September is Prostate Cancer Awareness Month

September is National Prostate Cancer Awareness Month, reminding us that one in seven men will be affected by prostate cancer in their lifetimes. It’s also a good reminder to take a few moments to learn more about the disease, the ongoing debate concerning screening for prostate cancer, its symptoms (or lack thereof), and the myriad of treatment options should you happen to be that one in seven.

There are plenty of resources out there from which you can learn. Schedule an appointment with your physician and have an open, honest discussion about your risks and whether or not you should be screened. In the end, it’s important to remember: It’s your body, your choice.

Please share this important reminder with the men in your life.

Six Years

Six years ago today, I was told I had prostate cancer. Guess what? It’s six years later and I’m still alive and kickin’. Woo-hoo!

PSA Trend 20160803Of course, the cancer storm clouds may be brewing as I head into my next PSA test in a few weeks. Who knows what crazy result it will yield. Remember, in the last 15 months, we’ve gone from undetectable to 0.05 to 0.04 to 0.08 to 0.05. Any bets on the results this time around??

My schedule in early December is quite hectic, so I’ll likely go for the blood draw during the week of 28 November. As usual, I’ll wait three days to get the results online, and then my appointment with the urologist is on 29 December.

Stay tuned. In the meantime, here’s wishing everyone a Happy Thanksgiving with family and friends!

Month 70 – Sharing Awareness

We’re about half-way through Prostate Cancer Awareness Month and it seems as there’s been some progress in getting the word out. More organizations seem to be helping to increase awareness than in the past, and that’s a good thing.

I’ll have to admit that my own approach to PCAM has changed slightly. I’m more inclined to tell people to educate themselves before making the decision to test.

Those of us who have been dealing with prostate cancer understand how complex, convoluted, conflicting, and confusing it can be. If you’ve never entertained the notion that you can get prostate cancer, you probably haven’t paid much attention to the raging debates in the field. DRE or no DRE? PSA test or no PSA test? Over-treatment versus under-treatment? Active surveillance versus treatment? That’s why it’s so important to educate yourself before being tested.

One of my former managers always said, “If you can’t stand the answer, don’t ask the question.” Your decision to get screened for prostate cancer is exactly that: your decision. You have to be comfortable with either path you take, and the best way to make that decision is by being educated. Please take a few moments this month—Prostate Cancer Awareness Month—to learn more about prostate cancer and how it can affect you. You can start with my Resources page.


I finally made my family and friends aware of my detectable PSA shortly after my visit with my urologist in August. There was concern from those who responded but, on the whole, the reaction was good. I knew that sitting on this for a year would cause some deserved criticism, too, but they seemed to understand my rationale.

It’s a relief to have it out in the open now. As one of my readers wrote on his own blog, “A burden shared is a burden halved.” Yep. It is. (Sorry, I can’t find the quote again to give credit where credit is due!)

On the whole, I’ve been able to push aside the emotions and thoughts that the cancer may be returning, and it feels good to be reengaged in the world. The next PSA test is in December.

Now if I can just get used to the fact that it’s dark when my alarm goes off in the morning… It wasn’t that long ago that the sun shining through my east-facing bedroom window woke me up and not the alarm. Autumn and shorter days are here! (In San Diego, shorter days are about the only indicator of it being autumn.)

Day 1,773 – Waiting Sucks

As you can tell from the title of this post, it’s going to be a long three months.

This morning, my mind was filled with thoughts of prostate cancer and it took considerable effort to get focused on the task at hand at work, but I eventually succeeded.  Some of the thoughts centered on the fear of the unknown and the long wait to get to the known, and others were more administrative in nature regarding this blog.

Sometimes I think pulling the plug on this blog would be just what the doctor ordered. By maintaining it, it forces prostate cancer to be in the forefront of my mind at least monthly.  But I also know that by not maintaining it, that isn’t going to make my current predicament go away, so I may as well blog about it.  I’ve learned things from others in the process of doing this, and I know that sharing my experience has helped at least a handful of people along the way.  Besides, when you’ve been doing something religiously for almost five years, it’s a tough habit to break.

