To encourage men to talk about the often taboo topic, Smith sometimes employs unconventional methods. “On at least five occasions, I have urged men to see a physician after overhearing them in the men’s room complaining of urination problems. No matter how, we have to identify the problem and talk about it.”
Smith’s first conversations about prostate cancer followed an annual physical. Smith, 57, knew he had a higher-than-average risk because he is African-American and has a family history of prostate cancer. During his routine rectal examination, Smith’s physician discovered a tumor, later diagnosed as malignant. Today, he is sharing his experiences with others.
And he is not the only one talking. Recently, celebrities including Arnold Palmer, Sidney Poitier and Norman Schwartzkopf have disclosed personal struggles with the disease.
The revelations are long overdue. Approximately one in 10 men will develop prostate cancer by age 85, with higher rates for African-American males. Last year, in the United States alone, more than 300,000 cases of prostate cancer were reported and 41,000 men died from the disease. Prostate cancer is the most common form of cancer in men and the second-leading cause of cancer-related death, trailing lung cancer, reports the American Cancer Society. Fortunately, improved screening methods and sophisticated treatment options are providing hope to thousands of men.
Knowledge saves lives
Although prostate cancer can be deadly, it may not cause noticeable symptoms, medical experts say. Therefore, routine examinations are critical. As with many forms of cancer, early detection increases the odds of recovery.
Unique to males, the prostate produces a fluid to transport sperm. The walnut-shaped gland, located below the bladder and in front of the rectum, encircles the urethra, a tube that carries urine. Usually the size of a chestnut, the gland is easily felt by a physician during a rectal exam, particularly if it is enlarged. The physician also checks for other irregularities.
Patients with symptoms may experience urination problems (although this often results from far less serious conditions); blood in the urine; pain while urinating; or continuing pain in the lower back, pelvis, spine, hips, upper thighs or ribs. Unfortunately, by the time such warning signs occur, the cancer may be highly advanced.
The American Cancer Society recommends men age 50 and over be examined annually. Both the American Cancer Society and The American Urological Association advise yearly exams for men 40 or older who are at high risk, including those of African-American descent and those with a family history of prostate cancer. It’s best to check with your own physician.
“Regular screenings are important for all men, but for groups at higher risk, including African-Americans and those with a strong history of the disease, screening should begin at age 40 in order to find problems earlier and treat them more aggressively,” says Marc Hirschhorn, M.D., a member of the Urology Group practice located in New Haven.
The American Cancer Society also recommends an annual blood test called a PSA (prostate-specific antigen). While many men, especially over age 50, have non-cancerous enlargement of the prostate and elevated PSA levels, most physicians will recommend further testing if either condition is found.
Such tests may include a transrectal ultrasound, during which sound waves are used to create an image of the prostate on a screen. “We are able to ascertain symmetry, size and abnormalities in the texture of the gland,” says Ralph DeVito, M.D., a board certified urologist and section chief of Urology at the Hospital of Saint Raphael. A biopsy may be done and prostate tissue examined for cancer cells.
“If the biopsies show a malignancy (cancer), we need to properly stage the disease,” adds DeVito. “Staging” determines how widespread the cancer is by evaluating the tumor’s size and the extent to which it has spread to surrounding lymph nodes or beyond. Additional tests might include a bone scan, CT scan (computerized tomography), MRI (magnetic resonance imaging) and biopsies of the lymph nodes.
Advanced tactics and treatments
The good news is that medical experts, armed with sophisticated screening methods and high-tech treatment options, are having increasing success in helping patients conquer prostate cancer. Two of the most advanced techniques include a three-dimensional computer that accurately portrays the shape, size and location of the prostate; and brachytherapy, a minimally invasive method of implanting radioactive seeds directly into the prostate, usually on an outpatient basis. Both techniques are available at the Hospital of Saint Raphael’s Father Michael J. McGivney Center for Cancer Care in New Haven.
“We have developed a great deal
of expertise in the treatment of prostate cancer at Saint Raphael’s,” says Joseph Cardinale, M.D., a board-certified radiologist and director of the Radiation Oncology Section. “Brachytherapy is one of the most exciting things we’re doing in the treatment of cancer.”
