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

Tuesday, February 23, 2016

Memorials: Peter Grimm, MD and Jay Cohen, MD


I am sad to report the passing of two giant contributors in the prostate cancer realm, Dr. Peter Grimm and Dr. Jay Cohen. 

Dr. Grimm was the Director of the Prostate Cancer Center of Seattle which pioneered seed implantation for prostate cancer. He was instrumental in establishing the Seattle Prostate Institute in 1997. Along with his colleagues, Dr. John Blasko and Dr. Haken Ragde, he trained over 6000 physicians worldwide in how to administer seed implants. Their team has treated over 10,000 patients since 1985. Over one thousand centers now perform seed implantation, which is now a treatment of choice for many men with prostate cancer.   Dr. Grimm completed his graduate training in radiation oncology at UCLA. 

Dr. Grimm’s technical endeavors, such as the development of six US patented devices, have led to continuous improvements in the equipment widely used in prostate brachytherapy. He has served as one of fifteen physicians on the Medicare Practicing Physicians Advisory Board in Washington DC and served on the American Society of Therapeutic Radiation Oncology economic committee. He was the CEO of ProQura, and served on advisory boards for many seed implant companies. As lead editor, Dr. Grimm and members of the Prostate Cancer Results Study Group published a collaborative book on prostate cancer, The Prostate Cancer Treatment Book. His curriculum vitae included over 80 scientific articles and book chapters on prostate cancer.  

Dr. Grimm received an Outstanding Achievement awards from the American Brachytherapy Society, Midwestern University, and the Northwest Osteopathic Foundation. Born and raised in Seattle, he had a lifelong passion for preserving wild salmon. He was a board member of Long Live the Kings, a non-profit organization dedicated to preserving wild salmon in the Northwest. In a cooperative effort with the Hood Canal Salmon Enhancement Group and Washington State Department of Wildlife, he has released over 3 million wild salmon.  He also serves as a board member for Pacific Northwest College. He leaves behind his spouse Dawn Winters, PhD and two children, Robyn Vera, DO a radiation oncology physician in Olympia Washington and Justin Grimm, an IT specialist.

I am also saddened to report that Dr. Jay S. Cohen passed away in December 2015. My interactions with Dr. Cohen were related to his excellent book on prostate cancer: Prostate Cancer Breakthroughs. However, outside of the prostate cancer world, his researching and writing skills were eclectic and broad. Among his many and varied interests were his extensive research on the causes of medication side-effects. He published his findings in eight books, leading medical journals, and articles and publications such as Newsweek, Bottom Line Health, The New York Times, The Washington Post, Consumer Reports, Wall Street Journal. Another of his books, Over Dose: The Case Against the Drug Companies was favorably reviewed by the Journal of the American Medical Association.  Dr. Cohen was an Adjunct Associate Professor of Psychiatry and the Chairman of the Medical Advisory Committee of the Erythromelalgia Association, and a Fellow of the American College of Nutrition. He lived in Del Mar, CA for over 40 years. He is survived by his son Rory Cohen and daughter-in-law Alana Cohen, and a nephew, Hal Cohen.

Tuesday, February 9, 2016

Sometimes Going Fishing with the Doctor Isn’t So Much Fun


When you go fishing, you can bring up all kinds of things besides fish—old rubber boots, pieces of a broken net and discarded trash. Once I caught an eel.  You never know what you will drag in when you drop your line overboard. 

The same analogy holds true for diagnostic testing in the medical world. Investigative studies can have unintended consequences. Of course the studies seem justified at the time. We presume that the doctor is being rightfully conscientious by using all the tools of modern medicine, “fishing” for the right answers.

Dr. Scholz asked me to relate the story of an extended medical fishing trip that started with my dermatologist for my annual, too-much-California-sun screening. While talking to my dermatologist, I mentioned some itching on my arms.  He gave me a few samples of lotion and referred me to my internist for further evaluation and blood testing to “make sure” the itching wasn’t a symptom of something more serious. My internist ordered some lab work (which was normal) but recommended that I have a routine chest x-ray since itching can be associated with lung cancer.  This suggestion may have occurred to him because he knew that lung cancer caused my mother’s death.  Since I hadn’t had a chest x-ray in years, I thought, “why not?”

In retrospect, the chest x-ray may have been a mistake.  Because that’s when the boat left the dock and the fishing really began in earnest.  Two days later, the chest x-ray revealed a “suspicious” spot on my lung. So, to identify what it was, a CT was ordered.  The spot was benign. “Whew!” It was only a bone artifact (the end of a rib visible due to the angle of the x-ray).  But…. the CT scan showed a suspicious spot in the liver, which shouldn’t have been there and was large enough to be of concern.  So, an MRI of the abdomen was ordered.  The MRI revealed that the liver spot was nothing but a harmless hemangioma, a collection of blood vessels that are common and mean nothing.  Another big relief. But…. guess what else the MRI found?  At the top end of the scan in my lower neck, it showed some abnormalities in my thyroid “that could not be ignored.”  So, a thyroid ultrasound was ordered.  It revealed two nodules that looked benign and would have been ignored completely if there had only been one.  But the only way to really know what types of cells the nodules consisted of was by doing a needle biopsy or an exploratory surgery. 

Yikes!  When would I get off this merry-go round?  Who could imagine that simply mentioning some itching to a dermatologist would lead me face to face with the possibility of thyroid cancer.  However, the doctor was kind enough to offer another alternative.  Because of the known, slow-growth rates of typical thyroid cancers, active surveillance and re-testing at future intervals was also an option, and the one I have selected.

So, six months later, a second thyroid ultrasound—my fifth imaging test—showed no changes from the previous test.  The fishing trip finally seems to be over.  I am back in the waiting pool anticipating next year’s medical expedition, much the same as the next round of prostate screening tests I am scheduled to undergo early in 2017.  Now, routinely surveilling my thyroid is going to be just like my prostate.  If next year’s fishing trip doesn’t run down any new tributaries and is uneventful, I expect it may even be possible to extend by a year or two the time the frequency of testing.

My medical fishing trip was not much fun.  Personally, I’d rather spend my time working, biking or walking, or doing almost anything besides waiting for the next set of results from the last odd thing that showed up unexpectedly. But life goes on and it isn’t possible to know precisely how it will end.  My recommendation—Give careful consideration to your doctor’s invitation to go fishing.  Take control over your medical destiny and ask you doctors if close surveillance is an alternative to further testing.