(Dateline: December 22, 1997, Jamestown, NC)

When the phone rang, it was almost 5PM at the end of a clear, but cool, December day - the Tuesday preceding Christmas. It was Dr. Who-shall-remain-Nameless calling.

"This is Dr. Who... , I have your biopsy results back... one of the specimens showed a small focus of Adenocarcinoma... the other cores etc etc etc..."

I didn't really hear the remaining words. The news at that late hour was to presage my life's activities for the next year. It didn't take too long before the resultant depression gave way to anger - an emotional pattern that I later learned was quite normal - and therefore to have been expected. As with most of the milestones associated with life with Prostate Cancer (PCa), operating in a catch-up mode appeared to be the rule - the seemingly inexorable press of time being somewhat overwhelming, even though unnecessary.

I was on The Net that evening, searching and reading into the next day, and every day thereafter for a month and a week.  During that period of time, many phone calls were made and returned, each one of them a part of the search for answers to too many unanswered questions. There were consultations with several M.D.'s -- an oncologist, another urologist, and a wise, elderly, now-retired family physician. It was to become a quest not unlike that of Diogenes' search for the truth... such is the way of men diagnosed with Prostate Cancer.(1)

An Intro... of sorts...

If you are a male - ~age 40 or above - you may have to partake of this experience sometime in your remaining life, and so it is for you (and your spouse) that I've written this page. (I'm making an educated guess (maybe a SWAG?) that for males currently of a younger age, there will be new technologies in place for routine screening and treatment of PCa, which will be more successful than those which we have at present.)

The most emotionally depressing realization was that, at the time of my study, (and still today, January 2001), there was no unanimity in medical circles for a recommended treatment for cure of cancer of the prostate - articles in the popular press notwithstanding. There are a number of accepted medical procedures, none of which, however, can fully demonstrate results such that they can be touted as THE CURE! The Radical Prostatectomy procedure is still referred to by some as the "Gold Standard", but that nomenclature is being challenged daily by proponents of newer technologies - Intensity Modulated Radiation Therapy (IMRT) being one of these. In truth, several of the existing modalities can probably "cure" if done early enough and done correctly. There is insufficient data at present to be more specific than that. (1/01)

Numerous types of reference materials exist, ranging from the quickie pamphlets found in medical offices and hospitals, to the burdensome medical reports weighed down with statistical proof of most any thesis you would like to see proved. Your quest is for information, however, so do your reading and don't despair. The golden rule for Prostate-involved people - the single, most important rule to embrace - is: become involved, become educated, partake in your own destiny. You will ultimately be responsible for making THE decision (even if it's a non-decision) regarding your medical treatment, and ditto for any and all health-related activities preceding and subsequent to THE treatment. It is, after all, your life!
(The term "treatment" as used here also includes a practice dubbed as "Watchful Waiting"... essentially a non-treatment as medical practices go.)

Some background info...

According to a surgeon-acquaintance of mine, most men (in the USA, anyway), by the time they reach ~80 years, can demonstrate evidence of cancer of the prostate if need be. A great many men - a USPS commemorative stamp advert states one out of five, more conventional wisdom states one in eight - will have the beast earlier in their lives, and if they learn of their plight, they will then be faced with that most fateful of decisions as well.

For most, PCa grows more slowly than other forms of human cancers, and there are a number of studies underway of treatment methods more advanced than are available today. For those men whose cancer is poorly differentiated (aggressive), there are delaying and palliative treatments which hopefully can prolong the fight until a more successful treatment comes out of a trial stage. Truly, if PCa is discovered and treated VERY EARLY in the course of events, numbers of men can be cured in the respect that they will die of some cause other than PCa. However, numbers of others will also die of other causes, but never knowing of the disease that was growing within. This is the paradox... to treat or not treat, and therefore whether even to know or not know.

Not surprisingly, there is not consensus among all of the Cancer agencies of the World (nor in the USA) regarding this dilemma. IMO, this is due primarily to the fact that there is no test yet available to identify and appropriately classify a prostate cancer cell - at an early stage - with respect to its future aggressiveness in your body. In other words, there is not a life model for you or I, into which we can plug some lab analysis of our own version of The Beast, and get an output which will tell us whether or not treatment would be beneficial to our longevity. On the upside, there are studies underway currently which have as their objective, a predictive test of aggressiveness. (Note: 2003 - this capability is growing near, and there are trials underway for just this purpose.)

Food for thought...

So, what I'm suggesting to you is to:

  1. read about the PSA & PSA II tests and the DRE, and, if you get these tests
    (and I hope that you do so regularly), and you have indications of PCa, then
  2. read and become educated in the subject of PCa and yourself; especially with
    regard to second (expert) readings of the Gleason score from your biopsy;
  3. consult with medical people representing several of the treatment methods, and
    after you've decided on the method of treatment you're most comfortable with,
  4. search out the most skilled practitioner of that modality as your attending physician!

Although following steps 1-4 should preclude it, for some, I might add a fifth item to the above... avoid all those who are peddling quackery and pseudo science in the name of a cure.

Getting up to Speed...

I'm not going to attempt to present or classify prospective treatments, current testing methods, statistical proofs, or anecdotal evidences. I am not a medical doctor, and I'm also not in a position to improve upon what others have done so very well already, and this is one of the great benefits of the Internet... the almost overwhelming and instant exchange of information for everyone's use and benefit.

There are basically four methods of (PCa) information dissemination and sharing in use on the net today:

  • The World Wide Web (WWW)
  • Mail lists
  • USENET Newsgroups (Forums)
  • Chat Groups

The Web is seemingly boundless with respect to the availability of Prostate Cancer-related information resources.

Here are some good fundamental sites:

(PLS NOTE: There are literally dozens of excellent Prostate Cancer Web sites on the net. I couldn't begin to list them all here and keep current with them. Do like I did... use a good search engine or a front end like GOOGLE and search on 'prostate' or 'cancer' or both, or take a look at the 'Resources and Links' sections on the Us TOO web site. You'll have enough reading for months on end! Do be a discerning reader, tho, as there is as much dis- and mis-information on this subject as on most all controversial topics these days. The "bad" info gets propagated just as fast as the good stuff!)

The single mail list to which I subscribe is:

  • P2P - Physician-to-Patient
    A very good moderated list with physicians answering patient questions. You can view the archives for this mailing list HERE.

The Newsgroups (following) were not of particular use to me as either a study or an information resource, but you may want to take a look.

I haven't had any inclination to join a CHAT group, so can offer no info on that method of info gathering.

The Prostate Cancer Research Institude (PCRI) has an excellent newsletter called Insights, which is currently available for free download from the web or via mail to your door. Additionally, the PCRI has video tapes available of recent presentations which could be used to augment your reading with the current thoughts of experts in the field. Contact the PCRI for info, or to donate -- it's your life you're working for!

(1) On January 27, 1998, my prostate gland was removed by Dr. David F. Paulson and associates at Duke University Prostate Cancer Center, in a procedure called a Radical Perineal Prostatectomy. As a result of my study, and from advice of others - medical and non-medical alike, I elected surgery over other modalities, and the perineal approach, while seemingly not in favor by most Urologists (or patients) these days, was Dr. Paulson's specialty, and one which was acceptable to me. (Return)

My current prognosis is good (2), but as your independent reading will tell you, the only 'sure thing' about cancer is that there is no 'sure thing', so maintaining a continuing vigilance remains the order of the day.

(2) As of Jan 2009, it is eleven years since that telephone call. My latest PSA test returned an 'undetectable' result... the good news continues!

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