This is one of the best stories on a prostate cancer journey that I have seen on video since I posted a blog on Rudy Giuliani.  These two political icons had access to a massive amount of information about their prostate treatment options….and then made opposite decisions: Senator  John Kerry chose surgery , while Mayor  Rudy Giuliani chose radiation seeds and external beam radiation.

Taken together, their compelling stories illustrate that there are many options in prostate cancer (as there are in breast cancer) and that men with prostate cancer need to be informed about all of their options, including the benefits, risks, and side effects of surgery on the one hand, or radiation therapy on the other. While the best evidence is that these two treatment approached have the same survival outcomes, the side effects and toxicities  are quite different. In the end, many men with prostate cancer have a major role in deciding which treatment is best for them.

Speaking at a LIVESTRONG Conference (Lance Armstrong Foundation ), Senator Kerry began his story by describing his personal experience with the tragedy of his father who died of prostate cancer. In his situation, Sen. Kerry had a PSA of 2.2 that rose to 2.7 based upon his annual physical exam. His wife, Teresa Hines Kerry told him, “That tick of 0.5 is significant and you should go back to your doctor”.  (I might have ignored this small elevation too! Husbands: listen to your wives…it may save your life!).  He then described the process of getting a rectal ultrasound, prostate biopsies, and communicating the “bad news” to his family.  He pointed out that “relationships change” when you carry the diagnosis of cancer.

How did Sen. Kerry approach this issue as a newly diagnosed prostate cancer patient? First, he read everything he could about prostate cancer, on the web and also from Dr Patrick Walsh’s book on prostate cancer. Next , he talked to many doctors of different specialties as well as other prostate cancer survivors about their experience. After reviewing all of his options, he chose surgery (at Memorial Sloan Kettering Cancer Center), with a prostatectomy and reported that he did very well after his surgery.

I have posted blogs about several famous people with prostate cancer, including Rudy Giuliani, Don Imus, Arnold Palmer, and Sen. Chris Dodd. Note that all of these stories include the importance of a physical exam (i.e. a rectal exam) and a screening PSA which was the method of first detecting the prostate cancer for all of these gentlemen. They also describe having a PSA as a monitor for recurrence.

The use of screening PSA tests is controversial. And the American Cancer Society has changed its recommendation to downgrade its value as a screening test at a national level (*see their policy statement below). Nevertheless, many men (including me) have an annual PSA because we believe in its value.  For more information about this see my blog “To Screen or Not To Screen: Detecting Prostate Cancer“.

In the circumstance with Sen. Kerry, cancer hit his family hard, since his wife had breast cancer (See my blog on Teresa Heinz Kerry) and his father died of prostate cancer.  Educate yourself so you’re prepared if your family faces similar circumstances. Sen. Kerry read Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer, which I would also highly recommend. Also for more information about prostate cancer, see our companion website: www.patientresource.net.

The American Cancer Society’s position on PSA screening:

“The American Cancer Society (ACS) does not support routine testing for prostate cancer at this time. ACS does believe that health care professionals should discuss the potential benefits and limitations of prostate cancer early detection testing with men before any testing begins. This discussion should include an offer for testing with the prostate-specific antigen (PSA) blood test and digital rectal exam (DRE) yearly, beginning at age 50, to men who are at average risk of prostate cancer and have at least a 10-year life expectancy. Following this discussion, those men who favor testing should be tested. Men should actively take part in this decision by learning about prostate cancer and the pros and cons of early detection and treatment of prostate cancer.

This discussion should take place starting at age 45 for men at high risk of developing prostate cancer. This includes African American men and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65). This discussion should take place at age 40 for men at even higher risk (those with several first-degree relatives who had prostate cancer at an early age). If, after this discussion, a man asks his health care professional to make the decision for him, he should be tested (unless there is a specific reason not to test). ”

For more information, go to their website at www.cancer.org.

Yet another well-known politician has announced that he has prostate cancer. Senator Chris Dodd (Democrat, Connecticut) described his experience that began with a rising PSA (Prostate-Specific Antigen; a  blood test). This screening test plus a physical exam first detected what is apparently a very early stage of prostate cancer. He then had a biopsy which showed prostate cancer.

Like so many other stories, Senator Dodd described  “getting a lot of information” from others, including fellow United States Senators who previously were treated with prostate cancer. He decided to have prostate surgery at Memorial Sloan Kettering Cancer Center. His story is very similar to that of Sen. John Kerry.

As Sen. Dodd described, his type of prostate cancer is very common and may affect one in six men, depending upon how long they live.  It can be a very manageable cancer with a good prognosis if it is detected early. That’s why I agree with those who recommend an annual PSA blood test as part of their annual physical exam (including a rectal exam). Our readers should know that the American Cancer Society has a more reserved recommendation about the use of PSA for prostate cancer screening (see below for details from the American Cancer Society).

Sen. Dodd joins a number of other famous people with prostate cancer with whom I have blogged in the past. This includes Mayor Rudy Giuliani, Don Imus, Arnold Palmer, and Sen. John Kerry.

For more information about prostate cancer surgery, go to our blogs about this subject. For more print information, go to our companion website www.patientresource.net.

American Cancer Society statement on PSA screening:

The American Cancer Society (ACS) does not support routine testing for prostate cancer at this time. ACS does believe that health care professionals should discuss the potential benefits and limitations of prostate cancer early detection testing with men before any testing begins. This discussion should include an offer for testing with the prostate-specific antigen (PSA) blood test and digital rectal exam (DRE) yearly, beginning at age 50, to men who are at average risk of prostate cancer and have at least a 10-year life expectancy. Following this discussion, those men who favor testing should be tested. Men should actively take part in this decision by learning about prostate cancer and the pros and cons of early detection and treatment of prostate cancer.

