NYT prostate cancer patient/writer reviews "Invasion of Prostate Snatchers"

New York Times writer Dana Jennings, who’s been publicly sharing his own story of prostate cancer, writes about a new book about someone else’s prostate cancer story.

It’s “Invasion of the Prostate Snatchers,” by Ralph H. Blum and Dr. Mark Scholz.

Jennings writes:

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“(The book) is a provocative and frank look at the bewildering world of prostate cancer, from the current state of the multibillion-dollar industry to the range of available treatments.

About 200,000 cases of prostate cancer are diagnosed each year in the United States, and the authors say nearly all of them are overtreated. Most men, they persuasively argue, would be better served having their cancer managed as a chronic condition.

Why? Because most prostate cancers are lackadaisical — the fourth-class mail of their kind. The authors say “active surveillance” is an effective initial treatment for most men.

They add that only about 1 in 7 men with newly diagnosed prostate cancer are at risk for a serious form of the disease. “Out of 50,000 radical prostatectomies performed every year in the United States alone,” Dr. Scholz writes, “more than 40,000 are unnecessary. In other words, the vast majority of men with prostate cancer would have lived just as long without any operation at all. Most did not need to have their sexuality

Yet radical prostatectomy is still the treatment recommended most often, even though a recent study in The New England Journal of Medicine suggested that it extended the lives of just 1 patient in 48.

And surgery, of course, is most often recommended by surgeons and urologists — who are also surgeons. Mr. Blum writes: “As one seasoned observer of the prostate cancer industry told me, ‘Your prostate is worth what Ted Turner would call serious cash money.’ ” As for patients, their rational thinking has been short-circuited by the word “cancer.” Scared, frantic and vulnerable — relying on a doctor’s insight — they are ripe to being sold on surgery as their best option. Just get it out.

Every urologist I met with after my diagnosis recommended surgery, even though it was believed then that I had a low-risk Stage 1 cancer. The best advice came from my personal urologist, who declined to do my operation because it was beyond him: “Avoid the community hospital guys who do a volume business in prostates.”

I did, but I’m still maimed. In my experience, doctors play down punishing side effects like incontinence, impotence and shrinking of the penis. Those are just words when you hear them, but beyond language when you go through them.”

Read Jennings’ full column. And you may want to pick up your own copy of “Invasion of the Prostate Snatchers.” I’m getting mine.

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Comments (16)

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Arnon Krongrad, MD

September 1, 2010 at 11:18 am

The cover photo implies an adversarial relationship between patient and doctor. Even greater adversity — indeed homocidal violence — was implied by the photos of a pistol and spent bullet casings that accompanied “I Want My Prostate Back” as published in April in Men’s Health. Are these photos good?
The physician-patient interface is problematic. This has been so since at least as long ago as when Herodotus’ Scythian king killed his doctors in an ox-pulled cart set on fire. Today I see imperfect communication and frustration in my work in the treatment of prostate cancer and in the treatment of chronic prostatitis (yes, these are my disclosures of conflict of interest: I am a surgeon).
To remedy the problems will take more than our hybridized physician-patient prostate cancer social network and prostatitis social network can muster. It will take a desire by physicans and patients to communicate objectively and openly. Constructive tones can be set. But they take hard work, vigilence, and actual desire.
To minimize the frustrations for physicians and for patients will require communication of actual knowledge, which includes knowledge of what we do not know. It will require a recognition of the abundant uncertainty that associates with illness.
Restraint is useful. Clenched fist, pistols: These are hyperbolic tools that are perhaps useful in generating headlines and selling books. They are ill suited to development of a climate in which physicians and patients can communicate and collaborate better.

Terry Corbin

September 8, 2010 at 4:23 pm

My disclosure: I am one of those patients who would like to have his prostate back. I went to a urologist with BPH symptoms and ended up having robotic radical prostatectomy. Each step seemed logical but there were many decisions (by my urologist) along the way that ignored the medical evidence that my condition was completely benign.
I highly recommend that patients with prostatitis or BPH read the HealthWise and/or Foundation for Informed Medical Decision Making information on prostate cancer–before you are told you might have cancer. If you have a biopsy and you are over 50, chances are there will be some abnormal cells that can be called early-stage cancer. Once the biopsy is done and the CA diagnosis is in, fear often takes over, and you are vulnerable to being railroaded into a surgery you don’t need. I also recommend that anyone with a recommendation for prostate surgery get a second opinion from a urologist at an academic center.

