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Bob Dole speaks out for early prostate cancer detection.

In 1986 we began our search for a celebrity who would do for prostate cancer what Betty Ford had done for breast cancer--have the courage to go public. Our effort began by asking Rose Kushner (a breast cancer patient) to write an article urging a nationally known figure to step forward. None did.

Now, six years later, we have found our prostate pin-up man--Senator Bob Dole, senior senator from Kansas and former presidential candidate. His celebrity qualifications can't be faulted. Moreover, he is persuasive ... believable ... articulate ... optimistic . . . pragmatic ... and a "people" person. He has (or had) prostate cancer. And he is willing to talk about it. He especially is eager to educate the men of America to the vital need for annual testing.

When I met Senator Dole in his office at the U.S. Capitol, he was as witty and dapper as ever. Except for the relatively new PSA prostate cancer test, he might now be numbered among the 38,000 American men who die--many needlessly and tragically--each year from prostate cancer. With early detection most prostate cancer patients could be saved.

Currently, interest is running high in the medical community for finding better ways to detect prostate cancer early in more men, before the cancer lesions spread beyond the prostate gland. The prostate-specific antigen (PSA) test can do this in many cases.

PSA, a glycoprotein, was first identified in 1971 in seminal plasma. It was named eight years later, when it was found to be specific to prostatic tissue. "PSA is now the most useful tumor marker available for diagnosing and managing prostate cancer," the Journal of the American Medical Association recently stated. "Its discovery represents one of the most significant advancements in the field of prostate cancer research in recent times."

The PSA test measures the amount of this specific protein produced by prostate cells. An elevated level of PSA can mean the presence of a benign growth of the prostate gland, commonly known as benign prostate hypertrophy (BPH). If the PSA is rapidly increasing or has increased recently, it may indicate an aggressive form of prostate cancer. Getting a baseline test is important so that an unexpected and ominous increase can be detected. Twenty-five percent of men with a PSA of 4 to 10 will be found by further testing to have prostate cancer. But 65 percent of men will be harboring prostate cancer if their PSA is more than 10. Not all prostate cancers, of course, are the aggressive type. Many may linger and just putter along, with the cells not actively dividing.

Before sitting down with Bob Dole, I already knew that his slightly enlarged prostate had been detected by Dr. Robert C. T. Krasner, the attending physician to Congress, during a routine physical. Because the patient had complained of frequent urination at night--a hallmark symptom of prostate problems--the doctor ordered a PSA. The test showed a protein level of 4.8 nanograms per milliliter, which is considered only slightly elevated.

Subsequent tests during the next two months showed the level still rising. After performing a biopsy, doctors found cancerous tissue, and the senator's prostate was removed in late December. Two weeks later he was back at work. We shudder to think how long Bob Dole's cancer might have grown before being detected by the digital rectal exam alone.

Thankfully, here he is now, ready, able, and most willing to talk to us about his prostate experience--and to alert our readers to the dangers of taking a healthy prostate for granted.

Post: "Have you had calls from around the country from people who've been helped by your coming out about your prostate cancer?"

Dole: "I've had a lot of calls. When I went public at the hospital, I think there was some difference of opinion. Even my office staff thought maybe I ought to go out and do it quietly, but it seemed to me that you ought to tell people right up front you've got a problem, and if it's resolved, then they don't have any doubts about it. When I made this statement about prostate cancer, I had mail coming from all over the country--hundreds and hundreds of letters when I was in the hospital. And primarily from men (or their wives) who had been through this process. Some said, |It's a piece of cake, don't worry about it. I'm out playing golf.' Or from others who have incontinence or impotence problems and who are sort of searching for help, wanting to know if I had any ideas.

"So it occurred to me (maybe you can make a plus out of a minus) to get busy and start contacting some of these people and learning more about it. So by now I must have made 300 or 400 phone calls to people across the country. I talked to them about it and sent them information. I did this not to try to tell them what to do, except to get their physical. I'm not a doctor. I'm not certain which test is the best, but certainly they should have the digital exam and maybe the PSA test, but again, that's up to the doctor. So I've sort of become the prostate pin-up boy, I guess, for the time being."

