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Selected Excerpts

• "The physician-patient relationship is not a marriage. One cannot survive without the other."
• "The prostate is fickle...intrinsically dispensable and disposable -although not replaceable."
• "This book is a man's journey through the whole prostatic landscape."

"Prostate misbehavior can dramatically change men and their partners forever. It can make a man's life miserable and kill him, too. The risk of a man being diagnosed with prostate cancer is one in six, but certain circumstances increase that risk exponentially. For example: if the man is obese, he has an additional 30% risk, if he has a family history of prostate cancer (one diagnosed close relative: father, brother) his risk is twice as high, if he has two relatives his risk is five times higher, and with three relatives the likelihood of his developing prostate cancer is 97%. And if he is black, he still has a 40% to 50% higher risk and twice the probabilities of dying of this disease.

No single cause has been identified yet. No single means to prevent it has been discovered either. However, we now know that prostate cancer is curable. The difference between dying of prostate cancer and having a good probability of being cured rests on early diagnosis, when the cancer is still localized within the gland. Most men are unaware of that difference, and a large percentage of those who know do believe they will not develop prostatic troubles. Many do not even know, until diagnosed, that they have a gland named prostate, and the TV media once confused it with the word "prostitute" -as do some word processors suggesting to replace the word "prostatitis".

* * * * *

"A man is not alone when fighting a prostate illness. And the fight is not new and not a characteristic of modern life or environment. Prostate illness is not and should not be a stigma either, whether personal or social. It is not contagious. In addition, it is curable -if caught early!

Yet, in spite of the thousands of scientists who for centuries paved the way for us to diagnose and cure prostate illnesses, and in spite of the 234,460 Americans who in 2006 are finding out that they have prostate cancer, each man feels truly alone when facing that discovery. No one else can take his place in sickness or in death."

* * * * *

"The anguish the average man feels when abruptly diagnosed with prostate cancer is mainly due to the unknown -to his lack of knowledge of what to expect when, what to do, and how his life will change. Implicitly, not knowing anything about the matter reveals his neglect of trying to learn. It is surprising that a mature adult (who naturally may have urinated about seven times a day or 2,555 times a year during, say, 40 years, that is, after 102,200 repetitions) may never have wondered about the intricacies that make his plumbing system work -and whether or not he knows anything about his prostate. By comparison, the same men, by age 40, surely know considerably more about how their automobile systems work. Hence, the cry of being devastated, depressed ("Why me?") by the news of prostatic illnesses is intrinsically senseless although it may be emotionally understandable."

* * * * *

"A man must learn...

• How to determine the physician's autonomy, substantially reduced by HMOs.
• When and how to request which tests and why.
• How to understand the significance of the test results.
• How to proceed to exercise his legal right to ask for a second opinion from another physician (urologist > oncologist or oncologist > urologist) within or outside his HMO staff.
• If he has the right and how to ask for a different treatment center offering his needed protocol, and which one or who will be responsible for providing follow-up care after the treatment.
• How to request and evaluate adequate statistics to understand his own individual situation.
• What questions to ask and how to ask -a number of questions will be suggested throughout this book. Many patients are afraid to ask, while many doctors maintain a defensive position that "they cannot answer un-asked questions" -a situation easily resolved when the patient takes with him to the visit a written list of questions and concerns about his health.
• How accessible is the chosen doctor.
• How to impress upon his physician and upon his HMO that he, the patient, must be given sufficient information to make a treatment decision, and that he has the right to receive a copy of all of his tests and analyses."

"It would be fascinating to be able to watch internally, in vivo, like children observing an electric train for the first time, the motion of fluids and secretions in their own liquefied nature running up and down and around defying gravity in one- or two-way conduits before exiting the body. From the kidneys to/through the penis, fluids cross tunnels and valves that open and close automatically, as light-signal posts by the side of the railroad tracks, contingent upon physiological needs, pleasure desire, mental instructions and physical condition of the individual. It is a unique combination of skillful design, high technology, and plumbing mastery. Amazingly, this extremely complex and delicate piece of "soft machinery" may endure perfect functioning for 40, 50, 60 or more years -when in good behavior."

* * * * *

"The psychological reaction to the news of having prostate cancer, a sensitive issue to all men, becomes even more crucial when intersecting the traditional social stigma of both "cancer" and "homosexuality". The concerns of a gay patient about his sexuality relative to his prostate cancer diagnosis extend to how to communicate with and which reaction to expect from his partner, the impact on his life style and social environment and, to worsen his anxiety, the uncertainty of finding medical specialists who understand the gay patient's emotional and psychological trauma in addition to his prostate condition."

THE MALE URINARY AND SEXUAL SYSTEM
(Items in bold correlate the drawing with the caption)

"Prostate-Specific Antigen (abbreviated PSA) is a type of enzyme produced primarily in the man's prostatic gland and concentrated in its tissue. Its chemical reaction, the protein, carries the semen (the fluid that propels the sperm at sexual orgasm) and helps to keep it in its liquid form.

