It is National Prostate Cancer Awareness Month—no better time than now to reset some thinking about this men's disease. It is the second most common form of cancer among men after skin cancer and the second leading cause of death of American men after lung cancer. In incidence and mortality, prostate cancer is to men what breast cancer is to women. Yet for many reasons, it has remained too long in the shadows. This problem fosters a good deal of misunderstanding about a disease that will be diagnosed in 242,000 American men and kill 28,000 of them in 2012. Globally, more than 16 million men and their families are challenged by prostate cancer.
Let me dispel some common myths right now: it is not just an old man’s disease, it is not “the good kind of cancer” with which to be diagnosed as it is not always slow growing as is commonly believed, and a family history is not always needed to be diagnosed. Further, prostate cancer is often asymptomatic, meaning you don't have to feel bad to have it growing inside your gland.
I know firsthand.
A age 51 (not an old man in my book), two years after joining the Prostate Cancer Foundation in Santa Monica to head up their communications, I was diagnosed with my own case. Ironic? Perhaps. But not surprising. I already knew that one in six American men will be diagnosed with prostate cancer in their lifetime. Someone needs to fall into the statistics. Why should I have been given a pass?
Two months following my diagnosis, I had a radical prostatectomy (removal of the prostate) and the cancer appeared to be contained and the margins were mostly clear. Despite believing that we had gotten all those nasty cells, one week later, the post-surgical pathology report showed that the cancer had metastasized to my lymph nodes. I was suddenly a Stage 4 cancer patient with advanced disease. It was on to 35 sessions of radiation therapy (equivalent to more than 48,000 chest x-rays) and two years of androgen deprivation therapy (ADT) to cut my production of testosterone since this hormone of manliness fuels the proliferation and spread of prostate cancer. Despite all the side effects I have had to endure from a near total lack of testosterone, I have been fashionably manscaped for the past two years and a new crop of hair follicles has taken root on my once more sparsely populated scalp. I suppose there are upsides to anything if you look for them.
With 27 genotypes or varieties of prostate cancer, it is not always slow-growing. There are both the indolent, non-life-threatening types that a man will die with rather than of, and the very aggressive varieties. In between the two ends of the spectrum lie a number of varieties that require moderate rather than aggressive treatment. For those diagnosed with varieties that appear less aggressive (Gleason score 6), active surveillance is often a viable option.
Since the age of 40, I had been having annual PSA tests and a digital rectal exam (DRE) as part of my annual physical. Just before my diagnosis, my PSA score nearly doubled—a signal that triggered a biopsy and subsequent diagnosis. And yes, the PSA test—though not a cancer-specific test—indeed saved my life with its ability to set off the smoke alarm and alert my physician that something might be going wrong in my little walnut-sized gland.
Today, as I wean off of ADT, I have a 30 to 40 percent chance of one day hearing the words “you are cancer free.” If not, there are a range of additional treatments and new drugs to be tried once I become resistant to ADT, as most patients invariably do. From my perspective, working alongside the world’s leading prostate cancer researchers, I often tell fellow patients that there is no better time to be a prostate cancer patient, if you have to be one, than today. So, I remain optimistic.
The good news about prostate cancer is that with early detection and treatment, the 5-year survival rate is nearly 97 percent.
Here’s what you can do to protect yourself and your loved ones:
1. Help break down the barriers of “macho-dom” and make prostate cancer something to talk about. If we can openly rally to save the ta-tas, we should be brave enough to save our walnuts;
2. Share family medical histories;
3. If you are over 40, talk with your physician about when it is right for you to begin annual PSA testing and DREs so you can make an informed decision depending on your health, family history and other relevant factors;
4. Eat a healthy diet and exercise—research shows that lifestyle plays an important role in preventing prostate cancer and disease recurrence;
5. Eat more cruciferous vegetables, particularly broccoli, which contain high levels of sulphorophanes that aid in the repair of damaged DNA;
6. And finally—just because you won’t believe this one—do not char you meats. The amount of char on an 8-ounce steak carries a carcinogen (PhIP) that is the equivalent of your prostate smoking a pack and a half of cigarettes. This compound interfere with the normal replication and repair of DNA in the prostate which can lead to the development of cancer.
For more information on prostate cancer, including the most recent updates on research, visit the Prostate Cancer Foundation website at www.pcf.org. For patient perspectives and discussion, visit my prostate cancer blog at www.mynewyorkminute.org.
I wish you all abundant health.