November 1, 2011
When prostate cancer scare hits close to home
When Rabbi John Rosove of Temple Israel of Hollywood was diagnosed with prostate cancer in 2009, he was devastated. Given a dire prognosis by his first doctor (who later turned out to have exaggerated the circumstances), he felt the weight of his own mortality for the first time.
“I never really understood what it meant to be sick like that,” he said. “I felt as though I had been given a death sentence.”
Upon seeing a second physician, Rosove was given better news — his cancer was serious but treatable.
Rosove is now cancer-free, but in that split second he joined the estimated 240,890 men who are diagnosed with prostate cancer in the United States each year. Over the course of their lifetimes, approximately one in six men in the U.S. will be diagnosed with the disease.
More men are being diagnosed with the disease while it’s still in the early stages, said Dr. J. Kellogg Parsons, a urologic oncologist at UC San Diego Moores Cancer Center.
“More people are getting tested, and there is more awareness among the public,” he said. “Men with cancer have always been reluctant to talk about it, and I see a change in that over the last five to 10 years. That, in turn, often affects screening.”
That screening generally involves a blood test called a prostate-specific antigen (PSA) test. The test is performed by drawing blood, and if PSA levels are high, a doctor may recommend a biopsy to see if cancer is present.
While commonly administered, the PSA test has generated a great deal of controversy recently. Because prostate cancer can be so slow-growing that a man’s natural course of life may outpace it, some medical experts believe that the test — and the subsequent treatment — might do more harm than good. Others who are in favor of the test say that it prevents death in men who have a disease that will spread quickly.
Even major health organizations are divided on the issue: In October of this year, the U.S. Preventive Services Task Force issued a draft recommendation that men who don’t show symptoms of prostate cancer not be given the PSA test. But the American Urological Association recommends that it be offered to men who are 40 and older and who have a life expectancy of at least 10 years.
“It’s imperfect,” Parsons said of the PSA test, “but the fundamentally important thing is that it is the best test for detecting the more aggressive cancers while they can still be treated and cured.”
The course of treatment for prostate cancer depends greatly on the individual, said Dr. Timothy Wilson, the chief of the Division of Urology & Urologic Oncology at City of Hope. A unique aspect of prostate cancer treatment, though, is that because it can be so markedly slow to progress in some men, doctors generally begin by assessing whether the cancer requires immediate treatment or just needs to be monitored.
“What we are trying to predict is what the cancer will do over time,” he said, “and how it may impact that gentleman’s life in terms of local symptoms, and when we think it might spread.”
Not surprisingly, some patients take more keenly to the notion of monitoring than others. Certain men who are diagnosed with prostate cancer may be happy not to have to undergo treatment, but rather to get regular PSA tests every three to four months, and biopsies every year.
But for others, the notion of having cancer in their body is more than they care to contemplate every day.
“Just the concept bothers the hell out of them,” said Wilson, who also serves as the director of City of Hope’s Prostate Cancer Program. “They want to have treatment because they just want to be done with it.”
Treatment generally involves either surgery or radiation, and, Wilson notes, both can be equally effective.
A rapidly emerging trend is the use of robotic-assisted surgery, in which the surgeon employs remotely controlled mechanical arms that have a broad range of highly precise movement to operate on the patient’s cancer. Parsons estimates that 60 percent of prostate cancer patients who undergo surgery have robotic-assisted treatment.
Not all patients are candidates for robotic-assisted surgery, he said, but for those who are, the results can be excellent. “A person will generally spend less time in hospital, they have less pain after surgery, and they are back to their normal activities more quickly.”
Survival rates for prostate cancer have improved over the past 13 years. According to the Centers for Disease Control and Prevention, 29,093 men died from prostate cancer in 2007, which demonstrates a decrease of about 3.9 percent each year from 1998.
But, Rosove said, we still have a long way to go in accepting those in our community who are dealing with the disease, and helping them through their illness.
“For men, there is an embarrassment about prostate cancer because of where it’s located,” he said. And for those who work in the entertainment industry, the pressure to be brimming with youth and vigor can cause some with the disease to suffer in silence.
When he was sick, he said, a number of men working in Hollywood confided that they, too, had prostate cancer but were terrified their colleagues would find out.
“They were afraid that they would be seen as sick and damaged, and they would be rejected,” he said. “To have to go through this in secret is a tragedy.”
During his own illness, Rosove said, his faith was never shaken, but rather, made stronger by the ordeal.
“I don’t have this childlike view that if something bad happens to you, God did it, or, ‘Why didn’t God stop it?’ We are human beings, and we get sick,” he said. “Did you expect to live forever?”