In mid-February, Paul Ziegler didn’t know much about his prostate gland except to figure that if he lived long enough, it would probably give him some sort of trouble. He didn’t fret over that fact.
That all changed on April 19.
“We’re going to stick you about eight times,” said the urologist. “We’ll be doing a section biopsy from every area of the prostate.”
Ziegler was lying in the fetal position on an examining table at Lake Forest Hospital. A female nurse was preparing instruments. He appeared calm and unbothered about wearing no clothes except his shirt, sweater and socks.
His physician, Dr. Dennis A. Pessis, was explaining the procedure, which would include eight prostate samples. The first two biopsies the doctor would do by first feeling the small lump in Ziegler’s prostate with his finger, then using a tiny spring-action needle probe to draw some cells from the lump that would be analyzed by a diagnostic laboratory.
The next six biopsies would be done at other points in the prostate with a larger rectal probe guided by ultrasound; this would help determine if there was cancer elsewhere in the gland.
Just weeks earlier, a blood test called the PSA (prostate-specific antigen) indicated there might be cancerous cells in Ziegler’s prostate. His PSA number was 6.5, up from about 4 when the test was last performed in September 1995. Ziegler routinely submitted to full blood work-ups every six months because he had suffered a heart attack nearly 10 years ago.
With the elevated PSA (0 to 4 is normal in a healthy man), Ziegler’s cardiologist recommended visiting a urology specialist. It probably wasn’t much to worry about, the cardiologist had said, but it’s best to be sure.
Pessis performed the subsequent physical exam, called the DRE (digital rectal exam, which has nothing to do with computers or even lasers; the digit refers to the doctor’s gloved index finger). The urologist discovered a palpable mass, one that seemed to protrude from the capsule of the prostate. He immediately suggested a biopsy.
The ultrasound picture during the biopsy showed a calcified area on the left side of the prostate. “That might be what I was feeling during the digital exam (rather than a cancerous tumor),” said Pessis. “There are no real suspicious areas on there but we can’t tell exactly by looking at the ultrasound. Sometimes things look like things they are not.”
The whole procedure was done in 10 minutes, which had included several grimaces and one slight grunt from Ziegler. The doctor asked him to rest for the next 24 hours, but Ziegler was hoping to play a round of golf at the nearby Deerpath course.
“I’ll ride in a cart,” said Ziegler.
“OK, but drink plenty of fluids,” said Pessis, who was thinking an afternoon of golf might relieve his patient’s mind more than it would tax his body. “Take it easy and call me in a week for the results.”
With that, Ziegler, a 67-year-old retired metallurgical engineer who still dabbles in consulting (including a recent assignment in China), stepped out of the examining room and into the two most anguished months of his life.
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Prostate cancer has arrived as a dreaded disease, the male counterpart to breast, ovarian and cervical cancers. “A positive biopsy result is a real shocker,” said Richard Feit of Glenview, who was diagnosed with cancer in early February and elected to have a radical prostatectomy (removal of the entire prostate) by April. “My initial reaction was it must be wrong. I wanted to have the test redone or reverified.”
The prostate gland is about the size of a walnut and shaped like an upside-down pear. It rests deep in the abdomen just under the bladder in a man’s body, attached to the urethra, the tube that carries urine from the bladder. The primary role of the prostate is to produce the seminal fluid necessary for sperm to travel during ejaculation.
The prostate weighs one ounce. Yet that hasn’t stopped it from instilling in the minds of men large measures of fear, uncertainty, vulnerability and terror about a potentially painful death. Cancer clearly scares men more than heart disease, which is a much bigger killer.
The media have paid more attention to increased risks and death rates and to the newest diet-related studies, which show that eating cooked tomatoes or taking zinc tablets and palmetto-berry supplements might prevent prostate problems. There also have been dozens of reports on prostate cancer cases of celebrities, including Republican presidential candidate Bob Dole. Trouble going to the bathroom is one thing-and usually private and not a subject of campaign briefings-but a phone call from the doctor notifying you of cancer is quite another matter.
