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Men: don't sit on the problem.

Regular screening can pick up early, curable cancers.

If you are a male over 50 or even 40, one of the most important things in your life may not be your job or the new house you're building. It may be that you are sitting on a prostate cancer that could be caught, if you act promptly. If you continue to sit on it, it could go into your lymph nodes and set up in your bones where it becomes so painful that without medication you won't care about your job or your house.

Urologists live the tragedy of having to tell men they have Stage C or D prostate cancer.

They know these cancers could have been caught in that window of opportunity, the time when they are curable. That's why, wherever our Bob Dole Prostate Cancer Detection Unit has gone with free screening, urologists, some renowned, and even some physicians who aren't urologists, come out of the woodwork to volunteer at the booths.

In Houston, a physician who specializes in emergency medicine came from PIano, a Texas town several hundred miles away, to volunteer at our booth. He stayed all week and did digital rectal exams on the men who were being PSA tested. He did the exams in what we called the "little room," a 5'x 5' makeshift room with no ceiling and just enough space for a chair and the patient. He joined renowned urologist Peter T. Scardino, Chairman and Professor of Urology at Baylor College of Medicine. Dr. Scardino, who is also Chief of Urology at The Methodist Hospital in Houston, has published widely on the subject of prostate cancer and has the respect of his colleagues throughout the world. He believes in screening men for prostate cancer now.

So does Dr. Philip Migliore, Head of Clinical Chemistry at The Methodist Hospital in Houston. He joined us at the booth in Houston and supplied us with a roomful of phlebotomists and technicians from the hospital. What a motivated group they were! Pathologists know the pain of discovering bad news in a man's cells as they search for the deadly evidence on their microscope slides. They know that they are saving and prolonging lives when they catch a cancer before it can be felt. So they worked tirelessly in the heat of the booths. The constant noise from the crowds causes fatigue after the first eight hours. But many of these dedicated volunteers worked every day all week.

Earnestly, they explained prostate cancer in lay terms to the members of the press who stopped by the booth. Mercifully, they didn't have time to read the few jeering statements from callous and uninformed writers who know so little of the subject that they can only make jokes about it. For the most part though, the media has been tremendously helpful in every city. CNN did a two-minute documentary on their world-wide newscast. Countless men no doubt heard about the PSA test for the first time.

We don't know what causes prostate cancer or why it is increasing in prevalence. We need to know. Yet we have relatively little research under way on prostate cancer and we aren't getting our men screened.

We're counting on Senator Bob Dole to change all that.

Having survived the disease himself, he knows how vital it is to get the word out that prostate cancer is the second most deadly cancer in men, and that it now can be detected at an early, curable stage using the PSA test.

Patients are confused when they hear of a physician reporting that the FDA hasn't approved the PSA blood test for screening, A major reason given for holding back has been that it would be too expensive to screen all men (not "cost effective").

To address the "cost effective" reason for not screening all males, perhaps we could follow the example of mammography screening where a trained RT (radiologic technician) performs the routine tests. To do the DRE (digital rectal exam) we could give a license to a newly trained medical worker called a DRT (digital rectal technician). This would be a new addition to the medical team and would free up the highly trained urology specialists to do their surgery and other more demanding work. It shouldn't take five to eight years of graduate medical education to learn how to feel for nodules in a prostate. With a concentrated course, sufficient competent DRTs should be trained in time to correct our deplorable neglected health problem: half of our males 50 and older are not having a DRE annually.

Rather than having no screening because of the cost, we should reduce the cost by having a trained technician with a sensitive finger search for nodules, completing one DRE every four minutes.

Breast Centers that have sprung up in many cities use teams of doctors and technicians to screen large numbers of women who come regularly to submit to a somewhat painful mamogram (mammograrns aren't any good unless they squeeze and compact the breast tissue).

We should now be establishing Prostate Centers where men could go for their yearly PSA and DRE. These centers could also have trans-rectal ultrasound equipment available for immediate use if presence of a nodule and a high PSA indicate the need.

The PSA can discover cancers that the DRE could miss. The digital rectal technician with a gloved finger would not be able to feel a beginning nodule in the anterior portion of the prostate. He can only reach and feel a cancer in the posterior portion of the prostate. If the patient has a DRE regularly, he would still be able to catch a cancer before it spreads out of the capsule. This is another reason for yearly screening.

Screening could normally begin with a baseline at age 40, as with breast cancer, and fetesting one or two years after that. Certainly a patient with a strong history of prostate cancer in his family should begin regular prostate screening in his 40s.

Prostate cancer is a deplorably neglected disease when it comes to research into who gets it and why they get it. We could look for clues by asking each visitor to the Prostate Centers to fill out a questionnaire at the computer. With yes and no answers, visitors could encode the data. Did his father have prostate cancer? How old was his father when he died? Did he die from the prostate cancer? Likewise for his uncles and his brothers. Prostate Centers around the country could all use the same software for the computerized questionnaires. It would save a lot of time encoding, as the information could be put into a data bank immediately. We could soon get a fix on how hereditary prostate cancer is, for example.

