The co-authors of Invasion of the Prostate Snatchers, blog alternate posts weekly. We invite you to post your comments.

Tuesday, August 25, 2015

Beware of Medical Witchdoctors


Words don't just have an impact on our thoughts and feelings, they have direct implications for our bodies, a fact that all of us should keep in mind every time we step into a doctor's office. What is said to us in times of stress can positively or negatively affect our health and well being.

Most of us, as children, are taught to believe in the infallibility of doctors, so the manner in which a doctor delivers a potentially life-threatening diagnosis can have a profound effect, and actually has the power to influence the course of the disease.

The stress of a cancer diagnosis can throw patients into an "altered state" in which they are particularly vulnerable to suggestion--both good and bad. During these critical intake moments, if the doctor's words are positive, they can plant within us, at a very deep level, positive expectations that we can beat the cancer, that we will be cured. Unfortunately, the reverse is equally true. When we are in this altered state the doctor can adversely affect our healing  and, in some cases, literally scare us to death by quoting negative statistics, relating the gruesome side effects of treatments, or worse, by using the dreaded word "terminal."

This latter behavior is a form of "hexing," the medical equivalent of a voodoo curse. If a witch doctor leapt out of the jungle, pointed a bone at you and told you that you were going to die in two months, you'd probably laugh, albeit a trifle nervously. But when a modern-day witch doctor, wearing a white coat, carrying a stethoscope, and supported by state-of-the-art scans and test results, tells you that you have only two months to live, his "curse" can significantly raise the chances that you will die. And often right on schedule.

Everyone has heard of the placebo effect, the beneficial results that a little sugar pill can produce if the patient is told by an authority figure (usually a doctor) that it will bring relief or healing. The mere suggestion actually causes the body to manufacture the chemicals necessary for the desired result. However, the placebo (Latin for "I will please") has a lesser known evil twin, the nocebo (Latin for "I will harm"), which can produce equally powerful negative effects. Suggestion can be a formidable tool, and a significant part of any doctor's job is to create a relationship with his patients based on trust, confidence and hope.

Hippocrates, the father of western medicine said, "A patient who is mortally sick may yet recover from his belief in the goodness of his physician." Although it is our own thoughts, our own beliefs that can either harm or heal us, it is often the doctor's words that start the process. And when the doctor arouses negative expectations, that is medical hexing.

Tuesday, August 18, 2015

High Cost of Pharmaceutical Agents


In the last five years the prostate cancer world has been blessed with some incredible pharmacetucal breakthroughs--Zytiga, Xofigo, Xtandi, Provenge and Jevtana, just to name a few.  All these new medications are proven to prolong life and improve quality of life.  In my day to day life practicing as a prostate oncologist, I have seen with my own eyes how these new medications have transformed "hopeless" situations into genuine cancer remissions.

The extremely high cost of these new pharmaceutical agents, however, is a hot topic that I have addressed in prevous blogs. A recent editorial  from the Wall Street Journal addresses this issue with uncommon wisdom and aptly points out how potentially dangerous seemingly well-intentioned efforts to control costs can end up snuffing out the new drug development process.

Please click on the link HERE to read this short and extremely well-written editorial:


Tuesday, August 11, 2015

For the Sake of Our Partners


I'm not usually a fan of statistics, but I was pleased to discover that although the American Cancer Society estimates in 2015, there will be approximately 220,800 new cases of prostate cancer in the U.S., more than 2.9 million men who have been diagnosed with the disease at some point are still alive today. So if your partner is one of the 220,800, take heart: In most cases, prostate cancer is not nearly as scary as it sounds.

However, when you first heard the diagnosis, "prostate cancer,"  you no doubt experienced a tidal wave of emotions. And at the same time you were trying to get a handle on your own fears, you wanted to support and try to reassure your partner. It's a tough act to balance, and it's only too easy to contain or ignore your own feelings and needs.

Often it seems that men are more intimidated than women about health problems, and when you are first given the bad news, you may find it is up to you to ask the pointed questions in the doctor's office, while your partner sits there in apparent--usually temporary-- shock. Also men are conditioned not to talk about their fears and anxieties, and you may fall into the trap of struggling to remain upbeat while hiding your own fears from him.

