Happy Holidays

Happy Holidays from Prostate Oncology Specialists.

Partners

BY RALPH BLUM

When your partner is diagnosed with prostate cancer you will undoubtedly experience a tidal wave of emotions, including the devastating fear that he might die. At the same time as you are trying to get a hold on your own fears, you also want to support and reassure your partner—who is struggling with the same shock and fear. It’s a tough act to balance, and it’s only too easy to repress or ignore your own feelings and needs.                                          

Often, it seems, men are more intimidated by health problems than women are, and when your partner is first diagnosed with prostate cancer you may find that it is up to you to ask the important questions in the doctor’s office while your partner sits there in apparent—usually temporary--shock. Moreover most men are conditioned not to talk about their fears and anxieties, and you may fall into the trap of struggling to remain upbeat, of hiding your own fears from him. While it is helpful to be as positive as you can, it is equally helpful to encourage him to express his feelings, and to talk openly together about his concerns that the cancer treatment is going to affect your relationship. One of his main fears will be of becoming impotent. It is not easy for men to understand that there is more to intimacy than erections.

There are many ways in which you can help your partner, in addition to giving him your love and support as he decides on his best treatment option. You can help him by learning everything you can about the disease and the various treatments so that you can discuss with him the sensitive issues and side effects involved. You can help him with other choices, such as choosing which doctor will perform his treatment. And you can help by driving him to treatments, picking up his medications at the pharmacy, and by keeping track of all his test results, x-rays and medical records, so that if the need arises to consult another doctor, he will have everything ready to take with him.

However, it is vital that you not neglect your own health (which it’s very easy to do!) or give up your own life and center everything around your partner and the cancer. Above all, take time out from thinking about the disease. Go out to dinner and to movies with your partner. Take weekends off and travel to favorite haunts. Enjoy, as much as possible the activities you have always liked to share. Indeed, the vow is “In sickness and in health.” But refuse to permit your whole live be held hostage to this condition.

It would be presumptuous of me to even attempt to address the real loneliness and frustration women feel from the lack of sex. My partner, Jeanne, however, is fierce on the subject.

“The women at the PCRI Conference all complained about it,” she told me. “But they feel they cannot reveal their feelings to a husband who is, I quote, ‘dealing with cancer, for God’s sake!’

When I asked Jeanne what she’d want to tell men, she said, “Curl up and just snuggle. No attempt at sex. Just relax. Hold each other, and listen as you begin to breath together. Try spooning. Meaning, lie curled up tummy to back. It’s called ‘the Embrace Meditation. . .’ There, that’s a start.”

I asked her, “Anything else you’d want to say to all the partners?”

“Yes. Let him know that helping him will actually help you to feel better, more confident, even more safe.”

As I was writing this, I remembered something that really helped me, something Jeanne told me right at the beginning, when I was first diagnosed, “Here’s what I feel,” she said.  “We both have prostate cancer. We’re in this together.”

Climactauria

BY MARK SCHOLZ, MD

Some men—unfortunately, only a minority—are genuinely pleased after prostate surgery.  Their erections are maintained, cancer is gone and they don’t leak urine. The excitement of surviving an operation with one’s manhood intact often leads to euphoria with repeated public declarations about the wonders of surgery:  “Come on in,” they say, “The water’s fine!”

In reality, there is no “good” treatment for prostate cancer. Sure, some men can luck out and are happy to talk about it. But more frequently, when men are asked how they are doing after surgery, they say they are fine, even when they are not. No man likes going public about his lost sexuality.  And there is little value in bemoaning what can’t be changed.

So, does it make any difference which treatment is chosen?  Is radiation any better?

Here is my estimate of the latest stats for a 65 year old with Intermediate-Risk prostate cancer with normal sexual and urinary function treated with either state-of-the-art surgery or radiation therapy administered by a world class surgeon or radiation therapist:

	Surgery	Radiation
Cure Rate	80%	85%
Impotence	50%	35%
Incontinence	8%	1%
Urinary Bother	2%	25%
Rectal Burn	0%	1%
Climactauria	12%	0%

As you can see, radiation has its own problems, particularly with what is termed, “urinary bother.” Bother can mean urgency, a need to go RIGHT NOW.  It can mean frequency, making multiple trips to the bathroom throughout the day. It can mean nocturia, having to urinate frequently at night.  Rectal burns are even more disastrous with unremitting pain, bleeding and leakage.  Fortunately this healthcare disaster is quite rare.

