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Recommended reading for prostate cancer awareness month
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HemOnc Today does not usually review books, but a recent one warrants high recommendation. Invasion of the Prostate Snatchers is a well-written piece that will provide a much needed safe harbor through the shoals of prostate cancer decision-making for oncologists and their confused patients.
Written by Ralph Blum, a multi-published novelist and cultural anthropologist, and Mark Scholz, MD, an internist/oncologist who specializes solely in prostate cancer care, the book is worth careful perusal. Chapters alternate between Blum, who was found to have modestly elevated PSA levels 20 years ago, when he was in his 50s, and Dr. Scholz, who encouraged Blum’s skepticism about suggested diagnostic and therapeutic endeavors.
In the book, Blum learns from his own literature searches and Scholz’s knowledge that taking advice solely from surgeons (urologists) is not particularly wise. His skepticism allows him to resist being herded into the biopsy/radical prostatectomy corral. Blum learns that even with high-risk disease (progressively increasing PSAs, high Gleason scores and significantly enlarged, palpable nodules), only 5% of patients will die of the disease, even if untreated.
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He also obtains straight talk about the nasty side effects suffered by more than one-third of patients after radical prostatectomy (including robotic and cryo techniques), radiation (including intensity modulation and brachytherapy radiation) and testosterone inhibition.
In turn, I personally learned of a most promising noninvasive diagnostic technique (Combidex) that uses nanoparticle iron infusion followed by MRI that accurately determines whether lymph nodes are invaded. The book suggests that the FDA’s split decision not to approve the technique 5 years ago was seriously flawed and should be revisited. Evidently, the technique has been used beneficially in Europe and provides critical information toward tailoring therapy (or no therapy) for intermediate-risk patients.
I plan to advise anyone — patients, friends or relatives — who asks my advice about how to deal with a moderately elevated PSA to read this book and especially to heed Blum’s pithy but sage summary remark: “Deciding on the best therapy requires disciplined thinking as it relates to risk category. So if you’re at the deciding stage, take a deep breath, or take a shot of Jack Daniel’s, read this chapter (chapter 16) several times, and then decide what to do.”
I would add: Find an internist/oncologist who solely specializes in caring for prostate cancer patients and is willing to unfailingly follow, when appropriate, the dictum: “Don’t just do something, stand there.”
For more information:
- Scholz M, Blum R. Invasion of the Prostate Snatchers: No More Unnecessary Biopsies, Radical Treatment or Loss of Sexual Potency. New York: Oxford Press; 2010.