Post: "Well, we've known many people who, like you, have prostate cancer and who feel very strongly that we should be out doing more to prevent it and catch it early, but they don't have your name. The fact that they are speaking out about it doesn't get as much attention as when you speak out."

Dole: "But a lot of men in their own way are doing good missionary work. I've talked to people in my state. A Mr. Herman Feldman from Atchison, Kansas, has collected all the information he can find; he goes around and leaves it at hospitals and barber shops. So different people can do different things. Len Dawson, who was a famous quarterback for the Kansas City Chiefs, only 56 years of age, just had the operation a couple of months ago. He's indicated a willingness to be more active and to talk about it in that part of Kansas, Missouri, and Iowa, where he's well known.

"To get men to talk about it as Betty Ford talked about breast cancer, in my view is what should happen. We asked David Broder, |Why don't you write a column about it? You've had the operation.' He says he's going to do it. Robert Novak of |Evans and Novak' writes a lot of political columns and he's on TV a lot. We said, |Why don't you go out and talk about it, alert people because you have credibility. You're somebody they recognize.' So, in any event, I think there are a lot of people doing a lot of good work, among them Senator Ted Stevens from Alaska, Senator Jesse Helms from North Carolina."

Post: "So you've got the ball rolling, really."

Dole: "So we've got it rolling, yes."

Post: "And because you're well known, and because we know your family, or feel like we do, we'd like to know what you would think of having a unit giving free digital rectal exams to men off the street, at events like the Dick Lugar Health Fair. Men 50 and older--they're the ones who need it. When we did this kind of free testing for AIDS, we got results by calling attention to the need. And when we offered free mammograms we got results. The men would be told to see their own doctors, of course, if the digital rectal exam showed anything suspicious.... This is what we would undertake to do if you agree. We'd honor you by putting your name to it."

Dole: "If it would help people, I'd be very honored to do it, of course.... Because the name of the game, as you know better than I, is early detection, whether it's breast cancer, or any kind of cancer.... I think anything that alerts people [is important]. We talk about health care and what we're going to do with a big health-care plan. We've got to alert people that we have opportunities now to take care of them and take care of their problems. They've got to want to do it and they have to come in and have the examination. I've been told, and you probably know, that only about 20 percent of men get annual physicals."

Post: "Right, and blacks have twice the incidence of prostate cancer." Dole: "That's what I've heard from black men who say, |Well, I'm glad you mentioned that,' and |I've had my physical,' and so everybody ought to be alerted to it."

Post: "Absolutely."

Dole: "And if you save 10, 15, 20, 30 people, if there are 34 to 40 thousand who die each year of prostate cancer, there's a lot of work to be done on early detection. Every time I get up to speak to a mature audience now, I look out and see if half or more are men. If some have a little gray hair, I know they're in their 50s or 60s and maybe even in their 40s. I say, |Let me first make a little unsolicited commercial announcement about prostate cancer and early detection,' and I've had people say, |Well, you at least got my attention and I went and had my PSA test.' So whenever I have a chance to speak, I don't want to bore anybody with all this stuff but it's in their interest. I've already had mine."

Post: "You could do a tremendous good if you got involved, I believe, and I don't know what your level of interest would be, but I understand that the PSA test kits now cost the hospital about $10, but if we did all of the men who need it done, we could bring that cost down."

Dole: "I think the National Cancer Institute has a little different view though."

Post: "Why? They don't want to get ... ?"

Dole: "They want to do a 16-year study first."

Post: "No, no, no. We don't want all those men to die. They'll be dead by then."

Dole: "That's about a half million as I calculate. But we've had them in this office along with Dr. Pat Walsh who is the preeminent surgeon on prostate surgery. He has the other view. He thinks early detection, PSA tests, digital exam, are very important."

Post: "You stay on our side."

Dole: "Yes, well, we're pushy. I mean, it seems to me that's a long time to wait and maybe the PSA test is not perfect. Some doctors don't recommend it. I've had people call me and write to me and say, |What am I going to do? My doctor says I don't need a PSA test.'