Steve

September 9, 2010 at 4:43 pm

I was diagnosed 4 years ago with PC and din’t allow the MD to railroad me into the operation. My PSA was 5.6 at the time. Thru
supplements, good diet,exercise, chinese herbs, stress reduction my PSA has
come down & stayed down. It is now 1.7 and I feel better than I ever did. My MD, who has practiced over 25 years can’t believe it. But hey, that’s life!

Dean Bunch

November 15, 2010 at 1:26 am

I haven’t read the book yet, but I am concerned that its sensational title will send men too far into the anti-prostatectomy mode, rather than where they should be, which is into the researching, listening, and logical-decision mode.
I received the dreaded call from my urologist in February, 2010. Despite the fact that my PSA was only 4.2 (just 0.2 over what is usually considered “normal”), my Gleason score on biopsy was 8-9, on a scale of 1-10. All of the biopsy samples taken were positive for cancer. I read Dr. Gleason’s “bible” and went to the appointment with my urologist, accompanied by my wife. Contrary to the warnings in Prostate Snatchers, my urologist went through all of the options, and encouraged me to get a second opinion if there were any doubts in my mind. In no way did he try to pressure me into surgery.
I had no doubts. Because of the advanced stage of my cancer, surgery and subsequent radiation were clearly indicated and I had the surgery on April 7. I knew that based upon my own research. I had the “open” as opposed to robotic surgery. I had the surgery on Wednesday, left the hospital on Friday, and returned to work full time on Monday morning. Post-surgical biopsy confirmed the advanced stage of the cancer. Thereafter, after regaining contentence within 90 days, I had radiation therapy, without any side effects. My PSA was at “non-detectible” levels, both after surgery and after the radiation.
Notwithstanding the side effects, I am very glad I had the surgery and have had no second thoughts.
The statistics from Prostate Snatchers (a high percentage of prostatectomies being unnecessary) are irrelevant to the man facing this decision. I didn’t care what the statistics were. I only cared about the statistic of one — me! What was best for me?
I recommend the same approach for anyone facing the decision. Read – read – read! Ask — ask — ask! Many of your friends, if you ask, will reveal that they have been through this decision-making process. Their input, together with the knowledge that is so readily available now through the many good books on the subject, will put YOU in a place to make the right decision FOR YOU. Don’t be scared away from surgery by Prostate Snatchers. Don’t be scared into surgery by a urologist (certainly not exemplified by my urologist) who simply defaults into surgery because he/she is a surgeon.
I recognize that it will be a more difficult decision for those men who had lower grade cancer than I had. However, with knowledge comes power and in this case you cannot have too much knowledge. With that knowledge you can make the correct decision for you which is all that matters. The statistics be damned!

Ron

May 16, 2011 at 5:09 pm

I am reading the book after having two biopsies (both negative). So much good in the book but what is so evident is the need for more research and the money that makes it possible. If prostate cancer is the 2nd leading cause of death in men AND every man will eventually have prostate cancer, should he live long enough, then why isn’t more being done to understand this disease and get men the help we need? If PC is the equivalent of breast cancer in women, then why aren’t there “blue ribbons” or marches against PC, or researchers on Oprah, or Jay Leno etc. ??? How sad that the founder of the PSA test wishes he had never discovered it since it is being used to “snatch” men’s prostates out at record levels. There is only one way of finding out if you have PC: the biopsy. Sad that I’ve had two, since my PSA was elevated, but no other method exists to determine whether or not I have BPH or cancer. How far away we are from knowing about this disease that afflicts so many.
Thank you for writing this book! It has given me so much hope and encouragement. I am mentioning it to all my pals who are hearing about their elevated PSA for the first time. I’m also mentioning it to all my doctor friends with hopes that they’ll use it to help men thru this maze of options and choices.
Ron

