When “No Action” Can Be “Right Action”

BY RALPH BLUM

Back in 1990, when a suspicious lump was discovered on my prostate, my ignorance of the prostate gland and the possibility of prostate cancer was monumental. No one in my family or even among my close friends had ever had prostate cancer, and it never occurred to me that I might one day have the disease.

Now, 25years later I am still alive, the average man over 50 is more aware of prostate cancer, and also many less toxic and more effective treatment options are available. And yet one thing has not changed: just hearing the doctor say, “I’m afraid it’s cancer,” can leave even the most pragmatic man planning the music for his funeral.

Truth is there is still a lot of misinformation and misunderstanding out there about this disease. So here are some facts that I hope will alleviate some of your fears, and also clarify why I still contend that if you have to have cancer, prostate cancer is the best deal in town.

Prostate cancer is unique among cancers because the mortality rate is so low. According to the American Cancer Society, more than 2 million men who have been diagnosed at some point are living with the disease in the U.S. It’s difficult to determine actual prostate cancer survival rates because most men are around 70 years old when diagnosed, and many of them will die from medical problems unrelated to the disease. But if you check out the “relative” 5-year survival rate of all stages of prostate cancer, you will find it is almost 100%. And that almost 100% of men with low-risk or  intermediate-risk disease live more than 10 years after diagnosis.

Why is it that the statistics for prostate cancer are so much less frightening than for other cancers?
 
1)    The PSA test is an early warning system that other cancers don’t have.
2)    It can easily be diagnosed at an early stage.
3)    In most cases it has an exceptionally slow growth rate.
4)    Extremely effective monitoring and treatment is now available.
5)    It has a pattern of spread that spares critical organs like the brain, lungs and liver.
6)    There is a safety net like no other called “hormone blockade” that induces remissions lasting more than 10 years in men with relapsed disease after surgery or radiation.

So instead of thinking about your funeral, what you really want to be focusing on is not rushing into some form of radical treatment that will virtually guarantee  some degree of impotence or incontinence.

It appears that patients and doctors alike struggle with the idea of “watching” anything called cancer. But unless you have the less common high-risk form of the disease, my advice to you is to consider “Active Surveillance” really carefully, especially if you are over 70. Because bottom line—and it bears repeating—out of over 200,000 men in the U.S. diagnosed annually with prostate cancer, the overwhelming majority will die with the disease, and not from it.

Potency

BY RALPH BLUM

One of the most worrying questions men diagnosed with prostate cancer face is: What are my chances of losing sexual function after treatment? The truth is all forms of prostate cancer treatment carry significant risk of impotence—defined as the inability to maintain an erection hard enough to penetrate. However, your chances vary greatly depending on a number of factors including your age, general health, potency prior to treatment, PSA levels, and last but not least, your treatment choice. Not surprisingly, regardless of which treatment they choose, older men whose sexual function is already low have the worst chance of good results.

While some men are willing to choose a therapy that offers a shorter life expectancy but better potency following treatment, for others the most important factor is curing the cancer. As one man said, “If you’re not alive, you don’t have to worry about sex.” Clearly it is a very individual choice as each man experiences sexual dysfunction in a profoundly personal way.

Since most men treated for early-stage prostate cancer typically live for decades, the choice of treatment is of paramount importance when it comes to quality of life issues. Surgery is still the preferred treatment for many men. But being operated on by less than the very finest surgeon dramatically increases the chances of impotence. The popularity of robotic surgery would lead one to believe that extensive studies have shown superior results compared to the traditional prostatectomy. However, according to Dr. Michael Barry of Massachusetts General Hospital in Boston and President of the Foundation for Informed Decision Making, it is not yet clear whether a robot-assisted laparoscopic prostatectomy is better or worse for maintaining sexual function than the older surgical techniques.

If retaining potency is your primary goal, IMRT or brachytherapy appear to give you the best results.  However, Dr. Durado Brooks, prostate cancer director for the American Cancer Society, cautions that sexual problems can show up later for men who also have either type of radiation therapy.

If you are like the gentleman in his early eighties who told me, “I’d rather be dead than unable to have another erection,” there are no easy answers. As far as I am concerned, the monastery beckons.

The Healing Power of Laughter

BY RALPH BLUM

If you have just been diagnosed with prostate cancer you are not alone. The American Cancer Society estimated that there would be over 241,000 new cases in the U.S. in 2012. And those men probably received a ton of information and advice from multiple sources to help them choose the best treatment.

Obviously their choice had to be guided by the clinical stage of their cancer, the extent of the disease, and their age and overall health. Undoubtedly they asked dozens of questions before making a final treatment decision.  But a question seldom asked is: “What are the psychological implications of the treatment?”

My prostate cancer journey began in 1990, and I monitored the cancer for 12 years before my PSA bumped up to a point that made some form of treatment necessary.  I chose hormone blockade, because being deprived of testosterone seemed more appealing than having my prostate sliced out or fried by electrons. However, I discovered that every cancer treatment comes with a stiff price—both physically and psychologically. So what is the best way to help combat the fear and stress of dealing with prostate cancer?

For me, the great “home remedy,” the ultimate anti-oxidant, is laughter. And that is not some demented form of denial. Over the past ten years, I have found that of all the things people have recommended to help get me through the bad times, laughter is at the top of the list.

“The best doctors in the world are Doctor Diet, Doctor Quiet and Doctor Merryman.” So wrote Jonathan Swift (1667-1743). Norman Cousins emphasized the healing power of laughter in his book, Anatomy of an Illness. Cousins called laughter “internal jogging.” And in his book, Peace, Love & Healing, Bernie Siegel wrote that, “love, laughter and peace of mind are physiologic.”

Without a doubt, laughter is the ultimate antioxidant. Here’s how the Discovery Health Web site describes the impact of laughter on the immune system: “When we laugh, natural killer cells which destroy tumors and viruses increase, along with Gamma-interferon (a disease-fighting protein), T cells (important for our immune system) and B cells (which make disease-fighting antibodies. As well as lowering blood pressure, laughter increases oxygen in the blood, which also encourages healing.”

Believe me when I say that my somewhat warped sense of humor has been a blessing to me in devastating moments. Time and again I have seen the relief and release that even stupid jokes or bawdy humor can provide to men who are under the gun. Cousins claimed he laughed his way back to health with old Groucho movies. For me, it was the amazing Carol Burnett, with the Marx Brothers a close second.

So find what works for you, because studies have shown that the debilitating emotion of fear can’t coexist with laughter, and that the relaxation response following a good laugh is worth its weight in gold. The message is clear: Lighten up!