Cancer

What Every Woman Should Know about Prostate Cancer

What to know when a loved one is diagnosed with prostate cancer.

What to know when a loved one is diagnosed with prostate cancer.

Become an empowered partner by learning about this common cancer type.

By John Leifer

If You Are Like Most American Women, chances are you serve as the key decision-maker when it comes to the health of your family— whether it’s       selecting a physician, deciding on treatment options, or taking steps to prevent the onset of illness. It’s a role that carries with it the awesome responsibility for making effective, informed deci­sions that give your loved ones the best chance of a good outcome and enduring health. This is particularly true when confronting the issue of cancer. And the cancer that is most likely to strike the men in your fam­ily, as they age, is prostate cancer.

What Exactly Is the Prostate?

The prostate is a walnut-size gland located between the bladder and the penis. It surrounds the urethra, the tube that carries urine from the bladder to the penis. When it becomes enlarged, a common condition with age, the urethra is squeezed and urinary prob­lems can result. The prostate plays an important role in reproduction, being responsible for much of the seminal fluid produced by a man.

What Is Prostate Cancer?

When cellular growth goes awry in any organ, cancer is often the result. When this happens in the prostate, it is referred to as prostate cancer. Doc­tors refer to the most common type of prostate cancer as adenocarcinoma of the prostate, based on the partic­ular type of cancer cells that have developed.

How Common Is Prostate Cancer?

With the exception of skin cancer, prostate is the most common cancer occurring in men. According to the National Cancer Institute (NCI), there are close to 3 million men liv­ing with prostate cancer in the United States. An additional 180,000 new cases of prostate cancer will be iden­tified in 2016, and approximately 26,000 deaths will be associated with the disease.1

The good news is that most forms of prostate cancer are relatively indolent, or slow growing. As a result, the five-year survival rate following a diagnosis of prostate cancer is 98.9 percent. The NCI further states that while “an esti­mated 16 percent of men will be diagnosed with prostate cancer in their lifetime…only 3 percent will die of it.”1

Are There Clear Symptoms Associated with Prostate Cancer?

Prostate problems are relatively common in men over the age of 55, and these issues may be mis­taken for cancer in some cases. An enlarged prostate, known as benign prostate hyperplasia (BPH), can be particularly troublesome, causing problems with urination, sexual function, and other symptoms. And while problematic, BPH is far more of a nuisance than a serious threat to a man’s health.

Though prostate cancer can mimic the symptoms of BPH, it can also be present without the appear­ance of symptoms, particularly in its early stages. When prostate cancer becomes advanced, other symptoms may be present, includ­ing bone pain (frequently occurring in the lower back) and unexplained weight loss.

How Is Prostate Cancer Diagnosed?

Preliminary diagnosis generally relies on screening, which consists of a blood test, known as a PSA (prostate specific antigen), accom­panied by a digital rectal exam. Because the prostate is located directly in front of the rectum, a physician is able to palpate the gland with his or her finger to see if there are any obvious abnor­malities. Neither test is definitive, which means that suspected cases of cancer must be biopsied.

When a man’s PSA reaches a cer­tain threshold or there is perceived abnormality upon physical exam­ination, the physician may recom­mend a biopsy. It should be noted that some physicians also recom­mend biopsies based on the rate of change in PSA levels, referred to as PSA velocity. Recent research sug­gests, however, that PSA velocity, by itself, is not a reliable measure on which to recommend biopsies.2

When performing a biopsy, a surgeon—most frequently a urol­ogist—relies on ultrasound-guided imaging to insert needles into various sites on the prostate. The hollow needles extract tissue cores that can then be examined to determine the extent of the disease. Twelve samples are most commonly collected.

The cores are then examined by a pathologist, who rates them based on what is known as the Gleason score,3which ranges from 2 to 10; higher numbers signify a more seri­ous expression of the disease.

If more-advanced disease is sus­pected, additional imaging studies may be performed to determine if the cancer has metastasized, or spread to bones or other organs. Based on the sum of the evidence collected through these various tests, patients are assigned a stage that indicates the extent of the dis­ease. The earliest-stage cancers are described at Stage I; cancer that has spread to other portions of the body are Stage IV.

What Types of Treatment Are Recommended?

The stage of the tumor and one’s age at diagnosis may significantly guide treatment options. Because many forms of prostate cancer are slow growing, very early-stage tumors may warrant careful observation, known as active surveillance, rather than aggressive treatment.