There are misconceptions about exactly what prostate cancer is-and what is not. Once that has been explained to a patient, he must determine the aggressiveness of his tumor, how far it already has spread and how fast it might grow. Add to that disagreements about the statistics of prostate cancer. Then, once a man understands the nature of his case and where he fits into the life expectancy odds, the important decision still awaits: Which treatment is the right one-and which doctor has the right idea and is most qualified to be trusted when a man’s life is on the line?
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Of course, that’s far from the end of it. There’s the operation itself and the anxiety of waiting for results on several counts. What’s more, every patient bounces back from surgery differently.
“My recovery has been much more difficult than I expected,” said Bill Davies, a vice president of Motorola who underwent a radical prostatectomy in early May.
His surgeons cut a deep hole in his abdomen, which measured about six inches in diameter and was equally deep. It was an hour and 49 minutes before they actually removed the prostate, because it’s vital to delicately cut it completely away from the bladder and urethra. The idea is to remove all of the cancerous prostate but as little as possible of the urethra and bladder to retain full bodily functions.
“It’s a lot of work for something that small,” said the surgeon, Dr. Gerald Chodak of the University of Chicago and Weiss Memorial Hospitals, while placing Davies’ prostate in a plastic jar, capping it and handing the specimen to a nurse for shipping to the pathology lab.
“The surgical wound took quite a while to heal,” recalled Davies, who like nearly all of Chodak’s patients was released from the hospital after only one night’s stay, because a spinal epidural was used rather than general anesthesia. “But what was really difficult was the emotional nature of having cancer. I had a heart attack about 18 months ago, but four days later I was on my laptop computer able to do some work. With this thing, I couldn’t work for weeks. I couldn’t read anything that required concentration. I wasn’t worried as much as I was absorbed in what might happen to me and whether they got all the cancer. My wife said I didn’t smile until my first day back at work. That was eight weeks later.”
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Depending on who is estimating, some 250,000 to 317,000 men will be diagnosed with prostate cancer in 1996. About 38,000 to 41,400 are expected to die from the disease. By the year 2000, diagnoses are expected to increase by roughly 90 percent and mortalities by 37 percent.
That makes prostate cancer the second leading cause of death among men with cancer (after lung cancer). It is also the second most common cancer for American men (after skin cancer) and the most frequently diagnosed.
Other numbers, used in classes taught by oncologist Dr. Jules E. Harris of Rush Medical College: Every three minutes a U.S. man is diagnosed with prostate cancer; every 15 minutes a man dies from it; one in five men will live long enough to be diagnosed with it (compared with one in eight for women and breast cancer); one in three men diagnosed with prostate cancer will die from it; the typical American man has a 1-in-323 chance of dying from the disease. African-Americans are at 37 percent greater risk than other men in the U.S.
But prostate cancer is not to be confused with benign prostatic hyperplasia (BPH), a common enlargement of the prostate in which non-cancerous cells grow inward toward the gland’s core rather than outward like cancer cells, which can eventually invade other parts of the body. The benign condition nonetheless terrifies many men who have seen the headlines about prostate cancer and think their own BPH symptoms-hesitancy in urination, weak flow, inability to stop, frequency, urgency, disrupted sleep, sense of not being able to fully empty the bladder-might be deadly.
In fact, a man with BPH has no more or less chance of developing prostate cancer than a man without BPH. Studies show that the incidence of BPH rises each year after 40 and increases enough to be present in half of all American men between the ages of 51 and 60, jumping to 80 percent in 80-year-olds. About 25 percent of men with BPH-including approximately 350,000 U.S. males each year at a cost of $3 billion-will require surgery to relieve symptoms, making it the most performed operation on all American men older than 55. A fair number of men need the surgery more than once.
Nor is prostatitis to be mistaken for prostate cancer. Prostatitis is a non-cancerous inflammation of the prostate accompanied by often painful or alarming symptoms such as difficult, frequent, urgent or burning urination and acute or vague pain in the lower back, perineum (the area between the rectum and scrotum) and penis. It can be caused by bacterial infection and is treatable with antibiotics, but many men have non-bacterial inflammation that proves elusive regarding exact cause and successful treatment. Prostate cancer is what has elevated a lowly gland with a three-centimeter diameter into high-profile, cover-story news.