During the procedure, about 120 radioactive seeds about the size of rice grains are implanted into the prostate, using thin, hollow needles. Placing the seeds directly into the prostate allows radiation to be positioned right at the tumor site, while sparing surrounding tissue. Because there is no incision, patients are usually sent home the same day, quickening their ability to resume their normal routines. The seeds do not need to be removed, because they lose their radioactivity over time and are made with materials compatible with the human body. Common side effects include increased frequency of urination, disruption to urine flow and a feeling of being unable to empty the bladder. Impotence can also occur, but is far less likely than with traditional radiation, particularly in men under age 70.
Another advanced method of fighting prostate cancer relies on the same technology that Hollywood filmmakers use to create three-dimensional special effects. A sophisticated computer system is used to construct a three-dimensional model of the patient’s tumor, accurately depicting its shape, size and location. This information is then used to create a customized pattern of radiation in which multiple beams are precisely positioned to conform to the shape and size of the tumor. The McGivney Center was the first in Connecticut to use this system, and to date, is one of only a handful in the state to offer it.
Known as three-dimensional conformal radiation therapy, this treatment method has several key benefits. Because there is a model of the tumor, physicians can visualize the entire area that needs treatment. And because the targeting is so precise, physicians can aggressively attack the tumor with higher-than-usual doses of radiation. Patients generally experience fewer side effects than with traditional radiation, because the targeted beams spare the healthy tissue surrounding the prostate, experts say.
Other treatment options include:
Surgery (radical prostatectomy): This involves removing the prostate and the two attached seminal vesicles. While extremely effective in curing early prostate cancer that has not spread, drawbacks include risk of temporary or permanent incontinence and/or impotence, although new techniques have lessened the chances of both.
Radiation Therapy: High-energy external radiation often cures non-aggressive tumors confined to the prostate. This treatment is common if cancer cells are found in the area immediately surrounding the gland. Radiation therapy causes impotence in approximately one-half of recipients, and has other side effects, such as temporary disruption of normal urinary and bowel habits.
Hormone Therapy: Because the hormone testosterone fuels the growth of prostate cancer, stopping its production altogether can reduce tumor size. Usually used in conjunction with other therapies, or in cancer that has spread beyond the prostate, this treatment requires either injections of drugs that block testosterone production or removal of the testicles.
Chemotherapy: Anti-cancer drugs, taken orally or intravenously, can slow tumor growth and are used most often in advanced cases to reduce pain and other symptoms.
Watchful Waiting: Since prostate cancer usually grows slowly, a physician may advise a “watch and wait” approach. This might occur if the patient has a life expectancy of less than 10 years, is asymptomatic with an advanced tumor or has a small, well-differentiated tumor.
“The treatment of prostate cancer needs to be measured in more than years of survival,” DeVito says. “Critical to the mixture is a patient’s quality of life. We must consider age, overall health, the extent of the cancer and any side effects of treatment. If a 78-year-old patient has been diagnosed with a well-contained, non-aggressive tumor, one could certainly argue that any treatment might be worse than choosing to monitor the condition. That is why I often tell my patients to go home, research their options, consider all the issues, talk to their families and then make their decision.”
The Urology Center’s Hirschhorn voices similar sentiments. “The best treatments can be offered only after considering all of the options available today, in light of a patient’s history and the quality of life that can be maintained.”
It can be difficult for patients to select a treatment method, because there are no hard and fast rules concerning the most appropriate option. Even physicians have been known to differ in their recommendations.
“The treatment of organ-confined prostate cancer is an area of confirmed controversy,” Cardinale asserts. In such cases, a medical conference may be in order. At the McGivney Center, urologists and oncologists will meet as a group to explore treatment options and to reach a consensus concerning the treatment to recommend to the patient.
“Challenging cases are discussed by specialists who will review the case as a group,” Cardinale explains. “It’s a team approach.”
Caring for the whole man
Caring for people with cancer involves more than determining the most appropriate course of medical treatment. The McGivney Center strives to nurture the “essence of a person,” says Eileen O’Connor, radiation oncology manager. “No one is doing better technical work than we are at the Hospital of Saint Raphael’s, but we also know the importance of treating the body, mind and spirit.”
