZ

As for the prostate gland itself? Its like Bulgaria. No one is quite sure just where it is or what goes on there.

HAL ACKERMAN , My Generation Magazine

For over twenty years, I have lived with prostate cancer. During that time, the most important thing I learned is that I was blessed with the form of the disease that was Low Risk rather than Aggressive, a cancer that is slow growing and almost never fatal. Which is why I fully expect to depart this earth a jolly old man, in my sleep, after a lovely day in the country with my honey and a few cherished friends.

My long and often humbling affiliation with prostate cancer began in Malibu, California, on a summer afternoon in 1990, when my family doctor, Jeff Harris, pulled on his latex glove, gave me his slow, surfers smile, and suggested that I drop em and assume the position. It was part of my regular checkup, the annual uncomfortable but necessary experience of the DRE or Digital Rectal Exam, the old doctor-inserts-finger-up-your-butt ritual most men over the age of forty-five are familiar with.

I was fifty-eight. Id probably had half a dozen normal DREs. Then on that sunny afternoon, while giving my prostate a conscientious probing, Jeff found a lump. And because my PSA was slightly elevated for my age, he wanted me to have a biopsy. Since without a biopsy you would not know for sure if there was cancer, I grudgingly agreed.

Jeff referred me to a Los Angeles urologistwho I will call Dr. Danforthto do a needle biopsy of the lump. Lying there on the surgeons table, I was sweating. My attitude was already surly and mistrustful. I was having a primitive reaction to letting some stranger cut out fragments, cores of my flesh. Heres this guy Ive known for only twenty minutes going at it with his transistorized jackhammer: Core! Core! . And hes hurting me, and Im lying there rigid, thinking: What if were really pissing off thosecancer cells? Core! Core! What if the shock triggers the diseased little mothers into making a run for itto get as far way from this demolition site as they can? Core! Core! What are the chances that if there is cancer, hes actually spreading it!

Three days later, Jeff called with the results of some blood tests. Then he announced almost casually, By the way, Dr. Danforth wants to redo the biopsy.

Youve got to be kidding!

Afraid Im serious.

Whoa! Redo it! Why?

Short pause. Seems he got crush artifact.

What is that supposed to mean?

The specimens he removed were crushed.

Crushed? You mean he blew it?

Something like that.

After I hung up, I just sat there. Redo the biopsy! Redo the bloody biopsy! Fat chance! I took a long, cold shower. Then I rang Dr. Danforths office. They asked when I wanted to reschedule. I felt like suggesting that they assemble the cores already in their possession, wrap them in their bill, have the doctor assume the position, then insert the whole thing.

Instead, I said Id be in touch.

As with most things, there was a good side to all this. Regardless of the lump and my slightly elevated PSA, and despite the urologists report evaluating the lump as suspicious for well-differentiated adenocarcinoma and his recommending surgeryeven without another biopsythanks to that crush artifact there was no proof positive. No way to be absolutely certain that I had prostate cancer. My gut feeling was: Time is on my side! So I decided there was no point worrying.

It was nine years before I submitted to another biopsy.

My father used to say to me, Whenever you get into a jam, whenever you get into a crisis or an emergency become the calmest person in the room and youll be able to figure your way out of it.

RUDOLPH GIULIANI

Im scheduled for surgery next week, but my doctor says the operation can make me impotentand the cancer may come back anyway. I really dont like the odds.

Every year, nearly a half-million men in the United States and Europe are diagnosed with prostate cancer. Most of them are under the terrifying impression that they are about to die. They dont realize that prostate cancer is different from other cancers. In reality, only about one out of seven men with the diseaseperhaps 15%are truly at risk. New research shows that there is an indolent variety of the disease that is not life threatening, a type that can be safely monitored without immediate treatment.

My days consist of providing counsel to desperate men seeking an alternative to a treatment that can deprive them of normal urinary and sexual function. When a man is diagnosed with prostate cancer, he is immediately confronted with conflicting opinions, partial information and doctors with a penchant for surgery. There was a time, now past, when surgery was considered an appropriate remedy. In fact, surgery was termed the gold standard of treatments. Thank God, we are off that gold standard.

The tragedy is that most men dont know this.

Research has now proven that many men who were cured by surgery had a form of the disease that was never destined to threaten their lives. Out of 50,000 radical prostatectomies performed every year in the United States alone, more than 40,000 are unnecessary. In other words, the vast majority of men with prostate cancer would have lived just as long without any operation at all. Most did not need to have their sexuality cut out.

Why, then, are so many prostate operations still being performed? The answer to this question is rarely discussed but easy to comprehend. Urologists, who are surgeons, dominate the field of prostate cancer. This is the only type of cancer where this is the case. Medical oncologists, the cancer specialists who manage all the other types of cancers, such as breast, colon and lung, are almost never involved in the management of newly diagnosed prostate cancer. Therefore I am something of an anomaly, a medical oncologist totally devoted to treating men with prostate cancer. There are over 10,000 medical oncologists in the United States. Fewer than a hundred of us specialize in prostate cancer. Defying all logic, medical oncologists are not trained in the treatment of early-stage prostate cancer to this day.

So how can a knowledgeable medical oncologist help a man with newly diagnosed prostate cancer? One of the biggest scientific breakthroughs has been the discovery that we can make a clear distinction between the aggressive form of prostate cancer and the more common Low-Risk variety. The latter form of the disease should probably not even be called cancer, but regarded instead as a