Of course, it being Prostate Cancer Awareness Month keeps the topic in my news feeds, too, and I feel compelled to work to increase awareness, so I guess I’ll just keep reading the stories.

On the bright side of this, the initial panic and fear have subsided.  I’m down to rational thought on what I should be doing or researching next.

Okay.  It’s late. I’m rambling.  Thanks for letting me think aloud. I’ll get this under control and will work on my patience…  Really.

prostate-cancer-awareness-hero-806x307,0

Prostate Cancer Awareness Month

prostate-cancer-awareness-hero-806x307,0
Image from cityofhope.org

It’s September and that means it’s Prostate Cancer Awareness Month. One in seven men will develop prostate cancer in their lives.

Please take time this month to understand and learn more about prostate cancer and to spread the word.  Awareness saves lives.

If you haven’t been checked recently (or ever), make an appointment with your doctor.  It was a screening during a long-overdue physical exam that caught my cancer, and here I am 4 years, 9 months, and 21 days since my diagnosis, still alive and advocating for prostate health.

The Prostate Cancer Foundation offers a great overview for those wanting to learn more.  Check it out here.


On a related note, I go for my next PSA test this week.  Results to follow in my next regularly scheduled post if I have them by then.

 

Month 46 – Views on Cancer Awareness

Okay.  Buckle up.  I’m climbing on my annual cancer awareness soap box.

Seeing pink on the the Chula Vista Fire Department’s Facebook page today made me see red.

I want to see powder blue.  Especially in September.

Why CVFD would post this during National Prostate Cancer Awareness Month is a bit perplexing.  (Actually, not really.  They just want to get a jump start on fundraising with October being Breast Cancer Awareness Month.)

One in seven of those male firefighters will face prostate cancer, and they apparently choose not to acknowledge it; they choose not to spread awareness; and they choose not to fight something that can directly impact themselves.

Why?

I’m not a marketing guru by any stretch of the imagination, but the Susan G. Komen Foundation certainly has turned its cause into an empire through effective and ubiquitous marketing.  Everywhere you turn, there’s a freakin’ pink something-or-other reminding you of the scourge of breast cancer and the need to cure it.  Hell, watch an NFL game next month and you’ll see 300-pound linebackers wearing pink shoes.

Don’t get me wrong. I’m not downplaying breast cancer at all, nor am I condemning the Susan G. Komen Foundation’s success.  In fact, just the opposite.  Prostate cancer awareness teams have to take a page from the Foundation’s marketing playbook.  But it may be more than a marketing issue.

Is there a stigma associated with prostate cancer that prevents people–men–from talking about it?

If so, how do we eradicate the stigma so that we can eradicate the disease?  How do we get men to realize that it’s not only okay to talk about prostate health, but we should go out of our way to talk about it.  There’s nothing embarrassing about it.

Do we show them stories like this reporting the death from prostate cancer of San Diego’s Bishop Cirilo Flores, who was diagnosed in April and died in September?

http://www.utsandiego.com/news/2014/sep/06/diocese-bishop-flores-death-catholic/

It’s not all doom and gloom.  The Prostate Cancer Foundation and others like the Safeway Foundation have been more visible with their efforts to increase awareness, even since I was diagnosed almost four years ago.  That’s good.  But we need more.  Much more.

And this little blog with its almost 15,000 clicks isn’t going to change the world of prostate cancer awareness by itself.  (Although I will keep tilting at that windmill…)

Time to climb down off my soap box.  Thanks for letting me vent.

Finally, lest you think I’m bashing our firefighters, especially today, I’m not.  I have a tremendous amount of respect for what our first responders do, day in, and day out.
Remembering 9/11

September is Prostate Cancer Awareness Month

September is Prostate Cancer Awareness Month, and even thought there’s been a lot in the news lately about changes in screening and treatment options, it’s still critical that men educate themselves about prostate cancer.

I had no clue that I would be introducing “cancer” into my vocabulary nearly four years ago, but I did.