When treatment is required, the urologist may recommend either radiation therapy or the surgical removal of the prostate, known as a radical prostatectomy. Radiation therapy can take several forms, with the most common being an external beam of radiation to tar­get the prostate and kill cancer cells. The most common form of external radiation is image mod­ulated radiation therapy (IMRT). IMRT generally involves five treat­ments per week for eight weeks.

A small number of cancer centers offer another form of external radi­ation known as proton therapy. Proton therapy is controversial4 because its cost greatly exceeds that of IMRT, and numerous experts have argued that there is insuffi­cient data to prove that it is more effective or less toxic.

For patients who do not want to undergo repeated treatments, referred to as fractions, brachyther­apy provides a highly effective option. Brachytherapy involves a single, surgical insertion of radio­active seeds into the cancerous por­tions of the prostate.

Before deciding on a treatment option, it is vitally important that you and your loved one understand the nature of each, as well as its potential short- and long-term side effects. It is advisable to get more than one opinion. Consider scheduling a consultation with both a urologist and a radiation oncologist. You may also find it helpful to do some research into the disease and your treatment options. The National Comprehensive Cancer Network at nccn.org provides excellent treatment guides based on disease and stage.

Are There Significant Side Effects of Treatment?

Prostate cancer treatment, whether involving surgery or radiation, can cause a host of short- and long-term side effects. Transient side effects are generally tolerated well. Long-term problems with incontinence and or erectile dysfunction, however, can have a major impact on a man’s qual­ity of life. Though estimates vary widely, it is reasonable to assume that such long-term or permanent side effects may occur in significant percentage5 of all patients.

When surgery is performed, a nerve associated with sexual func­tion can be severed. A skilled sur­geon may be able to spare the nerve, but there are no assurances. Radi­ation often damages the nerve, though the onset of symptoms may be delayed by as much as one to two years. You should actively question your physicians about their out­comes—specifically the frequency with which their patients experience long-term problems with inconti­nence and/or impotency.

What Is the Most Import­ant Thing You Can Do to Help Your Partner When He Is Diagnosed with Prostate Cancer?

First, encourage your loved one to slow down, despite the anxiety generated by a potential diagnosis of cancer, and gather the informa­tion needed to make truly informed decisions before proceeding with a biopsy or treatment. A great deal has been written about the overdi­agnosis and overtreatment of pros­tate cancer in recent years—with much of the controversy centering on the appropriateness of PSA test­ing among relatively young patients. Before undergoing a biopsy, talk to your doctor(s) about their confi­dence in the PSA scores and whether it may be wise to repeat the test in three to six months before proceed­ing to a biopsy.

This is your first step as you seek to become an expert on the disease, its presentation, and treatment. Once you have availed yourself of the best available information and medical opinions, you are ready to serve as an advocate who ensures that your loved one receives the most appropriate treatment based on the particular stage of disease. Remember, that may mean active surveillance rather than active treat­ment. You want him neither over­treated nor undertreated, both of which are real possibilities with prostate cancer.

Finally, be sure you tune in to the potential impact of the disease and its treatment on your loved one’s quality of life, as well as his self-es­teem. Issues of sexual function affect both of you, and being able to engage in open and effective dia­logue is important to the health of the relationship. You may wish to seek help from a counselor trained to address such issues.

Though prostate cancer is often cured, it may nonetheless take a toll on the family. The more empow­ered you and your loved one are with information, the greater your probability of limiting this toll and ensuring the best possible outcome from treatment.


References
1. SEER Cancer Statistics Fact Sheets: Prostate Cancer. National Cancer Institute website. Avail­able at: http://seer.cancer.gov/statfacts/html/ prost.html. Accessed July 25, 2016.
2. PSA Velocity Does Not Improve Prostate Can­cer Detection. National Cancer Institute website. Available at: http://www.cancer.gov/types/pros­tate/research/psa-velocity-detection. Accessed July 25, 2016.
3. Understanding Your Pathology Report: Pros­tate Cancer. American Cancer Society website. Available at: http://www.cancer.org/treatment/ understandingyourdiagnosis/understandin­gyourpathologyreport/prostatepathology/pros­tate-cancer-pathology. Accessed July 25, 2016.
4. Wisenbaugh ES, Andrews PE, Ferrigni RG et al. Proton beam therapy for localized pros­tate cancer 101: Basics, controversies, and facts. Reviews in Urology. 2014;16(2):67-75. doi: PMC4080851.
5. Pardo Y, Guedea F, Aguiló F et al. Qual­ity-of-life impact of primary treatments for localized prostate cancer in patients with­out hormonal treatment. Journal of Clinical Oncology. 2010;28(31):4687-96. doi: 10.1200/ JCO.2009.25.3245.