Steve

September 14, 2011 at 1:32 pm

As a 61 year old male with prostate cancer. I have seen Dr. Scholz and read his book. When I first visited my urologist with a PSA score of 6.0, he recommended a biopsy. When the results came in, we met for a meeting. He told me two of my 12 cores came back with positive results with one core reflecting 5% cancer and the other 25% for their respective areas. He told me my Gleason score was 6. He immediately recommended I have surgery. This I was reluctant to do without further research.
I read as much as a could, found people who had decided to have the surgery, and then went back to see the urologist. After discussing my condition for over an hour, we agreed active surveillance was an option I could take.
I then made an appointment to see Dr. Scholz. For over an our we discussed all the possible treatments for prostate cancer. We also discussed the side effeects asociated with the different forms of surgery and how likely they were to occur. Most of these side effects can significantly effect your daily life and the probability of them occurring are high enough that they warrant consideration before choosing a course of action.
But most importantly we discussed my condition and where I fell in the risk category. He told me there were three main categories of risk – (1) high, (2) medium, and (3) Low. he also said the low risk category was further broekn down into a category of very low risk patients. I was in that lowest category. At that level was surgery necessary now? The answer was no. Would it be in the near future? Not very likely. What was the best course of action? Active Surveillance.
I then proceeded to read Dr. Scholz book. The more I read, the more I understood the significance of giving your body a chance to fight this cancer. How do you do this? You take away the building blocks the cancer needs and you build up your own immune system. Dr Scholz does a great job explaining how cancer cells are created and what they need. If you take these elements away, the cancer cannot grow as rapidly. By building up your immune system you give your body a better chance of winning the battle against these foreign cells.
The message here is that we all need to be informed. Some of this information we can get from our doctors and some we need to find on our own.
There are choices out there and for those with low risk cancer the first choice does not have to be surgery. There was one wonderful point Dr. Sholz made in his book that really struck home with me. In real estate there are three important factors when choosing a home – location – location and location. In considering your options for treating low risk prostate cancer, there are three very important words for your life after treatment – “quality of life, quality of life, and quality of life”. This can not be underestimated by the patient or his doctor.

Vernice

October 6, 2011 at 8:35 am

I haven’t read the book yet too however I am quiet interested on this matter. I want to be aware on the issue on what’s going on. According to Dr. Scholz the vast majority of men with prostate cancer would have lived just as long without any operation at all, whew is this really true and the percentage? There are choices out there and for those with low risk cancer the first choice does not have to be surgery. There was one wonderful point Dr. Sholz made in his book that really struck home with me. In real estate there are three important factors when choosing a home location location and location. In considering your options for treating low risk prostate cancer, there are three very important words for your life after treatment “quality of life, quality of life, and quality of life”. This can not be underestimated by the patient or his doctor. Is this really make sense?

Steve Spadachene

December 9, 2011 at 7:08 pm

I have read the book co-authored by Dr. Scholz and have come to question the value of PSA testing.
Currently I see my urologist every three to six months because of mildly elevated PSA which at age 50 PSA read 1.9 and at age 54 read 3.6 on two seperate exams three months apart this year. Research has shown that a doubling of PSA in three years is cause for concern. When tested last month my PSA
had dropped to 2.6 . All three readings for PSA taken the same year 2011 . All to say that PSA is only a singular test and is helpful only in the context of other testing and professional interpretation which hopefully will be unbiased and have your best interest as the patient.

Steve Spadachene

December 9, 2011 at 7:08 pm

I have read the book co-authored by Dr. Scholz and have come to question the value of PSA testing.
Currently I see my urologist every three to six months because of mildly elevated PSA which at age 50 PSA read 1.9 and at age 54 read 3.6 on two seperate exams three months apart this year. Research has shown that a doubling of PSA in three years is cause for concern. When tested last month my PSA
had dropped to 2.6 . All three readings for PSA taken the same year 2011 . All to say that PSA is only a singular test and is helpful only in the context of other testing and professional interpretation which hopefully will be unbiased and have your best interest as the patient.