It happened after a digital rectal exam during a routine physical that I had put off for a couple of years.  That day changed my life and was the beginning of this journey.

Please take time in September to talk to the men in your lives about this important issue, and ask them to learn a little more about it.

Three Years Since Diagnosis

Three Years

So it was three years ago yesterday that my urologist confirmed what my gut had been telling me for 5 weeks–I had prostate cancer.  Kind of hard to believe that it’s been that long ago already.

Looking back on the experience, I didn’t realize how much it would impact others.  My sister had a melt down when she heard the news.  Friends that I thought would be there for me couldn’t even bring themselves to be in the same room with me, let alone have an open discussion about cancer.  And acquaintances that I barely interacted with prior to the diagnosis became my staunchest supporters.

The biggest lesson that I learned was that I, as the cancer patient, would have to take the lead and guide those around me through example as to how and when it was okay to talk about the diagnosis.  People were afraid to bring up the topic or simply ask, “How are you doing?” for fear that it would send me into a tizzy.

So for those of you reading who may be newly diagnosed, remember that even though it’s primarily about you, it’s also about everyone you come in contact with as well.  Look at the world through their eyes.  (Or, perhaps, even how you yourself acted when you learned that a friend or family member was diagnosed with cancer.)  And, if you do have a close friend or family member who can’t be there for you, don’t push it and don’t judge them.  Accept it and move on.

Latest PSA Results

My latest six month check-up shows that my PSA remains undetectable (<0.03 ng/ml) which is great news, of course.  No signs of little cancer bugs.  Next check-up: 13 May 2014.

More Men’s Health Awareness

To promote men’s health awareness as a part of Movember, Matt Lauer and Al Roker had DRE prostate exams done live on the Today show (don’t worry, you don’t see the actual DRE being performed):

Matt Lauer and Al Roker have prostate exams

It’s great that we continue to increase awareness, but I really wish the men’s health community would be more consolidated and more focused in its efforts.

My local grocery chain highlights prostate cancer in June; there’s National Prostate Cancer Awareness Month in September, and there’s Movember in November.  Perhaps it’s good that there are year-round activities, but by being somewhat disjointed, we lack the higher profile and oomph that the breast cancer awareness campaign has.

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Finally, for those readers in the U.S. about to observe Thanksgiving, I hope you have a great holiday with family and friends.

Movember

I forgot that November is “Movember.”  Men grow moustaches to support awareness about men’s health issues, including prostate cancer, testicular cancer, and mental health.

You’re supposed to start the month clean-shaven on 1 November and grow and groom a moustache through the end of the month.  Moustache-growing teams raise money to support cancer research and men’s health.  You can read about it here:

Movember

It’s been decades since I last tried growing a moustache, and when I did, the light blond whiskers on my upper lip were barely visible, so you really couldn’t tell it was there.  Maybe I’ll give it another shot this month and see what happens.  I’m guessing it may be more gray than blond, and will still be barely visible.  Oh well.

Month 34 – Perspectives on Prostate Cancer

September
is
National Prostate Cancer Awareness Month

Well, I really don’t have much of an update from a personal perspective.  Things are pretty much status quo, which is good.

I was amazed, however, that since the last post, this blog has surpassed the 10,000 page views mark, with readers from around the globe.  It’s astonishing to me given my original intent when starting this blog.

Speaking of readers, one of the blog readers (a fellow prostate cancer patient and now friend), forwarded me the article below shortly after my last post.

Again, there have been so many changes in guidance on testing and treatment in the last year that it will make your head spin.  If I were newly diagnosed today, I’m not sure what I would do.

I take that back.  One thing I would do is slow the decision-making process down and research, research, research.  But even at that, at some point you and your physician(s) are going to have to make a decision based on the best information available to you at that point in time, and there will always be some element of risk in whatever decision you make, no matter how thoroughly researched.

Does that mean that I rushed my own decision and regret having had the radical prostatectomy?  Generally speaking, no and no.

Yes, I could have kept on researching, but near the end, my head was ready to explode from all of the information that I had gathered, and that was taking an emotional and physical toll on me.