The most visible news coverage has included the stories of famous men who have battled prostate cancer in recent years. Among the survivors: Dole, Gen. Norman Schwarzkopf, junk bond star and ex-convict Michael Milken, actors Jerry Lewis and Sidney Poitier, race car driver Richard Petty, football coach Marv Levy, King Hussein of Jordan and publisher Michael Korda, whose new book, “Man to Man” (Random House, $20) recounts his story. Among those men 70 or younger who have died from prostate tumors: actors Telly Savalas and Bill Bixby, rocker Frank Zappa, business tycoon Steve Ross and publisher Robert Maynard.
Some physicians contend that the media have inordinately fanned the flames and fears of men-and women who love them. For example, Time magazine called prostate cancer an epidemic in an April 1 cover story, claiming that one in five men will develop the disease but citing no specific sources.
“I’m not a believer in the prostate cancer epidemic,” said Pessis, who splits his time between the Rush-Presbyterian-St. Luke’s Medical Center and Rush-affiliated Lake Forest Hospital. “We are diagnosing more prostate cancer because physicians are much more careful about digital rectal examinations. There are more DREs being done by general physicians than ever before, and anything felt is sent to a urologist. Any elevations in the PSA (the blood test was first used about 10 years ago) now indicate a biopsy might be necessary.”
“The numbers are probably closer to one in 10 men who will develop the disease,” said Chodak.
Pessis said new research speculates that percentage rates of prostate cancer may actually decrease in the next five years because more prostate cancer already has been diagnosed. But the overall numbers will go up as more Baby Boomers turn 50.
“Patients come in with symptoms like getting up at night,” said Pessis. “They want to know they don’t have prostate cancer.”
Chodak, who also operated on Feit, is a pioneer of early screening for prostate cancer. He co-authored a 1984 paper for the Journal of the American Medical Association showing that digital rectal exams can reliably spot many prostate tumors before the cancer spreads to other parts of the body, especially the bones. At the time, 75,000 new cases of prostate cancer were diagnosed each year, but only one-fourth were caught in early stages, when treatments are most effective. Advanced prostate cancer is extremely difficult to curtail; most therapies use hormones and potent chemotherapy drugs, and all are experimental.
“Hormone therapy can provide a stopgap,” said Dr. Robert G. Kilbourn, who recently moved to Chicago from Houston’s M.D. Anderson Cancer Center to start the city’s first comprehensive prostate cancer center at Rush-Presbyterian-St. Luke’s. “Some of my patients respond quite well and have lived up to 10 years with advanced disease. Others only make it for a couple of months.
“But there is nothing we know today that can cure prostate cancer, unless your cancer is confined to the gland and you get it all in surgery.”
The problem is, prostate cancer is usually asymptomatic. While someone with BPH or prostatitis will know it from a change in bodily functions, prostate tumors grow and spread beyond the prostate body without any physical warning signs.
Getting an annual digital rectal exam and PSA test-not one or the other, but both-is the most complete way to know cancer might be developing in a man’s body. If you wait for symptoms, it will be too late.
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Paul Ziegler’s world flipped upside down on a Friday. One week after the biopsy, April 26, Pessis called.
“I’m sorry,” he said. “The biopsy was positive. You have cancer.”
The rest of the conversation is a blur for Ziegler. He did manage to hear that the doctor wanted him to go for a bone scan and an MRI (magnetic resonance imaging) scan. Ziegler also wrote down the next appointment, May 13, and figured he would want his wife, Dona,to go with him this time.
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The PSA blood test is a man’s version of the Pap smear used to detect early cervical cancer in women-and it is no less controversial than the Pap test, which has come under fire for inconsistencies and human error among lab technicians who read the microscopic scrapings of cells. The PSA is a simple test. Urologists hope the less invasive screening method will prompt more men to submit to regular exams.
Even so, the PSA is considered unnecessary, misleading and a waste of money by some medical authorities (lab work for a typical PSA blood test is about $70 to $125).