It's natural for both of you to fear how the cancer could change your lives, how it might affect your relationship, especially your intimate relationship. Your partner is likely to be fearful that a treatment that might be his best chance of eradicating the cancer would also have the highest chance of leaving him impotent.  Although most men don't subscribe to the idea that they are exclusively the products of their hormones, the degree to which sexual function returns--or fails to return--after prostate cancer treatment, is a matter of serious concern to them all.

So while it's helpful to be as positive as you can, it's equally important to talk openly about intimacy issues. Perhaps point out that sex isn't just about erections. And let him know that your main concern is his survival, and that what both of you need now is emotional closeness.

Let your partner know that you need to help him in any way you can--that helping him will make you feel better. One way you can do this is by learning everything you can about prostate cancer and the various treatments, so that you can discuss them knowledgably with him as he decides his best treatment option.  Hopefully, his best option will be Active Surveillance. If not, 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 he wants to get a second opinion (and he should!), he will have a folder with everything he needs to take with him.
Having said all that, it is vital that you don't neglect your own health or give up your own life and center everything around your partner and the cancer. Take time out from thinking and talking about the disease and enjoy activities you have always liked doing together. Remember: the statistics are on your side, so don't let your lives be held hostage to prostate cancer!


Tuesday, August 4, 2015

Alternatives to Immediate Prostate Biopsy


Your PSA is elevated. Now your doctor recommends a needle biopsy, 12 cores through the rectum to check for cancer in the prostate.  Sounds icky, but also logical; after all who wants to miss cancer? But come on, do you really have to do 12 stabs via the rectum?

Each year over a million men submit their prostates for a biopsy.  At an average cost of around four thousand dollars, the prostate biopsy business is a 4-billion-dollar-a-year enterprise.  But it’s not merely the cost that gives pause.  Three percent of men end up hospitalized with life-threatening infections.  Around a 100,000 men every year get a confounding diagnosis of Grade 6 prostate cancer, a truly harmless entity, unless you get suckered into an unnecessary radical prostatectomy.

Obviously, prostate biopsy is an unpleasant proposition with notable risks.  However, ignoring a high PSA incurs the risk of missing a diagnosis of a higher grade prostate cancer. As things stand now, of the million biopsies being done annually, over a hundred thousand men with Grade 7 or higher cancers are being detected. For these men, their early diagnosis is beneficial, leading to early, curative treatment in a timely fashion.

How can we detect the 100,000 men with higher-grade cancers that need to be detected without doing 900,000 “unnecessary” biopsies?   The answer to this question continues to evolve as technology marches forward. Our latest thinking at Prostate Oncology (assuming the PSA is not wildly elevated, say over 20) is a three step process:

1.    Simply repeat the PSA to confirm it is indeed abnormally elevated.  All sorts of things can cause temporary elevations of PSA ranging from nonspecific inflammation of the prostate, to recent sexual activity, to simple laboratory errors. 

2.    If the PSA remains elevated with repeat testing the next step to consider is an OPKO-4Kscore blood test. The OPKO test reports a percentage estimate of the likelihood of higher grade cancer being present.  The test is not perfect, but it performs pretty well.  For example, if a specific patient receives an OPKO report with an estimated risk of high grade disease of less than 15%, a standard random biopsy (if he elected to do one) will confirm the absence of high grade disease 92% of the time. Not bad.

3.    Our next step at Prostate Oncology, in the cases where a patient has an OPKO test indicating that the risk of high grade disease is over 15%, is to obtain a prostate scan with high-resolution color Doppler ultrasound or with a 3-Tesla multiparametric MRI. With scanning, the location of the high-grade disease can be determined over 90% of the time so that a targeted biopsy with 2 or 3 cores can be substituted for the traditional 12-core biopsy.       
The business of prostate biopsy has become so out of control the US Preventative Services Task Force advocates against PSA testing altogether.  The Task Force’s scientifically-based arguments that PSA testing is causing more harm than good are really quite convincing.  However, back in 2011 when they published their recommendations, the OPKO test and 3-Tesla multiparametric prostate MRI were unavailable. With the advent of these new technologies, PSA screening to detect higher grade prostate cancers at an early stage when they are still curable makes perfect sense.