"I don't want to get into a contest with some local doctor in Hutchinson, Kansas, or wherever, but I talk to them and say, well, I'd go see someone else. Go see a urologist."

Post: "Yes, a phlebotomist can draw blood for a PSA test."

Dole: "A lot of people have high PSAs and no cancer."

Post: "That's ri ht. It could just be a benign enlarged prostate."

Dole: "Or an infection."

Post: "Right, but we could get the price down and I think people in commerce like my husband, or your wife [Elizabeth Dole at the Red Cross], and other people who see industrialists all the time could certainly persuade the manufacturers and the labs to get the price to where everyone could afford a PSA blood test."

Dole: "That's another problem. I said the average price was $31, on the Larry King show, I think, and I had a lot of letters saying that it cost $62.50 or whatever."

Post: "But someone has to uncover all these problems."

Dole: "Some people say, |Well, you get all these things free, Senator; I have to pay for mine.' That's not the case. We have insurance here. We pay our insurance like anybody else and then I have some benefits for being a wounded veteran, but the important thing is to get the word out to people regardless of their status, regardless of their economic status or anything else, they ought to be careful."

Post: "Well, you're the best communicator we have and you have Vicki Stack on your staff who is an R.N. by training and that is very fortuitous, and I think that what I see in you is the Arnold Schwarzenegger of prostate cancer prevention. You know we weren't going very far in the President's Council on Physical Fitness and Sports until we got Arnold Schwarzenegger, and now it's nationwide. We're working with AARP (American Association of Retired Persons) and with the AAHPERD (American Alliance for Health, Physical Education, Recreation and Dance) and all of the organizations because he's a good communicator as you are. We congratulate you on what you've done for prostate cancer already."

Dole: "On May 12, I had the honor of addressing the annual meeting of the American Urological Association, an event in Washington attended by thousands of urologists. I told them that I was happy to be there as one of those Americans who was a beneficiary of early detection and good care--and I thanked them. So did Senator Ted Stevens, who has also made a great recovery and who is very articulate and very dedicated to helping get the word out. Senator Jesse Helms of North Carolina had radiation for his prostate cancer."

Post: "You haven't needed radiation?"

Dole: "No, I don't want any. I want to say it's over."

Post: "Finished!"

Dole: "Finished. We had this meeting about three weeks ago, USTOO, a support group, and I asked for a show of hands how many have had surgery and how many have had radiation. Some guys said, What about both?' A lot of those guys have had both; they had the surgery, or radiation and then surgery, so I'm one of the lucky ones so far."

Post: "Stick to your guns. Since we don't have enough money for everything, we believe that the medical profession should place more emphasis on prevention."

Dole: "Well, not that we're trying to do it by comparison, but we spend about $2.1 billion on AIDS research, which is very important, and maybe that's fine. We spent $24 million on research for prostate cancer, which kills about the same number of people a year. We've increased that to $100 million at least. We don't have the money yet, but we have an authorization. We only spent about $120 million I think for breast cancer. So we need to take a look at our priorities."

Post: "These causes have celebrities and so the squeaky wheels..."

Dole: "And I don't want to fault them, it's great, but I think we ought to take a look at what's the number one cancer killer: lung cancer. And number two for men is prostate cancer, so we should at least look at priorities and say, well, we ought to focus more on this or that."

Post: "I think Dr. Louis Sullivan [Secretary of Health and Human Services] will be very much in favor of having this campaign start now, and you're our spokesman, you're our Arnold Schwarzenegger of the crusade."

Dole: "I keep telling these guys, I said one out of eleven, right? You look at all ages, but when you're over 50, it's one out of three and I assume 0hen you get over 60 it's even one out of two-and-a-half so it's not a very big group if you find three men ... In this room there are five men and I've already had it, and one of these guys is going to get it, so it's something they ought to take care of when they get older. They're all too young now."

Post: "Well, it's increasing in prevalence."

Dole: "And heredity is a factor too, right? That's an indication we've received."

Post: "Yes, so that if you were doing screening out in the mobile units, if you had to choose, you'd do digitals on all of them but PSAs on only those men who have had a history of it? But I hope we can increase the demand and get the cost of the kits down so that it will be cost effective to screen all men over 50."