 

Post-Traumatic Growth in Cancer Patients

Breaking the changes that bind us can result in unprecedented growth.

Breaking the changes that bind us can result in unprecedented growth.

The Transforming Power of Stress

There are few life events that can transform our daily reality more swiftly than a diagnosis of cancer. A once neatly planned future can seemingly evaporate in the wake of an overwhelming existential threat. The degree to which we remain mired in this nether-land of despair can be a function of the severity of our cancer, coupled with a myriad of variables – from our psychological health to our spirituality.

Fortunately, for most patients, the profound shock f cancer diminishes significantly over a relatively short period of time. For others, however, the distress associated with cancer may be a frequent or constant companion on the cancer journey, and it may even lead to post-traumatic stress disorder (PTSD).

There is yet another group, though, whose brush with mortality transforms them in a life-affirming direction. For these patients, the threat of cancer results not in PTSD, but in quite the opposite – post-traumatic growth (PTG).

PTG vs PTSD

The term post-traumatic growth was first coined by researchers Richard Calhoun and Lawrence Tedeschi more than two decades ago.[1] Calhoun and Tedeschi stated that two criteria must be met to satisfy their definition of post-traumatic growth: 1) The individual must struggle with a life-changing event; 2) that struggle then leads to profound growth and change.[2] Such growth may take many forms, including enhanced personal relationships, a deepened sense of spirituality, or an awareness of the transcendent meaning of life.[3]

It could be argued that scientists such as Calhoun and Tedeschi have simply formalized and named an idea that predates them by millennia: the indomitable spirit of human beings. It is a force that allows us not only to overcome seemingly insurmountable adversity, but to derive profound meaning from the experience. It has long been a topic of interest to philosophers and poets. Shakespeare eloquently stated: “Sweet are the uses of adversity which, like the toad, ugly and venomous, wears yet a precious jewel in his head.” [4]

The Illuminating Wisdom of Victor Frankl

One of the most profound examples of post-traumatic growth comes not from a cancer patient, but from Viktor Frankl, an Austrian psychiatrist deported to Auschwitz by the Nazis:

The dawn was grey around us; grey was the sky above; grey the snow in the pale light of dawn; grey the rags in which my fellow prisoners were clad, and grey their faces. I was again conversing silently with my wife, or perhaps I was struggling to find the reason for my sufferings, my slow dying. In a last violent protest against the hopelessness of imminent death, I sensed my spirit piercing through the enveloping gloom. I felt it transcend that hopeless, meaningless world, and from somewhere I heard a victorious “Yes” in answer to my question of the existence of an ultimate purpose. At that moment a light was lit in a distant farmhouse, which stood on the horizon as if painted there, in the midst of the miserable grey of a dawning morning in Bavaria. “Et lux in tenebris lucet” – and the light shineth in the darkness.

Frankl had endured unrelenting trauma – including the death of his family – and yet his indomitable spirit was able to rise above it – to be set free. Reflecting on his experiences, Frankl offered this guidance: “The way in which a man accepts his fate and all the suffering it entails, the way in which he takes up his cross, gives him ample opportunity – even under the most difficult circumstances – to add a deeper meaning to his life.”[6]

Cancer has the power to inflict profound suffering, but only the human spirit has the power to transform that suffering into tremendous growth – growth that causes one to rise above an uncertain future, and find profound meaning in one’s relationships, faith, and the simple joys of life.

 

 

[1] Calhoun, L. G., & Tedeschi, R. G. (1995).Trauma and transformation: Growing in the aftermath of suffering. Thousand Oaks, CA: Sage.

 

[2] Sears, S. R., Stanton, A. L., & Danoff-Burg, S. (2003). The yellow brick road and the Emerald City: Benefit finding, positive reappraisal coping, and posttraumatic growth in women with early-stage breast cancer. Health Psychology, 22(5), 487-497.

 

[3] Stanton, A. L., Bower, J. E., & Low, C. A. (2006). Posttraumatic growth after cancer. In L. G. Calhoun & R. G. Tedeschi (Eds.), Handbook of posttraumatic growth: Research and practice (pp. 138-175). Mahwah, NJ: Erlbaum.

 

[4] Read more at: http://www.brainyquote.com/quotes/keywords/adversity_3.html

 

[5] Frankl, V. E. Man’s search for meaning. (1984). Boston, MA: Beacon Press, p. 60.