For example, not all managed-care programs adhere to the recommendation of the American Cancer Society, which advises routine testing of all male patients over 50 (or 40 for men at greater risk, such as African-Americans or men whose fathers or brothers have the disease). That’s because some studies show the test can report high PSA levels in men who don’t have cancer or have what’s known as incidental cancer (basically dormant cancer cells, which studies show are present in up to 50 percent of all men who are autopsied and found to have died of other causes). High PSAs can lead to biopsies and, more rarely, to surgeries that could have been avoided.
Another concern is that the test is perhaps less relevant for older men.
“I am not a fan of early diagnosis and treatment of men with life expectancies less than 10 years,” said Dr. Charles Brendler, chairman of the urology department at the University of Chicago, who spent years at Johns Hopkins University in Baltimore, considered the nation’s top prostate cancer treatment center. “I don’t recommend PSA screening in men over 70. Routine obtaining of PSAs in elderly men is causing a lot of undue concern. I’ve had 82-year-old men in my office worried about an elevated PSA. I tell them, ‘You may have prostate cancer, but I don’t recommend surgery at such an advanced age.’
“Instead, I tell them we will watch things by rectal exam. If the DRE shows a palpable tumor, then we’ll explore radiation or hormone treatments that are less invasive.”
The blood-screening technique might also reveal a low PSA in some men with growing tumors, in which case it loses all effectiveness as an early detector.
Defenders of the PSA test, which is becoming widely used at larger medical centers, contend that the blood test can catch tumors too small to detect by rectal exam (classified as Stage A). Bill Davies, for one, found out about his cancer from a blood test during a routine physical exam. He couldn’t remember his last DRE, and the urologist who first found the nodule on his prostate said it was unlikely most general practitioners would have found it.
One reason for all the confusion: The PSA test measures prostate-specific antigens, not cancer-specific antigens. Some PSA is normal, since it is an enzyme used to break down coagulated sperm and move them through the reproductive tract. An increased amount is a sign of trouble, but can also indicate BPH.
The newest thinking is that tracking PSA over time provides the most viable use of the blood screening. This is called measuring “PSA velocity” and many urologists suggest a PSA test every six months if you are particularly concerned about your prostate. Even a significant rise within the normal 0 to 4 range should be monitored. When someone like Ziegler (from 4.0 to 6.5 in six months) shows an abrupt jump in readings, it’s time to conduct a digital rectal exam.
The DRE is an efficient screening technique when done by an experienced urologist (less so for general physicians), though it is impossible for the doctor to feel the entire prostate no matter what length his finger.
The procedure is equally overrated and overwrought from the patient’s perspective. Men who have survived serious war wounds or suffered heart attacks still won’t agree to see a physician with a lubricated, gloved index finger. It may be mildly uncomfortable but it’s not painful. Nor is it especially undignified, especially in light of the positives of detecting early stages of cancer or getting a clean bill of health.
“We’ve got to get over this digital rectal thing,” said Schwarzkopf, the Gulf War hero who is now a national spokesman for prostate cancer awareness and pitchman for Michael Milken’s private crusade (CaP CURE) to raise funds for research that fall woefully short of money available to seek a cure for breast cancer.
“These urologists are professionals. They do this thousands of times each year. It’s an awkward moment, but don’t be your own worst enemy.”
Schwarzkopf told his own story about awkwardness.
“I had a DRE every year when I was active in the military,” said Schwarzkopf. “Of course, I didn’t like it. But I think the Air Force captain who was my physician liked it even less. He would be thinking, ‘I’m supposed to do what to the general?’ and I would be scowling and saying, ‘Let’s get this over with.’ “
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On May 13, more than two weeks after receiving the positive biopsy results, Paul and Dona Ziegler were in a waiting room chatting about their grandchildren, then fell silent, imagining the same range of scenarios only Schwarzkopf and other cancer patients and their loved ones would understand.