PSA is made by healthy as well as by prostatic cancerous cells. A healthy prostate keeps or locks in the gland the major portion of PSA, and therefore, levels in the blood are very low, "undetectable". However, when the prostate begins to misbehave, a higher amount of PSA "leaks" from the gland into the blood stream. Consequently, the PSA level has become a crucial marker: generally, the higher its amount in the blood, the more cause for alarm that something abnormal is going on inside the gland. When the doctor during the DRE detects abnormalities in, for example, volume or symmetry of the gland, or bumps, or soft/hard spots, he recommends a PSA blood test."

* * * * *

"The biopsy result may be Negative, meaning no cancer was detected. However, sometimes the pathologist's result comes out negative, and yet, microscopic cancerous cells are already quietly "crawling" inside the prostate. The latter is known as "a false negative biopsy". Specialists believe that either the cancer in those cells was not yet detectable or else, the urologist did not extract sufficient samples or extracted them from zones other than the one[s] where the cancer is nesting. When the result is Suspicious, many specialists advise patients to have a second opinion on the same tissue samples from another pathology laboratory and even a second biopsy done by the same or by another urologist.

Statistically, a first biopsy detects about 85% of cancers and reveals that only 25% to 35% of elevated PSA levels are truly caused by cancer -a formidable diagnosing device. A second biopsy may miss only 10% of cancers.

Although the urologist and the pathologist are not infallible, the biopsy is considered the most accurate means to judge that there is not cancer or prove that there is. It is an indispensable aid to making diagnosis and treatment decisions. Millions of prostate biopsies are performed annually worldwide."

* * * * *

It is an enlargement of the gland and generally not related to the process of malignancy. It is considered not cancerous. However, it can coexist with cancer and therefore, share the same symptoms. Additionally, one of the causes of the enlargement is the production of the hormone metabolite dihydrotestosterone (DHT), judged by many experts to be greatly responsible for benign prostate enlargement and possibly for prostate cancer. Studies link it also to high fat diets and family history.

Puberty (14 to 18 years) is considered the period of "maturation" of the prostate, which grows until the third decade. After the 30s and until age 45-50, it has a so-called "stationary size"; afterwards, it may suffer enlargement (BPH) or progressive atrophy. In the U.S., 25% of white men experience prostate enlargement starting at about age 40, 50% at age 50. For black men these numbers are 25% at age 35 and 50% at age 45 --always 5 years earlier for blacks. For every decade increase in age, the percentage of all men with probability of prostate enlargement also increases by ten: at age 60, 60% have prostate enlargement; at 70, 70%; at 80, 80%; at 90, 90%, and when/if we reach 100?Bingo! all of us are "expected" to somehow have an

* * * * *

"Perhaps the most relevant issue has not been dealt with in the years-long screening controversy among specialists, HMOs and governments: Where is the patient? This Author has been unable to find comparable studies showing what patients think, feel or want regarding being tested or screened. It is somewhat like the attitude in "traditional old fashioned" homes where everybody argued and made decisions about younger members without concern for their voice, not to mention for their vote. The difference is that, in our case and in our times, the patient is the center upon whom the whole healthcare is built and the one who pays for all of the components of his healthcare environment. Interestingly, all over the world (and especially in the U.S.) men for many years have enrolled for screening projects voluntarily and by the hundreds of thousands, but some entities and doctors still must be further convinced in order to administer testing. Statistics show that PSA testing has caused a substantial decrease of incidence of metastatic disease at the time of diagnosis by 75%, and a decreased death rate of 25%."

"There are many types of cancers and they are named after the part of the body where they originate: prostate cancer, lung, breast, testicles, etc. Each requires its own treatment specifically tailored to both the cancer tumor characteristics and the patient. Furthermore, when three men have prostate cancer, each is a different cancer because it is fundamentally individual. There are two main groups of cancerous tumors: Carcinoma and Sarcoma. Carcinoma starts in the epithelial tissue (skin or lining of inner organs), sarcoma starts in connective tissue (bones, cartilage). The tumor of the prostate is a carcinoma in 95% of the cases."

* * * * *

"Irrespective of when it is discovered and of the severity of the disease, the diagnosis of prostate cancer dramatically changes the life of the man. His struggle will extend also to his wife or partner and to their families -they all are impacted by the man's ambivalent target of wanting to find answers and wanting to survive. It stirs up in his sensitivity a whole spectrum of issues -somehow unresolved by many men. Upon the diagnostic event, a sector of men accept it blindly, they suspect being a victim ("Why me?"), others will research and fight the disease and will not be affected by inner struggles, while still others find their values stirred up by uncertainties on unresolved questions on Life and Death -but are determined to fight anyway. Essentially, those with a fighting attitude become heroes of their own life and merit respect and admiration."