 

[6] Ibid., p. 88

 

 

PROFILES IN COURAGE — Four People Discuss the Profound Impact That Cancer Had on Their Lives and the Lives of Loved Ones

Meet Mary Diagnosis: Breast Cancer

Meet Mary
Diagnosis: Breast Cancer

Meet Ali: Diagnosis: Head & Neck Cancer

Meet Ali:
Diagnosis: Head & Neck Cancer

Meet Diane Diagnosis: Leukemia and husband died of melanoma

Meet Diane
Diagnosis: Leukemia and husband died of melanoma

Meet Darrell Caregiver for wife over 20 year struggle w/lymphoma and leukemia

Meet Darrell
Caregiver for wife over 20 year struggle w/lymphoma and leukemia

 

PLEASE INVEST 7 MINUTES WATCHING THEIR POIGNANT VIDEO at: https://youtu.be/1Dy4kO7Zk70

 

When Initial Treatment Proves Insufficient… Searching for the Silver Lining

shutterstock_252209614“Cancer is not a straight line. It’s up and down.”

Elizabeth Edwards

When an initial treatment proves insufficient

Cancer treatments fail. It’s that simple. Though patients enter treatment with great hope, that hope may be dashed when either further evidence of disease or proof of recurrence is discovered. Sometimes the failure is apparent immediately, as was the case with my wife, Lori’s, lumpectomy. Other times the disease reappears months, years, even decades later. Evaluation of the effectiveness of your cancer treatment depends upon the modality used.

 Hitting the reset button

If your initial treatment failed to cure your cancer, than you have reached another critical signpost along your journey: The need to modify your treatment plan to include new modalities of care. It’s a bit like hitting the reset button and starting the game over. This can be a particularly difficult time for many patients because the preferred treatment option has proven unsuccessful, often triggering new waves of anxiety and doubt.

 The “middle stage” of cancer

Many patients enter a midpoint in their journey with cancer. It is what author and ovarian cancer survivor Susan Gubar defines as the “middle stage.” Writing in a June 5, 2014 article in the New York Times, Gubar stated:

“For some of us, there is a middle stage in this journey. Because of advances in cancer research and the efforts of dedicated oncologists, a large population today deals with disease kept in abeyance. The cancer has returned and has been controlled, but it will never go away completely. Like me, these people cope with cancer that is treatable for some unforeseeable amount of time. Chronic cancer means you will die from it—unless you are first hit by the proverbial bus—but not now, not necessarily soon.”

The word “chronic” resides between the category of cured and the category of terminal. It refers to disease that is not spreading, malignancy that can be arrested but not eradicated. At times, the term may seem incommensurate with repetitive and arduous regimens aimed at an (eventually) fatal disease. For unlike diabetes or asthma, cancer does not respond predictably to treatment.

Still, quite a few patients with some types of leukemia or lymphoma, prostate or ovarian cancer live for years. While in the 1970s, 10 percent of women with metastatic breast cancer survived five or more years, today up to 40 percent do. Chronic disease may lack the drama of diagnosis and early treatment; even friends can get bored by mounting details. Its evolution does not conform to the feel-good stories of recovery that most of us want to read. But neither does it adhere to the frightfully degenerative plot of quickly advancing tumors.[ii]

 Allowing for disappointment while not relinquishing hope

When you hit these milestones, it is time to be kind to yourself: a time to express your disappointment without relinquishing your hope. You will be traversing a new path on your journey, but first, you must understand how the additional knowledge acquired to date about your condition impacts your staging, prognosis, and recommended treatment options. Your physician should provide this information, as well as recommended modifications to the treatment plan.

Now’s the time to take out your compass and reassess the direction you are headed. It is essential that you go through an appropriate level of due diligence with your doctor regarding the next phase(s) of treatment. Just as you inquired about efficacy, side effects, treatment duration, and other factors prior to your first course of treatment, you need to repeat the process again now. Three very important questions to consider are:

  1. what are the goals of this treatment;
  2. what is the likelihood it will be successful; and
  3. what short-term and long-term effects may the treatment have on my quality of life? Only once you’ve completed this process can you truly provide your physician with informed consent to proceed.

 Due diligence déjà vu

Just as you asked many questions about your initial treatment, so, too, must you feel fully informed about the next steps in your journey. In addition to understanding the fundamental nature of the recommended treatment, you may also wish to ask your physicians the following questions:

  • Why might this treatment be effective when others have failed?
  • Are there other options for treatment that we should discuss?
  • What are the side effects or after-effects of treatment that I may experience?
  • Who will perform this treatment, and what are his or her qualifications for doing so?
  • Will my insurance cover the cost of this treatment?
  • Where I can learn more about this treatment before agreeing to it?