“There is a mass in the posterior left peripheral zone, where most of the cancer is harbored,” said the doctor a few minutes later, reading from the MRI report. “It extends outside the pseudocapsule. . . . This gives us an idea this may be a Stage C tumor of the prostate. Having a C lesion means the tumor is beyond the capsule but hasn’t gone anywhere else (Stage D is when it spreads). If it were a Stage B lesion, it would be contained in the gland.”
The doctor took his time, careful to explain his findings.
“If this tumor were confined to the prostate gland, my advice for someone your age (anyone under 70) would be surgery, period. But I don’t force that even in the case of a B tumor. Surgery has its own set of problems. There’s 20 to 30 percent incontinence (inability to control urination). Men older than 60 have a 68 percent chance of experiencing impotence (partial or no erections) even though we try to preserve the neuromuscular bundles (that control this sexual function). There’s also a necessity for transfusion in many cases, though you can use your own blood. Plus, there’s the risk of anesthesia.”
That’s about when Paul Ziegler started rejecting the idea of surgery, an option selected by many but certainly not all prostate cancer patients under 70. He listened carefully as Pessis explained the other treatment options:
– Radiation therapy. He could choose between external beam radiation, which shoots radioactive lasers at the prostate (with possible exposure to surrounding areas such as the bladder and rectum), or brachytherapy, a method of injecting radioactive “seeds” directly into the prostate in order to radiate inside-to-out and avoid surrounding body parts (some patients opt for a combination of both therapies). The seed therapy is gaining respectability through continuing research, but received perhaps its biggest boost when 59-year-old Intel CEO Andy Grove, a telecommunications industry guru, wrote a May 13 Fortune cover story describing why he was fighting his prostate cancer with radiation seeds rather than a radical prostatectomy.
In any radiation scenario, Rush protocol is to give hormone shots aimed at shrinking the prostate before the therapy. This pre-radiation approach is not shared by a number of other area hospitals; there is no conclusive research on the subject.
Radiation was the therapy Pessis recommended, based on the MRI (“it shows about an 82 percent chance your cancer had spread beyond the prostate”) and an expanded biopsy report showing that Ziegler’s tumor graded a 7 of possible 10 on the Gleason scale, an index created by a pathologist named Dr. Lawrence Gleason that measures the differentiation of cells within the prostate. Ziegler’s tumor showed poorly differentiated cells, which meant the cancer had infiltrated the gland more extensively than, say, a patient who graded a 2 or 4, signaling a more noticeable difference between healthy and cancerous cells.
But, even with the Gleason numbers, it is still guesswork for doctors to tell any patient just how fast his tumor might grow. For many men, cancer is slow-acting; for others, especially younger patients, it can be swift and aggressive.
– Cryotherapy. An investigative non-surgical technique that sends extremely cold liquid nitrogen into the prostate via a rectal probe. This freezes the prostate and causes cancer cells within the gland to rupture when they thaw. First used in the 1960s at the University of Iowa, the therapy is back in favor with some doctors because ultrasound equipment can more accurately guide the nitrogen than an unassisted probe can.
– Hormone therapy only. This is the least invasive method but not recommended unless the cancer has definitely spread beyond the prostate (Ziegler’s bone scan was clean). Men with such advanced prostate disease won’t benefit from surgery, and they risk side effects from the operation that can only further hinder the quality of their lives.
– Watchful waiting. Pessis didn’t advise this approach for Ziegler. Its premise is that if a cancer is confined to the prostate and is not aggressive, it doesn’t necessarily need to be treated, especially in older men. They simply go in for regular PSAs and DREs three to four times a year. Chodak has published controversial studies concluding that there is not much significant difference in life expectancy within the first 10 years for men who elect surgery, compared with those who practice watchful waiting with a cancer that appears to be confined to the prostate.
Chodak said his critics have made too much of his studies: “The statistics are comparing surgery and watchful waiting 10 years out on the curve. If you plan to live longer, then the numbers change (long-term studies are still developing, but it appears surgery or radiation are better performers than doing nothing). We don’t have the data yet that far out on the curve.”