And, had my quality of life post-prostatectomy been not as good as it is, then I may have had a bit more regret about having had it.  Of course, any man would like to have full erections without drug assistance and no stress incontinence.  But my issues are relatively minor in the grand scheme of things and have little or no impact on my daily life.  That’s pretty good considering…

So read the article for a thought-provoking perspective, and use September to educate yourself and the guys in your life about prostate cancer.

*    *    *

From Bloomberg

What If What You “Survived” Wasn’t Cancer?

What If What You ’Survived’ Wasn’t Cancer?

You’re feeling fine when you go for your annual physical. But your mammogram looks a little funny, or your PSA test is a little high, or you get a CT lung scan and a nodule shows up. You get a biopsy, and the doctor delivers the bad news: You have cancer. Because you don’t want to die, you agree to be sliced up and irradiated. Then, fortunately, you’re pronounced a “cancer survivor.” You’re glad they caught it early.

But maybe you went through all that pain for nothing.

For decades, the reigning theory has been that the earlier a cancer is spotted and treated, the less likely it is to be lethal, because it won’t have time to grow and spread. Yet this theory infers causality from correlation. It implicitly assumes that cancer is cancer is cancer, even though we now know that even in the same part of the body, cancer is many different diseases — some aggressive, some not. Perhaps people survive early-stage cancers not because they’re treated in time, but because their disease never would have become life-threatening at all.

This isn’t just logical nit-picking. Thanks to widespread screening, the number of early-stage cancers identified has skyrocketed. In many instances — including types of breast, prostate, thyroid and lung cancers — more early diagnoses haven’t led to proportionate decreases in mortality. (New drugs, not early detection, account for at least two-thirds of the reduction in breast-cancer mortality.) The cancers the tests pick up aren’t necessarily life-threatening. They’re just really common. So more sensitive tests and more frequent screening mean more cancer, more cancer treatment and more cancer survivors.

“We’ll all be cancer survivors if we keep going at the rate that we’re going,” says Peter Carroll, the chairman of the department of urology at the University of California at San Francisco and a specialist in prostate cancer.

Distracting Doctors

In a well-intended effort to save lives, the emphasis on early detection is essentially looking under the lamp post: Putting many patients who don’t have life-threatening diseases through traumatic treatments while distracting doctors from the bigger challenge of developing ways to identify and treat the really dangerous fast-growing cancers.

“Physicians, patients, and the general public must recognize that overdiagnosis is common and occurs more frequently with cancer screening,” argues a recent JAMA article by the oncologists Laura J. Esserman (a surgeon and breast-cancer specialist), Ian M. Thompson Jr. (a urologist) and Brian Reid (a specialist in esophageal cancer). They argue for limiting the term “cancer” to conditions likely to be life-threatening if left untreated.
That’s going to be a tough change for a lot of people to swallow. For patients and the rest of the public, getting tested offers a sense of control, encouraging an almost superstitious belief that frequent screening will ward off death. (A few years ago, when the actress Christina Applegate was making the talk-show rounds urging young women to get breast MRIs, my own oncologist told me he was getting calls from women who thought the tests would not merely detect but prevent breast cancer.)
Early detection of non-life-threatening cancers also produces a steady supply of “cancer survivors,” who work to support cancer charities and make their efforts look successful. There’s an entire industry devoted to celebrating “breast cancer survivors” in particular, and many women are heavily invested in that identity. It offers a heroic honorific as a reward for enduring horrible treatments. A term originally coined to remind cancer patients that their disease need not be fatal has become a badge of personal achievement.

Fearing Mistakes

Physicians, meanwhile, fear making a mistake. It seems safer to treat someone who doesn’t really need it than to miss something potentially fatal. But, warns Esserman, director of the Carol Franc Buck Breast Care Center at UCSF, “the cancers that grow and spread very quickly are not the ones that you can catch in time with screening.” If anything, emphasizing early detection misdirects research and funding. “We have to come up with better treatments, we have to figure out who’s really at risk for those and figure out how to prevent them,” she says. “We’re not going to fix it with screening.”

