- The Washington Times - Monday, May 2, 2005

When Poolesville resident John L. Willey first learned he had prostate cancer, he went so far as to trail a urologist out of his office and into the building’s elevator to get answers as quickly as possible.

Mr. Willey may be impulsive, but his instincts are sound. The quicker a prostate cancer patient acts, the better the chance for a successful recovery.

It’s a message Mr. Willey, 60, spreads as a member of the board of directors of the National Prostate Cancer Coalition in the District.

“It’s important people understand what they need to do — act,” Mr. Willey says.

That’s because various health organizations report 1 in 6 men will get prostate cancer at some point in their lives. The disease typically strikes men older than 50, though cases in younger men have been discovered. In its early stages, prostate cancer has no symptoms. By the time the man is feeling ill, either from urinary complications or pain around the waist, the cancer has spread beyond the prostate.

The news is worse for men in the District. Prostate cancer is the No. 1 health concern among men in Washington, according to the National Prostate Cancer Coalition. Black men are 60 percent more likely to develop prostate cancer and 2.4 times more likely to die from it than men of other races, according to the coalition. Researchers don’t fully know why this is, though they know blacks metabolize testosterone in a speedier fashion, which contributes to accelerated tumor growth.

The cancer isn’t a death sentence.

Former District Mayor Marion Barry, now a D.C. Council member, survived treatment and will celebrate 10 cancer-free years in December.

The only screening test available is the prostate-specific antigen (PSA) blood test, which measures the levels of a protein produced by the cells of the prostate gland. The higher the PSA level, the more likely a man has prostate cancer, although a high number can be caused by other conditions.

Men age 50 and older are encouraged to submit to the test annually, and those younger than 50 are urged to do so if they are black or have a history of prostate cancer in the family.

If a patient’s PSA test figures change dramatically over a year’s time, that also could be cause for alarm.

If a doctor believes a patient’s positive test is accurate, or if a second test has confirmed the high PSA level, a biopsy may be taken as the next step in the treatment process.

It’s one reason the test draws fire from some who feel it’s too imperfect to be a reliable guide.

Jamie Bearse, spokesman for the National Prostate Cancer Coalition, says no matter the disagreements, the test is the only type of its kind for patients right now.

“It’s a lifesaver if you look at the statistics,” he says. “Over the last 10 years or so, deaths have fallen about 25 percent. Screening is a big factor.”

More than 99 percent of men with prostate cancer survive if the disease is caught in its earliest stages, he adds.

The test soon could have company. A number of biomarker drugs are in production as well as a urine test that could suss out cancerous prostate cells, he says. Both could be available in the next decade, he estimates.

That could be a major boost for potential patients because the PSA’s false-positive rate is as high as 80 percent, according to the Prostate Cancer Foundation in Los Angeles, citing 2003 information from the Journal of the American Medical Association. The test also has a 20 percent false-negative rate, meaning 1 in 5 cancers would be missed if the PSA were the only test used.

Leslie Michelson, chief executive officer of the foundation, contends the PSA test is having a huge impact with patients.

“We used to find 80 percent of men upon diagnosis had advanced disease,” Mr. Michelson says. Now, 80 percent of patients have cancer that hasn’t spread beyond the prostate’s borders.

That improvement, combined with more effective treatments, means tomorrow’s cancer patient has far more hope than someone diagnosed a decade ago.

A recent surgical improvement occurred at Johns Hopkins Hospital in Baltimore, where a surgeon developed a technique that spares some nerve damage. The prostate is located below the bladder and in front of the rectum, so operations involving it often leave patients with significant side effects.

“The technique spares men’s nerves while removing the prostate. It dramatically reduces the incidence of incontinence and impotence,” Mr. Michelson says.

Another advance involves robotically assisted surgery that reduces the chances of human error resulting in nerve damage.

About 41 percent of patients undergo a prostatectomy, while just over 22 percent agree to one of two forms of radiation therapy, according to the Prostate Cancer Foundation, citing data from the CaPSURE registry of 10,018 men in the United States. CaPSURE is a national disease registry for men with prostate cancer.

Nearly 17 percent attempt primary hormone therapy, while 6 percent wait and watch before making a decision. The remaining nearly 14 percent either undergo cryotherapy to destroy the damaged prostate gland or their information was not registered in the database.

Other recent innovations include research showing cholesterol-lowering drugs including statins may cut the risk of advanced prostate cancer in half, according to work by the Johns Hopkins Bloomberg School of Public Health and Kimmel Cancer Center.

Mr. Willey opted for surgery. He didn’t have any cancerous cells outside of the prostate, and the prognosis for surgery in such situations is excellent. He followed his surgery with immunotherapy, in which tiny cancerous prostate cells were injected into his lymph nodes and bones. The body quickly fights the incoming cells and learns how to attack similar cancer cells.

Dr. Mohan Verghese, director of urologic oncology at the Washington Hospital Center in Northwest, uses a cryosurgical technique to excise cancerous prostates from patients. The outpatient procedure is well-suited for those for whom radiation therapy has failed.

The surgery leaves the majority of patients with sexual dysfunction but often prevents injury to the rectum and urethra.

Mr. Willey says the most important thing a newly diagnosed prostate cancer patient can do is “to recognize you need to be well-informed and make a decision based on all the information available.”

The Internet has made that task easier since he was diagnosed in 1992.

“I was buying book after book after book [on prostate cancer]. Now, you can find an article five weeks old [online] and it might be dated,” he says.

Just don’t get too bogged down with facts and figures.

“Study but then act, and act quickly,” he advises. “Tumors grow, and you have to act with all deliberate speed.”

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