For a man who may expect to live 10 or more years, the statistics point to surgery as the best option. Recurrence is minimal (a new multi-institutional study published in August estimated 6 percent) if there is no disease found beyond the capsule of the prostate, bladder, seminal vesicles or lymph nodes in the area. (Lymph nodes are routinely removed by some surgeons and sent immediately to the pathology lab for testing; a positive result indicates that the cancer has spread beyond the prostate and surgery is halted.)
There is a hitch: “Forty to 50 percent of the men who undergo radial prostatectomies are later found to have cancer beyond the prostate,” said Pessis. “We think the disease is isolated but we find microscopic cancer in pathology.”
These surgical patients then go back into a treatment cycle, usually for radiation or hormone therapy or both.
Radiation therapy presents the same problem and percentages, with the added concern that you haven’t removed any body parts to determine evidence of microscopic cancer. In addition, a recent Stanford University study showed that radiation “cured” only about 20 to 25 percent of patients after a decade. The remaining 75 to 80 percent can expect recurrence within about six to eight years, and roughly 50 percent of all radiation patients will become impotent within five years of treatment.
The statistics for cryotherapy are limited by its experimental nature. Hormonal therapy is applicable mostly to advanced cases, and research shows that although it can deter cancer growth, recurrence is likely within two years.
Of course, the percentages seem to be zero or 100 percent, good or bad, for each individual cancer patient.
“The public can sometimes get a bad picture,” said Pessis. “We have patients in all modalities who are doing well.”
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Paul Ziegler was leaning toward the radiation therapy recommended by Pessis but agreed to get a second opinion at the insistence of his daughter, a psychiatrist in Berkeley, Calif., who had been anxiously working the phones to learn all she could about her father’s disease. While she got different perspectives from numerous physician friends, there was consensus on one point: Get another opinion.
On May 20, the Zieglers visited Dr. Brendler at his University of Chicago offices in Hyde Park. The doctor previously had been sent the biopsy and MRI report.
“I don’t think radiation therapy is the way to go,” Brendler said.
Brendler explained his reasons: His opinion was that the tumor was probably Stage B and not beyond the capsule of the prostate. He discounted the accuracy of the MRI, which he said could be picking up minor hemorrhaging caused by probing during biopsies. Also, he knew of no evidence that using hormones before radiation helped at all.
“So what’s the probability the cancer has spread beyond the capsule?” asked Paul Ziegler.
“About 50-50,” said Brendler. “My recommendation is a radical prostatectomy.
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Surgery may be the “gold-standard” for men with cancer apparently confined to the prostate, but it presents complications that often worry the men more than disease itself. Doctors report a fair number of patients whose eyes “glaze over” when it’s mentioned that impotence is a possibility-anywhere from a 10 to 50 percent chance depending on the source of research statistics.
New surgical techniques, especially a “nerve-sparing” method invented by Dr. Patrick C. Walsh at Johns Hopkins, give hope of decreasing impotence. Even best-case, removal of the prostate means the man will have “dry” orgasms (no ejaculation) because the prostate is no longer making seminal fluid to transport the sperm produced in the testicles. Besides, it is 6 to 18 months before you know for sure if your potency has returned.
Walsh, co-author of “The Prostate: A Guide for Men and Women Who Love Them” (Johns Hopkins University Press, $15.95), urges any man considering surgery to find an experienced urologist. “Preferably, a doctor who does this operation every day or several times a week,” he writes. “Also, find out how often your surgeon’s patients require radiation therapy after surgery, or treatment with hormones. If the number is greater than 15 percent, this suggests the doctor either doesn’t do a good job selecting a surgical candidate or is not completely removing all cancer during surgery.”
Incontinence is another surgical complication that scares some men. Numbers vary, but 20 percent seems about the lowest estimate and 40 percent the highest. The moment of truth is when a temporary catheter is removed and the patient finds out if he can control his urine during the subsequent weeks.
Brendler said he recently conducted an anonymous survey of about 250 recent patients. More than 90 percent reported wearing one or zero incontinence pads (such as Depends) within six months of the prostatectomy. “We have new surgical techniques that are making it less and less likely men will face this problem in the future.”