Bob Dole tells of his brother-in-law who has prostate cancer. This brotherin-law had three brothers, one of whom has died from prostate cancer, and the other two brothers now have it as well.

More is being learned daily about screening of an elevated PSA as more data is being accumulated. One prostate cancer specialist told me that he had never seen a PSA higher than 45 where there was no cancer of the prostate present.

A PSA that went up too fast alerted Bob Dole's doctors to his prostate cancer. His PSA wasn't very high, but it went up faster than expected. The PSA test has been approved by the FDA for use in monitoring prostate cancer patients. After radiation or surgery, frequent PSA tests are done to make sure all the cancer cells have been arrested. If they haven't been, the growing prostate cells would be manufacturing more of the prostatespecific antigen--the protein that only prostate cells produce. Then the oncologist would know that more aggressive treatment would be necessary to destroy the cancer cells.

Most of the informed urologists we have interviewed believe that the evidence is compelling and overwhelming that the PSA test should be approved as a screening test by the FDA and should be a reimbursable medical expense wherever possible. Until such time, we believe volunteer efforts should be mobilized.

Bob Dole, the inspiration for our mobile testing campaign, has been on hand at almost every testing site, greeting the men who line up for PSA testing and drawing more media attention to this disease than it has previously received. When he came to Indianapolis, he shook hands with almost every man in a line that tested 394 men. He remarked that many of the hands he shook were the rough hands of working men who had taken time off from work to stand in line to wait and be tested. As he went down the line shaking hands, if a man wanted to ask a question about the consequences of the Bob Dole prostate surgery, he would stop to answer.

Volunteers from US TOO and the AFUD (American Foundation of Urological Diseases) volunteers came to help in numbers. Many of the US TOO members are prostate cancer victims themselves. Many had their disease caught too late, before the PSA test was used for screening, and through not having had even a digital rectal exam until it was too late.

These men reach out to those in the crowd who are coping with their prostate cancers in all the various stages. They know the subject. They have favorite books to recommend. They pass out pamphlets and they make support group contacts in a man's hometown. They help wives understand the vagaries of prostate cancer.

They know that fear of the unknown is the worst. They provide the facts and the hope for more research. Prostate cancer is a neglected disease. Its closet sufferers haven't exactly been shouting out for help. One of the doctors pointed out, "For every prostate cancer death, only $1,000 is spent on research each year. Four thousand dollars is spent for research for every breast cancer death each year. And $100,000 is spent on research for each AIDS death. It's time for prostate cancer to be given its fair share of attention and funding."

David Sykes, our associate publisher who joined us from London, England, proved to be a godsend. One would never have expected that a young lad from a privileged home would find a health opportunity for middle-America so challenging that he worked 14 hours a day without stopping or complaining even in the 950 heat of the Midwest summer. David took to managing the testing sites like a duck to water. He troubleshot for the testing booth, keeping supplies always flowing. When long lines caused a shortage of purple stopper tubes, David came to the rescue.

At a Midwestern state fair, farmers who had come to exhibit their animals and produce, lined up for examinations. Farmers are quite accustomed to making do with what's available for themselves or their livestock, and they recognized the testing site as a practical and expeditious way to get a job done. Appreciative, they told all their male friends and relatives and ran David Sykes out of supplies before the first weekend was over. Bob Dole stayed for three or four hours on Sunday afternoon to encourage them and, all told, more than 2,140 men came through the booth.

Prostate cancer's recent entry into the limelight is making a difference. Dr. Peter Scardino told me he has already seen the evidence in his own urology practice. "It used to be that when I had office hours and I would see 10 or 15 men with prostate cancer, six or seven would come in with a tumor that had already spread to the bones, well beyond the prostate. Maybe two or three of them would be early enough and small enough to cure with the techniques we have nowadays," Dr. Scardino said. "Now, it's the other way around. I'd say we're seeing six or seven men who have it localized and we have the chance of curing it, and maybe only two or three have an advanced stage of the disease. So I think we're going to see, down the road, a reduction in the terrible mortality rate of 34,000 to 35,000 men every year."

Ideally, the PSA test should do for men what the Pap smear did for women. In 1958, the United States was losing some 8,500 women a year to cervical cancer. Then Dr. Papanicolaou developed the Pap smear, and women everywhere were tested. The number of deaths has dropped dramatically to an estimated 4,400 in 1992. When I asked Dr. William Catalona, one of our country's foremost experts on prostate cancer, whether we could do the same with prostate cancer deaths using the PSA, his answer was, "We could do better." This was good news, but obviously before this happens there remain hurdles to surmount.

One is compliance. Recently, a friend died from cancer of the cervix. She hadn't been Pap smeared for several years. Just as some women still don't have their yearly mammogram and Pap smear, some men won't go in for a PSA test, but this year many men still don't even know what PSA means. Also, the cost of the PSA test will have to come down as did the cost of the Pap smear and the mammogram. The mass production of test kits and the rapidly improved technology for the equipment on which to run them will be driven by demand so that costs will drop.

