Fighting Back When
Foe Is Prostate Cancer
By: John Langone
New York Times, October 23, 2001
Never underestimate prostate cancer," Dr.
Patrick Walsh, a professor of urology at Johns Hopkins, warns in his book.
"It is a formidable adversary, which springs up in several places at
once inside the prostate."
Indeed, with an average of seven separate tumors
growing inside of it, a cancerous prostate is a challenge that must be met
if the patient is not to be one of the estimated 31,500 Americans who die
of it each year.
The most effective treatment, if the cancer is
confined to the prostate, is still radical prostatectomy, the total
removal of the walnut-sized gland which provides a third of the fluid that
makes up semen.
But as good as it is, this surgical approach is, as
the authors of the two books agree, intended for relatively younger,
otherwise healthy men who are not only curable but who can reasonably
expect to live at least another 15 or so years.
Dr. Rous, who is a professor of urology at Dartmouth
Medical School, and Dr. Walsh also agree that when the operation is
performed by well-trained surgeons fewer complications arise, and potency
— loss of which may be temporary or permanent after surgery — can be
preserved in many men.
The two books cover the same ground, and generally
take the same views of various treatments — for example, Dr. Walsh's
refers to radiation treatment as "an excellent option" and Dr.
Rous's calls it a "very valid and fine means of treating prostate
cancer." But Dr. Walsh's book is easier to use because of its
organization, comprehensiveness and writing style.
This is not to say that Dr. Rous's work should be
ignored. It costs less, is more compact in size and contains all the
essential information from anatomy of the prostate to diagnosis,
treatments and complications.
But it often bogs down in medical journal terminology
like "a urodynamic study is often of benefit in revealing a detrusor/
sphincter dyssnergia."
Dr. Walsh's guide, with easy-to-follow charts,
illustrations and sidebars on a variety of topics (treatment pros and
cons, cancer staging, diagnostic procedures, diet and exercise, to name a
few) makes a complex disease less confusing to the average reader,
especially the patient who needs to evaluate his options from watchful
waiting to radical surgery.
There are especially valuable sections on the role of
environment, diet and race in prostate cancer. For example, Dr. Walsh
points out that the disease is common in Western countries and rare in
Asia, but when Asian men migrate to the West, their risk, probably because
of diet, increases over time. "The risk changes from place to
place," he writes, "and in many ways from man to man."
Dr. Walsh also examines the reasons that the number
of black men per 100,000 who develop prostate cancer is 40 percent higher
than the number of white men and that black men seem to get more severe
forms of the disease. Genetic susceptibility, inadequate exposure to
vitamin D because black skin is more efficient at blocking out sunlight
and diet are possible reasons. The discussion is vital because, as Dr.
Walsh writes, black men generally delay seeking medical care.
"African-American men," he advises,
"should start screening for prostate cancer at age 40." But he
adds that information from certain health care centers, like military
clinics or H.M.O.'s where availability of medical care seems to be equal,
suggests that black men "still seem to fare poorly when it comes to
prostate cancer."
Nonetheless, early detection and improvements in
treatment save lives. As Dr. Rous advises, "If prostatic cancer is to
be diagnosed at a time when it is still potentially curable, I believe
that a blood P.S.A. test (a measure of an enzyme made by the prostate, an
elevated level of which can signal cancer) and a digital rectal
examination should be done annually in all men over 50 and in men over 40
who are African-American or who have a first-degree relative (a father or
brother) in whom prostate cancer was diagnosed before the age of 60."
"Dr. Patrick Walsh's Guide to Surviving
Prostate Cancer," by Patrick C. Walsh and Janet Farrar Worthington,
Warner Books, $25.95.
"The Prostate Book: Sound Advice on Symptoms
and Treatment," by Dr. Stephen N. Rous, W. W. Norton & Company,
$26.95.
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