What is climactauria?  Ejaculating urine instead of semen.  One of the world’s top surgeons, Herbert Lepor from New York University reported on the incidence of climactauria in 1,459 men he treated with radical prostatectomy between 2001 to 2007. The percentage of men reporting any degree of climactauria 24 months after surgery was 36%.  The percentage reporting severe climactauria after 24 months was 12%. The stats in less eminent surgeons are probably worse.

Men contemplating surgery or radiation need to review the stats.  Both surgery and radiation are unappealing.  However, to my way of thinking, if a man’s conditionsdictates a need for treatment, skillful radiation appears less daunting than skillful surgery.

Calling All 40 Year Old Black Men

BY RALPH BLUM

According to the National Cancer Institute, African Americans may have the highest rates of prostate cancer in the world. Furthermore, black men often develop the disease at a younger age than white men, and the cancer is often more aggressive.

Although the National Institute of Health is conducting studies to determine why this is the case, the reason for this disparity between African American and Caucasian men is complex and not yet clear. In part, it may reflect unequal access to quality health care because they tend to be diagnosed at more advanced stages, i.e., they wait till it’s too late.

While all African American men are at significantly higher risk, black men with an immediate family member who had prostate cancer have a one in three chance of developing the disease. The risk rises to 83% when two immediate family members have the disease, and with three family members, the risk mounts to 97%.

So it is absolutely vital to get yourself checked out before symptoms appear that indicate the presence of prostate cancer. Symptoms include: the need to urinate frequently (especially at night); difficult, painful, burning or bloody urination; painful ejaculation; frequent pain or stiffness in the lower back, hips, or upper thighs. Once symptoms appear, it means that the cancer has already reached a more advanced stage and chances of survival are considerably reduced.

In June 2003, Nation of Islam leader, the Honorable Minister Louis Farrakhan, announced the launch of his Prostate Cancer Foundation  (LFPCF). Minister Farrakhan, himself a survivor of prostate cancer, apparently saw the high death rate among African American men diagnosed with the disease as a call to action to the black community, and the strongest persuasion for early screening. “If that is not motivation to save your life,” he said, “then nothing can motivate you.”

Despite the lack of conclusive study results, one thing is certain: early annual screening for prostate cancer is critical for African American men and should begin at age forty to forty-five.

Aside from financial concerns, another factor that deters many African American men from getting regular screening for prostate cancer, is that it involves not only the PSA blood test but also the primitive yet effective doctor-inserting-finger-up-your-anus technique known as the Digital Rectal Exam (DRE) to which black men have a serious aversion. Minister Farrakhan put it rather more delicately: “As men, we are difficult in terms of allowing ourselves to be tested.” And that is a problem.

A word of caution: When I alerted two concerned black friends that “free annual pre-screening, educational materials and medical referrals were available” via the Louis Farrakhan Prostate Cancer Foundation in Chicago, they called the number provided on the LFPCF website, and got a Toyota dealership in Houston. It appears that the website has not been updated since 2003.

When I checked with a black minister who is concerned about prostate cancer in his community, he said, “The Rev. Farrakhan sometimes fails to follow through. Usually, it’s a question of funds. The African American community would welcome hearing words of encouragement from black authority figures like Oprah, Tavis Smiley and Rev. Jesse Jackson.”

Meanwhile, it is left to local groups to motive men to get tested. According to Ron Brewington, Associate Professor of Broadcasting Journalism at Santa Monica College, the Trinity Baptist Church on

Jefferson Boulevard

in Los Angeles does provide screenings. Addressing a group of men at the church recently, Brewington said, “I’d rather have a finger up my butt than have them throw dirt in my face. The fact that you’re here tells me you want to live. I applaud each of you.”

Deaths from prostate cancer in the United States have declined, primarily because more than 90 percent of prostate cancers are diagnosed at an early stage However, African American men are still more than twice as likely as white men to die of the disease largely because they continue to be diagnosed at more advanced stages. So if you are a 40 year old African American man, consider this a three-alarm wake-up call.