In the here and now, Richard Feit is thrilled that his incontinence problems were completely cleared in four weeks.
“I feel fortunate,” said Feit, who credits a series of maneuvers known as Kegel Exercises for helping regain control of his bladder (as does Schwarzkopf). “I have friends who have been wearing pads for one or two years (after surgery).”
Bill Davies, who is 56, was also fortunate (though he did find out in mid-July that the surgery had removed all of his cancer). Two months after surgery, he candidly admitted to changing pads twice a day and visiting the bathroom nearly every half hour. By mid-August, his ability to control his bladder was nearly normal and he was optimistic about fully recovering his potency.
“I learned from reading up on prostate cancer before my surgery,” said Davies. “You better get over any shyness if you are going to help yourself.”
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Paul Ziegler left his second opinion meeting, “pretty much confused about the two wildly different viewpoints.”
During the next month, he consulted a radiologist at Lake Forest Hospital, who estimated Ziegler’s chances to live five years at 80 percent and to live 10 years at 70 percent if he decided on radiation treatment.
He talked for hours with his wife. He did more reading. He worried about incontinence if he elected surgery and suspected the chances for developing a problem were worse than some doctors explained. He lay awake at night, sifting through more information than he thought he could absorb.
A long four weeks later, he made his decision to stick with radiation therapy. He was already taking hormone shots in anticipation of his first radiation appointment Aug. 20; the hormone has caused him to gain some weight, and he is losing upper body muscle strength despite regular workouts in his health club’s weight room.
Ziegler said the early weeks of radiation sessions have been smooth, with none of the diarrhea experienced by some patients. Doctors told him he might start feeling fatigued by late September. He will undergo treatment for about 15 minutes each weekday morning for seven weeks.
“I figure I have a finite number of good years left,” said Ziegler. “Why spend the first recovering when the first one is likely to be the best year?
“My whole mental outlook has improved since I made the decision. What’s most disturbing about prostate cancer is there is a lack of any one clear answer. But I have come to grips with the 70 and 80 percent life expectancies. I feel good about things.”
INCREASED DANGER FOR AFRICAN-AMERICAN MALES
The trouble started during a trip about two years ago. Roosevelt Ferguson returned to his resort room on Hilton Head Island, S.C., only to find that he couldn’t urinate. When he failed again the next morning, local doctors inserted a catheter and suggested he fly home to Chicago for treatment.
So much for vacation. Within two weeks, Ferguson, then 59, discovered he had prostate cancer. His PSA level was an unbelievable 350 on a scale in which 4 is the high side of normal.
After six months of hormone therapy to decrease the frightening PSA level, Ferguson drove twice weekly to Fermi National Accelerator Laboratory in Batavia for a special neutron radiation therapy.
“The first day I bumped into one patient’s relative in the corridor,” recalled Ferguson. “She said, ‘You know, only the worst cases are referred here.’ “
Ferguson found more positive support when he joined a local chapter of the Us Too organization, which sponsors regular group sessions for men with prostate cancer.
“I saw a lot of survivors at the meetings,” he said. “That made me feel like I wasn’t alone.”
Ferguson is far from alone among African-American men who have been diagnosed with prostate cancer.
African-American men have the highest rate of prostate cancer among any population group in the world. There is no documented explanation, though researchers speculate that high-fat diets (especially animal fats) increase certain male hormones that might cause cancer. Scientists cite studies reporting high prostate cancer rates in the States compared with Asian countries that thrive on low-fat, high-fiber eating patterns.
Another theory holds that lack of ultraviolet rays from the sun will cause a vitamin D deficiency, which might lead to prostate cancer growth. One study revealed that black men from Zaire who moved to Belgium had much lower vitamin D content in their blood than blacks who remained in Zaire. Another piece of evidence: All men in the less-sunny Scandinavian countries and Canada run a higher risk.
In any case, Ferguson has become an advocate of each person learning more about his own risk.
“I make sure all of my friends are getting tested,” said Ferguson. “I don’t want this to creep up on them. At least two of my friends have discovered cancer in recent months.”
