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The Nature of Prostate Cancer

Prostate cancer, the second-leading cause of death among men and the leading cause of male cancer death in Connecticut, still flies under the radar. How much do you know about this potentially deadly disease?

 

My husband, sister-in-law and I sat together with my father-in-law as he breathed his last breaths. Dying from complications from prostate cancer, Paul endured dozens of difficult, painful and intrusive treatments. His quality of life had been poor for many years. He accepted this bravely, but when the end came—which was five years ago this past Saturday—it was a relief. 

The Centers for Disease Control and Prevention estimates that 2012 will see the diagnoses of another 241,740 new cases of PC. And although prostate cancer affects as many men as breast cancer does women, there is a lack of public awareness of this life-changing disease that must be addressed.

Breast cancer advocacy organizations have done an outstanding job raising funds and awareness for their cause. As many readers are no doubt aware, October saw an outpouring of pink ribbons in sports, on billboards and in the news as survivors, family members and volunteers stepped forward to help end this terrible disease.

Yet aside from skin cancer, the CDC reports that PC is the most commonly diagnosed form of cancer in men. African Americans and men with close hereditary ties to PC are more susceptible to the disease. Thankfully, hospitals have stepped up screening efforts, and as a result, incidence rates have declined steadily since 2004.

Unfortunately, it is still the second-leading cause of death among American men. Nearly 29,000 will succumb this year from prostate cancer. Since the disease itself usually offers no symptoms in its early stages, many men find themselves facing difficult treatment options as the disease progresses.

Advanced disease symptoms nearly always include difficulty with urination. Increased frequency, difficulty starting or stopping urination, evidence of blood, a burning sensation and weak or interrupted flow commonly occur. If it has spread to the bones, victims tend to feel pain in the hips, spine, ribs and more, according to the CDC.

There is no consensus on a “best” way to treat prostate cancer, even in its earliest stages. Laparoscopic surgery and radiation treatments are common early, while chemotherapy is often used later. Hormones, Paul’s initial treatment, are also still used; unfortunately, at some point the cancer becomes hormone-refractory (meaning, the hormone treatment is no longer effective).

Men with hormone refractory prostate cancer may be appropriate candidates for Provenge, a recently developed vaccine that prolongs life when chemotherapy and hormones no longer work. And Zytiga, the CDC reports, is a new drug that treats metastatic HRPC patients.

Although the United States leads the way in medical research in any number of areas, the traditional American approach to treating prostate cancer differs greatly with the method of treatment in Europe. While American doctors recommend early screening and treatment—even though a recent study indicated counter-indicated early screening effectiveness at saving lives— historically, European doctors have preferred the wait-and-see approach.

Here’s the rationale: Because prostate cancer cells are often slow growers, and the treatment options for prostate cancer frequently cause impotence, pain, discomfort, weight loss and reduced immunity to other illnesses, these doctors feel it’s simply better to let the disease run its course. In other words, these doctors advise their patients to (potentially) trade length of life for one of higher quality.

Recent evidence suggests, however, that European patients are unwilling to adopt this relaxed approach.

Paul was originally diagnosed in 1991 after an unexplained illness wouldn’t clear up. When his physicians discovered the cancer, it was stage 4 and it had metastasized throughout his body. His doctors estimated he had a 10 percent chance of survival.

Miraculously, through hormone treatment, he went into remission; unfortunately, the cancer returned with a vengeance just after he retired.

During the last years of his life, we watched helplessly as he underwent endless rounds of chemotherapy that depleted his energy and his appetite. A simple tooth extraction caused excruciating pain in his jaw, from which he never recovered and rendered eating even the softest of foods difficult.

He was unable to drive or care for himself without assistance from others. Methadone and morphine were the painkillers of choice in his long cocktail of daily medicines. He was happy to see us visit—Paul still lived on Long Island and we drove there nearly every weekend for more than a year to visit him before he died—but he grew increasingly quiet as the prognosis grew dimmer and dimmer.

It was the only time I have ever been with someone when they passed. He squeezed our hands, gasped quietly, and fell still.

I knew then two things for certain. The first is that I do not want to be alone when I die. The second? Family is everything. 

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