Real Men Don't Get Prostate Cancer

by Dr. John E. Bonfadini, Ed.D., Professor Emeritus, George Mason University

I wanted the title of this column to convey what I believe is the general publics attitude toward prostate cancer. Unlike breast cancer, which has been brought to the forefront of public awareness, prostate cancer remains largely in the closet. 

Can you visualize thousands of male senior citizens in a 5-K run wearing brown T-shirts with a symbol that looks like an apple? It just isn't going to happen. We can appreciate the devastation that breast cancer can bring to a woman for obvious reasons. The prostate is a hidden, walnut-sized gland that few ever discuss except in old age. One common idea is that both types of cancer can be cured with early detection, but can lead to death if not treated in their early stages. I cant talk about breast cancer, so Ill leave that important topic to someone else. But as of this year, I have more than enough experience to talk about prostate cancer, the No. 2 killer of men.

Last year 28,000 men died from the disease. About one in six men will get prostate cancer, but only one in 35 will succumb to the disease. These statistics might create the illusion of, Why worry about it?

I frequently tell the story about my suffering from severe stomach problems. One day, on my way to the emergency room, I spotted one of my family doctors so I stopped and expressed my concern about having stomach cancer. He said the statistics were in my favor, about 100 to 1. Then he added, What do you care about the statistics if you're the one?

Over the past eight years I have been dealing with prostate problems and in November I found out I was the one. I'm going to share my story in hopes that it may help someone now or in the future who is concerned about prostate cancer.

According to the American Cancer Society, the relative five-year survival rate is 100 percent and the relative 10-year survival rate is 91 percent for all men with prostate cancer. The relative 15-year survival rate is 76 percent. Keep in mind that five-year survival rates are based on patients diagnosed and first treated more than five years ago, and 10-year survival rates are based on patients diagnosed more than 10 years ago. Modern methods of detection and treatment mean that many prostate cancers are now found earlier and can be treated more effectively.

This analysis makes me feel a little better, but I still realize that 28,000 will die of the disease and I may be one. My story began eight years ago when I had a yearly physical exam. My wife called me to say the doctor called he'd told her that everything was fine, except my prostate-specific antigen (PSA) level was a little high 4.6 and I should see my urologist. She wasn't concerned; however, the fact that the 4.6 reading was higher than the 4.0 possible-biopsy level got my attention. Id been having urination problems and felt something was wrong. After a digital-rectal examination (DRE), my urologist recommended antibiotics, and that I have a follow-up PSA in two weeks. I did this and got good news my PSA had fallen to 3.9. The doctor told me to go home and come back in a year. As long as the number was less than 4, I had a false sense of security.

Over the next few years, I had several examinations. The PSAs fluctuated in the 3-to-4 range until one test showed up at 4.2. At this point my doctor recommended a free-PSA test, which would provide another measurement. My free-PSA test results were in the range where a biopsy is recommended. Oh! The dreaded biopsy! After having 12 holes punched in the walnut gland, I anxiously waited for the results. My doctor called and said the results were negative. I thought about the Seinfeld episode in which George gets a call from the doctor and misinterprets the meaning of negative. My spirits were lifted, but I continued having problems related to the prostate. I thought, Who cares? I don't have cancer.

Over the next few years I had PSA readings of 3.2, 2.9, 2.8, and 2.6. My PSA level was falling, so I felt there was no need to worry. Then one day after an examination, my urologist said my prostrate didn't feel just right. But since my PSA level was going down, wed just follow it for a few months. During the next DRE, my doctor found a small nodule on the right side of my prostate so it was time for a second biopsy. I asked my doctor what were the chances of this being cancer. He answered, about 14 percent. I taught statistics at George Mason University, so to me, numbers have always been important.

After a few days, my doctor called and said he'd wanted to wait until after Thanksgiving to discuss this, but my results showed that two of the 12 biopsy cores contained cancer cells. The nodule tested negative. My staging was T2b (in both sides of prostate) with a mildly aggressive Gleason score of 6. The computer graph showed there was an 80-percent chance that the cancer was confined to the prostate.

My urologist told me all treatment options were open. I could choose surgery, radiation, seed implants, or cryotheraphy. Id already read everything on the subject I could find on the Internet and could probably qualify for another Ph.D. on prostate cancer to match my educational doctorate. I knew I wanted to go the Brachytherapy route (seed implants). At this point, I got a stroke of luck. My urologist recommended consulting with Dr. Koutrouvelis, who did seed implants using a special 3-D Stereotaxis method at Uro-Radiology Prostate Institute in Vienna, Va. 

During my initial meeting with Dr. K, he said that if my test results were correct Id probably live 10 years if I did nothing. He added that his research has found in a significant number of cases, patients are under-staged and therefore he recommended another biopsy using his procedure, which included biopsy of the seminal vesicles. His process uses a CT scan rather than the traditional ultrasound in placing the needles. It produces a 3-D image, allowing increased accuracy and seminal-vesicle biopsy. My result showed that not only was the nodule cancerous, but I also had cancer in my left seminal vesicle. I was upstaged to T3b cancer outside the prostate. Dr. K said he could successfully treat the cancer using his method because it allowed him to seed the seminal vesicles and was extremely accurate in placing the seeds in the prostate.

I completed the treatment on Jan. 27, 2009, receiving 200 seeds in the prostate and seminal vesicles, delivered by 57 needles. Can you say OUCH? I was given a spinal injection anesthetic and I personally chose not to have any further sedation, so it really wasn't that bad. I was able to get up and go home in three hours.

Since then, I've battled some side effects that follow almost any treatment for prostate cancer. They are improving, and I hope my next PSA-test results will show I'm headed in the right direction. Dr. Ks book, A Breakthrough in Prostate Cancer Treatment, will give you more details and statistics on prostate cancer and its treatment. His book is available from Amazon.com. I highly recommend it. Living with the side effects of the treatment can sometimes be worse than the disease.

My goal in writing this column is to show that numbers do lie, and to encourage a discussion on prostate and other cancers. Most all families have or at some point will have loved ones who suffer from cancer. With hope, more knowledge will lead to more cures and extended lives.

If you need more information, e-mail me at [email protected].