It may be helpful to then take a few days, do your own research, talk with your caregiver, and then come to the most informed decision possible. Regardless of the outcome, you will feel as though you entered this phase of treatment with a solid understanding of its probable outcome, side effects, and costs.

 The End of Active Treatment for Lori

Lori endured a second major surgery—bilateral mastectomies. The difficulty of the recovery was far more than Lori or I anticipated.

(IN LORI’S WORDS) Once I had a chance to digest the news about my initial pathology, I knew I needed more surgery—a mastectomy. I also knew that my type of cancer was also more likely to be present in the opposite breast and to evade early detection by imaging. So, I opted for bilateral mastectomies. It would take coordination between my breast surgeon and my reconstructive surgeon, which even under the most optimal circumstances can take several weeks. I decided to allow myself my hour of sadness, but then take that energy, become my own advocate, and push hard to get things done as soon as possible.

While waiting for my second surgery, I knew I needed to take care of my spiritual, psychological, and physical needs. I packed much of our house to get ready to move, took time to exercise, read my Bible, talk to friends. Mother’s Day was during that time, and all I wanted was to see my sons, so my husband arranged for them to fly home from California and Wisconsin for the weekend. We talked, went to church, and even took in a baseball game. My surgery was scheduled for early the next week.

The day of surgery was also the day before our scheduled move. My sister Janet, a nurse at Duke University Medical Center, came the night of surgery to help with my care and allow John to be with the movers the next day. She stayed with me those first few days when I felt so physically helpless. She brought me “home” to our new house (and new beginning for me) where we were greeted by a chaotic setting of John supervising the movers. Her calming presence, encouragement, and hands-on care were invaluable. I will always be grateful she was there by my side. My brother Chris and his wife Gail took the second watch and stayed for several days, helping me as I struggled to gain strength, as well as helping John unpack our new house. They all dropped their jobs, families, and plans to come and help. Having my strong support system was a tremendous blessing, and I strongly believe it was a key to my recovery.

The final pathology report came out. I held my breath, said a prayer for strength, and waited on the other end of the phone while Dr. V. read me her findings. There had proved to be many spots of cancer creeping through my breast—that was the scary news. But this time there was excellent clearance around the tumor—the margins were negative! A genetic test done to predict my recurrence was also low—so I was not going to need chemotherapy. My risk could be reduced by taking a pill each day to block estrogen.

I knew I had found a silver lining—and a new beginning. Three weeks later I was back at work, now armed with a personal story to complement those of my patients. We would help one another on this journey.

 

[i] Elizabeth Edwards, BrainyQuote, http://www.brainyquote.com/quotes/authors/e/elizabeth_edwards.html

[ii] Gubar, “Living with Cancer.”

Important Information for Newly Diagnosed Cancer Patients and Their Loved Ones…I Hope You Will Listen

INTERVIEW on KBOO FM in Portland (Health Watch with David Naimon 8/3/15)

INTERVIEW on KBOO FM in Portland (Health Watch with David Naimon 8/3/15)

Radio host, David Naimon, (of KBOO FM/Portland) does an excellent job of asking guest, John Leifer, pivotally important questions regarding issues facing recently diagnosed cancer patients and their loved ones.

Among the many topics covered in this 30 minute interview are:

  • How to evaluate and select a physician
  • How to know whether you are receiving the appropriate treatment for your condition
  • When to obtain a second opinion
  • The importance of understanding the goals of your treatment
  • Differentiating between cure, control, and comfort in cancer treatment
  • Unexplained geographic variations in care, and what they can mean to your treatment
  • Financial issues associated with treatment and how to manage the challenges
  • Identifying if your physician has a financial conflict of interest associated with your treatment…and what this can be mean to your care
  • The role of nutrition and exercise during the journey through cancer
  • The role of complementary medicine in cancer treatment
  • How to obtain more information about your disease and its treatment

The interview came about due to the publication of Leifer’s new book, After You Hear It’s Cancer: A Guide to Navigating the Difficult Journey Ahead, written collaboratively with his wife, Lori, a radiation oncologist in practice for 25+ years.

John has spent 30 years immersed in the health care industry as a health care executive, consultant, academician, and author.

In addition to their formal training, John and Lori also bring the perspective of patient and caregiver (Dr. Leifer is a cancer survivor)

Here’s a link to the podcast:  https://kboo.fm/afteryouhearitscancerbyjohnleifer

 

Here is a link to the book’s web-site:

www.afteryouhearitscancer.com