The words of Secretary of Health and Human Services, Dr. Louis Sullivan, when he visited our Houston test site, were reassuring. "We must make routine testing a national priority," he said.

The cause of prostate cancer remains unknown. It is generally assumed that cancer cells in the prostate are somehow stimulated by the male hormone, testosterone. Once cancer has started, there's no way of telling how fast it will grow. Sometimes growth is slow and a man will die of some other disease before prostate cancer is even detected. Other times growth is rapid.

Although some men may live for many years without having the cancer discovered, the tumor eventually will grow to the point that the prostate will squeeze the urethra, the tube through which urine is expelled from the body, causing difficulty urinating. This is usually the first symptom of prostate cancer.

It is important to remember that difficulty urinating is also a symptom of other disorders, so if one has this problem, it's not always cancer, but one should see a doctor immediately.

Cancer cells may leave the prostate and attack other cells outside the prostate without causing symptoms. Some cancer cells may break off and spread through the body to the lymph nodes, lungs, and bones, especially the bones of the hip and lower back. Back pain is the most common symptom of prostate cancer that has spread to other parts of the body.

The physician's classification system for this deadly disease says it all. Simplified, the stages range from A to D and the prognosis gets steadily worse. At Stage A, a prostate cancer tumor is still located within the prostate gland and is too small to be felt by a doctor's finger during a digital rectal exam. In the past, such tiny tumors would be discovered only by chance during surgery for a benign tumor or for some other prostate disorder. Now small tumors can be detected using the PSA blood test, and as a result they can be treated early with surgery or radiation therapy and cured. At Stage B, a tumor is still within the prostate, but is large enough to be felt during a rectal exam. Again, surgery or radiation can be curative. At stage C, the tumor has spread to other nearby areas, sometimes causing difficulty urinating. And at Stage D the tumor has spread to other parts of the body, commonly the bones. Victims at this stage may have difficulty urinating and suffer bone pain, weight loss, and fatigue.

Doctors must know exactly where the cancer is in the body and how it is behaving in order to choose the most effective treatment. This varies with each individual case. If treatment is started when the cancer is at an early stage, the disease can be cured. Treatment started at a later stage can extend life and help relieve symptoms.

Doctors often use radiation treatments in Stage-A,-B,-and-C patients to help prevent the cancer from spreading. In Stage-D patients, they rely on hormone therapy to reduce the body's production of testosterone, slow the growth of the cancer, and help relieve symptoms. This used to mean surgical removal of the testicles or estrogen therapy which could lead to heart and blood vessel problems. Lately, the prospect for Stage-D patients has improved with LHRH (luteinizing hormone releasing hormone) therapy. Once-a-month injections of this drug produced under the brand names Lupron, made by TAP Pharmaceuticals-a division of Abbott Laboratories, or Zoladex, made by ICI Pharma, work just as well as surgical removal and avoids the side effects of estrogen therapy.

Sometimes antiandrogen therapy is used in conjunction with LHRH therapy. This involves administering a drug called an antiandrogen that blocks the activity of male hormones and helps ease bone pain until testosterone levels begin to fall in response to the LHRH therapy. Antiandrogen therapy does have some side effects including diarrhea, nausea and vomiting, and enlargement of the male breasts.

These hormone therapies can extend the life of an advanced prostate cancer patient. While palliative, they can provide comfort during the course of the disease. Chemotherapy, which can provide marvelous cures for testicular cancer, has not been successful in curing prostate cancer.

As we go to press David Sykes and I are in Atlanta for another prostate cancer screening event where Dr. Sam Graham, head of the Urology Department of Emory University Medical School, will help us staff a booth at the Ritz Carlton, Buckhead, in conjunction with the scheduled meeting of the President's Council on Physical Fitness & Sports, and the Healthy Fitness Leaders Award banquet.

In Atlanta at the meeting of the American Cancer Society, we interviewed Dr. Gerald P. Murphy who is a urologist and is also the chief medical officer of the American Cancer Society. He told me that the Society will act on changing their guidelines to recommend PSA testing for screening all men 50 and over.

"Are you in favor of the recommendation?" I asked.

"Of course," he replied.

"What do you make of the recent adverse publicity about screenings put forth by Dr. Chodak in Chicago?" I asked him.

"He's just been reading his own press clips," Dr. Murphy responded and laughed.
COPYRIGHT 1992 Saturday Evening Post Society
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1992 Gale, Cengage Learning. All rights reserved.

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Title Annotation:Bob Dole Prostate Cancer Detection Unit offers free screening tests
Author:SerVaas, Cory
Publication:Saturday Evening Post
Date:Nov 1, 1992
Previous Article:Up on the rooftop and down.
Next Article:Gold, frankincense and myrrh.

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