This discussion should take place starting at age 45 for men at high risk of developing prostate cancer. This includes African American men and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65). This discussion should take place at age 40 for men at even higher risk (those with several first-degree relatives who had prostate cancer at an early age).

If, after this discussion, a man asks his health care professional to make the decision for him, he should be tested (unless there is a specific reason not to test).

For more information, go to their website at www.cancer.org

Here is an inspiring, but poignant story by a legacy in golf, Arnold Palmer, a 14 year prostate cancer survivor. Cancer has ravaged his family, as it does in many others. His wife, Winny, died of ovarian cancer in 1999, and his daughter had breast cancer at age 32, but who is living today over 15 years later!

Arnold Palmer has been a great spokesman for cancer, is a dedicated cancer survivor, and has “given back” to the cancer community with the many cancer programs and buildings he has funded. You’ll enjoy his story!

Here’s more information from our companion website, patientresource.net:

With the widespread use of prostate-specific antigen (PSA) testing to identify men at increased risk of prostate cancer, more individuals have been diagnosed with prostate cancer than in the period before PSA testing was widely available (pre-1992). Cancers diagnosed through PSA testing are often early stage or less advanced cancers. According to data from the National Cancer Institute, more than 90 percent of all prostate cancers are now diagnosed at a less advanced stage and men are surviving longer after diagnosis and treatment.

PSA is a widely used biological marker, or biomarker, of prostate cancer risk. A lot of research is currently being done to identify other biomarkers of risk that may enhance the predictive value of nomograms and improve a physician’s ability to predict capsular penetration and distant metastasis (spread) of prostate cancer, as well as cancer recurrence after treatment. A nomogram, as defined by the National Cancer Institute, is a mathematical device or model that shows relationships between things. For example, a nomogram of height and weight measurements can be used to find the surface area of a person, without doing the math, to determine the right dose of chemotherapy. Nomograms of patient and disease characteristics can help predict the outcome of some kinds of cancer.

Once prostate cancer is diagnosed, you and your doctor must go through a process of risk assessment, estimating the likelihood that your cancer has or may spread outside the prostate and assessing your risk of disease recurrence after treatment. This assessment combined with characteristics of your overall health will allow your doctor to advise which treatment option will benefit you the most. Your doctor will use factors such as your Gleason score, PSA level, tumor stage and the number of tumor samples (called cores) taken by biopsy that are positive for cancer.

Radio personality Don Imus has announced that he developed prostate cancer. Listen to his description of how his PSA has varied and gone up and down over the years. This video is just a heads-up for men in the older age group to get a regular PSA test as part of your annual health check-up. Here’s more information from our companion website, patientresource.net:

PSA is a widely used biological marker, or biomarker, of prostate cancer risk. A lot of research is currently being done to identify other biomarkers of risk that may enhance the predictive value of nomograms and improve a physician’s ability to predict capsular penetration and distant metastasis (spread) of prostate cancer as well as cancer recurrence after treatment. A nomogram, as defined by the National Cancer Institute, is a mathematical device or model that shows relationships between things. For example, a nomogram of height and weight measurements can be used to find the surface area of a person, without doing the math, to determine the right dose of chemotherapy. Nomograms of patient and disease characteristics can help predict the outcome of some kinds of cancer.

New approaches to risk assessment for prostate cancer are also emerging that combine biomarker testing, biopsy tissue analysis and clinical data to provide personalized risk assessments that could improve the accuracy of predicting patient outcomes from cancer treatments.

OK guys, listen to Rudy Giuliani talk about his prostate cancer. It’s a common disease for men older than 60 and it’s tragic if the cancer grows outside the capsule of the gland or worse, if it spreads to the lymph glands or to the bone. Many men suffer mightily because they didn’t want to have their prostate checked (not a particularly fun part of a physical exam, I’ll admit), but it does save lives.

At least get to know the guidelines for when you should have a blood test for your PSA levels. I know, there are controversies about the PSA test, but I would clearly weigh in on the side of having your PSA checked periodically. Ask your doctor what he or she thinks would be the right thing for you to do.

Here’s more information from our companion website:

With the widespread use of prostate-specific antigen (PSA) testing to identify men at increased risk of prostate cancer, more individuals have been diagnosed with prostate cancer than in the period before PSA testing was widely available (pre-1992). Cancers diagnosed through PSA testing are often early stage or less advanced cancers. According to data from the National Cancer Institute, more than 90 percent of all prostate cancers are now diagnosed at a less advanced stage and men are surviving longer after diagnosis and treatment.

Once prostate cancer is diagnosed, you and your doctor must go through a process of risk assessment, estimating the likelihood that your cancer has or may spread outside the prostate and assessing your risk of disease recurrence after treatment. This assessment combined with characteristics of your overall health will allow your doctor to advise which treatment option will benefit you the most. Your doctor will use factors such as your Gleason score (see Staging Prostate Cancer, page 73), PSA level, tumor stage and the number of tumor samples (called cores) taken by biopsy that are positive for cancer.

A variety of factors and tools can be used to assess your chances of surviving prostate cancer and the effectiveness of treatment in halting the progression of the disease. Among the tools your doctor may use are Internet-based calculators or nomograms, published tables and biological markers that may help predict outcomes.