Making the right choice
After considering all factors in his case, Donald Bryan chose the McGivney Center for seed implants. “I know several people who have undergone surgery and external radiation, and I didn’t want to experience the possible side effects, nor the time and inconvenience involved,” says the 69-year old New Haven resident. “The procedure was much easier than I had imagined, and the discomfort only minor. Taking everything about my case into consideration, my wife and I believe that the seeds will achieve the same or better results than other options.”
John Smith’s case was different. While his tumor was confined to the gland and could have been removed through surgery, Smith initially opted for external radiation therapy (seed implantation was not yet available).
“My wife and I decided against the surgery and elected the seven weeks of radiation treatments,” he says. “For me it was extremely convenient (he could walk from his job to the McGivney Center for the half-hour daily treatments), and hopefully wouldn’t have the side effects of the surgery.”
When Smith received word that his PSA levels had decreased dramatically, he hoped his preliminary course of treatment had been successful. However, he later experienced a cancer recurrence. Smith then spoke to two oncologists (cancer specialists) — one was a local physician, the other was an old friend.
“This time, we all felt that surgery was the answer,” Smith recalls. “I was in the hospital for a week, didn’t suffer much discomfort, but did experience some problems with incontinence and impotence. But my wife and I agree, the most important thing is getting rid of the cancer.”
Smith believes men can learn something from women when it comes to taking charge of their health and speaking up about their concerns.
“Women are light years ahead when it comes to serious illnesses because of their willingness to talk and seek out information,” Smith says. “But more and more men are communicating and I want to be there to help them.”
Accompanying story: Man to Man and Beyond
“‘You’re not alone’ is the message we want to get across to prostate cancer patients at the Hospital of Saint Raphael,” says Vanna Dest, R.N., radiation oncology clinical nurse specialist and co-facilitator of the hospital’s prostate cancer support group. The group meets monthly at the Father Michael J. McGivney Center for Cancer Care, welcoming patients and family members to hear guest speakers and to talk with each other.
“It’s nice to know other people are in similar situations,” Dest says. Patients often describe their experiences with cancer as an “emotional roller coaster” and tend to become frustrated because they have little control over the disease. “We offer them a forum where they can verbalize their feelings and fears, and let them know that a lot of these emotions are a normal reaction to having cancer,” she says.
Joseph Zehnder has been attending meetings for two years. “The group is great,” the 72-year-old Orange resident enthusiastically states. “The guest speakers have been very interesting and have given us much useful information. And the members are all very open — there are no secrets. I have met people in all stages of the disease, with very different feelings about the effects on their lives. It helps to listen to them and talk about it.”
Often, cancer patients don’t consider themselves “survivors” or “cured” until they have been cancer-free for at least five years. Dest and co-facilitator Agnes Barba, M.S.W., an oncology social worker, encourage patients to view themselves as survivors from the moment they are diagnosed.
“We try to instill hope,” says Dest. “And we help people to enhance their coping skills and strategies.”
There is increasing evidence that support groups themselves may be healthy. A Stanford University study found patients with metastatic breast cancer (cancer that had spread beyond the breast) who attended a support group lived an average of 18 months longer than those who did not. While all received standard cancer care, the findings suggest that participation in the group enhanced the effectiveness of the medical treatment. Experts say it also is possible that the support group lessened depression or stimulated the patients’ immune systems, helping them to better fight their disease.
For men who find it too difficult to discuss their feelings face-to-face, the American Cancer Society has initiated the “Early Support” telephone program, an extension of its existing “Man to Man” prostate cancer support program. “A man can call at the first sign of prostate abnormality,” says David Woodmansee, vice president for public issues and communications of the American Cancer Society of Connecticut. “We not only provide information, but we make every attempt to put them in touch with an American Cancer Society volunteer whose experiences most closely match theirs. Our telephone program allows them to maintain some sense of anonymity, yet discuss very important issues.”
Woodmansee stresses that volunteers don’t take the place of medical professionals. “Our members are there as a resource, and have access to several physicians should medical questions arise,” he says.
For more information about prostate cancer or these programs, call the McGivney Cancer Center at 203-789-3131 or the American Cancer Society, toll-free at 1-800-ACS-2345 or in North Haven at 203-234-3900.
This
page was last updated on 04/23/2001
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