Dole: "The University of Kansas Medical Center, for example, has a grant, and they do PSAs free twice a month. Now that's in that area, and some of our smaller hospitals in Kansas during, I think it's National Prostate Cancer Awareness Week in September, screen for prostate cancer."

Post: "I want to ask you something. If we did a big Saturday Evening Ball in Kansas somewhere, we'd write to all of our subscribers in Kansas and tell them we're going to have a Saturday Evening Ball, a Robert Dole Prostate Cancer Prevention Ball to support prostate cancer research--would you come and dance?"

Dole: "Do I have to dance?"

Post: "You have to."

Dole: "Elizabeth likes to dance. I'll just have her dance and I'll watch her."

Post: "Arnold Schwarzenegger came to Indianapolis for the first Annual Saturday Evening Ball for the President's Council. He came to launch our campaign for senior citizen fitness through exercise."

Dole: "Did you have a big crowd?"

Post: "Well, we didn't sell tickets. It had to be by invitation or we would have been overrun, because they all wanted to dance with Arnold."

Dole: "Oh, I see, yes."

Post: He's chairman of the President's Council on Physical Fitness and Sports, but you see we would do this with you for the Second Annual Saturday Evening Ball. You could be the featured celebrity. Our Poster Pin Up."

Dole: "They can dance with Arnold and I'll make the speech."

Post: "You'll be getting an invitation to the Ball."

Following our interview with Dole, we talked with Robert Novak and David Broder about their prostate cancer experiences. Robert Novak of "Evans and Novak" and writer for Chicago Sun-Times had prostate surgery in May of 1991. We asked him if he had experienced any symptoms.

Novak: "No symptoms. Zero symptoms. It was detected during an annual which came back elevated. Still there were no symptoms whatsoever. We took a second PSA to make sure they were right; they were. Finally, I had the operation. Not only was the prostate malignant, but they termed it progressive. There's a term that they use to describe the progression, but it's a number. I believe that mine was very high. I ended up seeing a couple of other doctors, but the prostate was removed by Dr. Pat Walsh at Johns Hopkins. He flies all over the country to perform this type of surgery."

Post: "Do you speak out now about the need for PSA?"

Novak: "I have my own private campaign going, telling my story to my colleagues in order for them to get checked. Several have taken my advice, but luckily none has repeated my experience."

Post: "Do you plan on writing about this in the future?"

Novak: "It's not really my type of story. Maybe I'll write in the future. There have been several journalists who've had similar experiences. David Broder just had his prostate taken out. He's doing fine."

Post: "So, you are all for taking the PSA and preventive screening?"

Novak: "Absolutely. If you wait till symptoms arrive, it just may be too

David Broder, the Washington Post syndicated columnist, told us how Senator Dole had helped him during his illness.

Broder: "Senator Dole was enormously helpful and supportive of me. We talked four or five times during the process and he was really terrific."

Post: "How was the problem detected?"

Broder: "During an annual physical. Shortly after Thanksgiving, I went for my annual physical which I have been having for years, but this year my doctor added the PSA to his annual battery of tests. The first PSA test result came back elevated, so he ordered another test--the same results came back on the second test. He directed me to a urologist who performed a biopsy. The results were positive, so I had the surgery on April 9 and returned to work four weeks later."

Post: "Did you have any symptoms?"

Broder: "No symptoms. I would have been blissfully unaware of the problem except for the PSA."

Post: "And now you are a proponent of PSA screening?"

Broder: "Absolutely, I have been spreading the message around to all the old geezers I know.... Again, Senator Dole has been absolutely terrific to me throughout my ordeal, and he is very important for other prostate cancer victims in forming support groups and going public about his disease."
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Author:SerVaas, Cory
Publication:Saturday Evening Post
Article Type:Interview
Date:Jul 1, 1992
Previous Article:The first Saturday Evening Ball: Arnold Schwarzenegger urges seniors to waltz their way to fitness.
Next Article:A launching at the Dick Lugar Health Fair.

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