There are plenty of scientific unknowns. Take the commonly diagnosed breast cancer called ductal carcinoma in situ, which accounts for about a third of new U.S. diagnoses, 60,000 a year. In these cases, the cells lining the walls of milk ducts look like cancer, but they haven’t invaded the surrounding breast tissue. DCIS was a rare diagnosis before the introduction of mammograms, which are highly sensitive to milk-duct calcifications, and the JAMA article labels it a “premalignant condition” that shouldn’t even be called cancer. Arguably, a lot of women who think of themselves as “breast cancer survivors” have survived treatment, not cancer.

Yet oncologists who identify DCIS have been surgically removing it (and in many cases the entire surrounding breast) for 40 years, so it’s hard to know how dangerous it actually is. “Since we really don’t know the true natural history of DCIS we do not know if DCIS always progresses to invasive cancer or not,” says Colin Wells, a radiologist at the University of California at Los Angeles specializing in breast imaging. “There are some reasons to think not, but this needs to be worked out” with further research. If DCIS does spread to invade breast tissue, the question remains whether that cancer threatens to go beyond the breast, becoming lethal if untreated.

By contrast, we do know that a lot of prostate cancer isn’t dangerous. Autopsy studies show it’s quite common in older men who die from unrelated causes. “Out there in the street, if you remove the prostates in men over the age of 50, 30 to 40 percent would have some kind of cancer,” Carroll says, “most likely, low grade and low volume.”

Distinguishing Tumors

Thanks to more sensitive tests, he notes, the prostate “cancers we’re detecting today are totally different than the cancers we saw two decades ago. And our ability to distinguish these tumors is much better. We have the wherewithal now to be able to tell a patient that your cancer is highly likely confined to your prostate, of small volume, slow growing, and something that may not need immediate treatment at all.”

Carroll has more than 1,000 patients under “active surveillance,” getting regular PSA tests, imaging and biopsies. Only about one in three turns out to need treatment within five to 10 years. (An additional 10 percent opt for surgery simply because they get tired of all the tests or can’t take the anxiety.) The program is also working, Carroll says, to “decrease the burden of testing,” ideally by eliminating the need for repeated biopsies.

Prostate cancer illustrates the cultural barriers to abandoning what Esserman calls today’s “scorched earth policy.” Despite the widespread awareness that many prostate cancers aren’t life-threatening, many physicians are determined to find and treat it any time a PSA score comes in a little high. “I saw a gentleman this week who had had 12 biopsies, no cancer, and they said there must be cancer in there and they did 24,” says Ian Thompson of the University of Texas Health Science Center at San Antonio, who is one of the JAMA authors.

A prostate-cancer diagnosis is still terrifying to patients and their families. Thompson describes many of his conversations with patients — and especially with their wives — as “talking them off the ledge.” When he tells patients they’re likely to be fine without immediate treatment, they often worry how they’ll explain the good news to their children or neighbors. People expect a cancer diagnosis to entail trauma.

Although Carroll thinks calling slow-growing prostate tumors “cancer” is important to encourage vigilance, Thompson wants to change the nomenclature, using the term IDLE (indolent lesions of epithelial origin) to describe low-risk cases where waiting isn’t likely to make a difference. Just using the word “cancer,” he argues, creates unnecessary suffering.

“The number of people that will die from those slow-growing prostate cancers is really low,” he says, but the unacknowledged costs of giving them a cancer diagnosis are huge: “the person who can’t sleep for two weeks before his next test results, and all the follow-up biopsies and all the lost wages, and the people who can’t get life insurance because they now have a new cancer diagnosis, the person whose firm says, ‘Well, we’re concerned you have cancer and therefore you can’t be promoted to this job.’”

It’s a compelling case, but changing the vocabulary finesses the fundamental cultural issue: the widespread and incorrect belief that “cancer” is a single condition, defined only by site in the body, rather than a broad category like “infectious disease.” Someone doesn’t develop “cancer” but, rather, “a cancer.” How frightening that diagnosis should be depends on which one.