(continued
- page 2 of 2)
(click here to return to page 1))
A
Primer on Prostate Cancer
Written and Compiled by Donna Pogliano
The
Primer has evolved into a book called "A Primer on Prostate
Cancer, The Empowered Patient's Guide", by Stephen B. Strum, MD, FACP
and Donna Pogliano, available through web booksellers, at local libraries and
bookstores and at the website of the publisher.
TREATMENT
OPTIONS
SURGERY
Radical prostatectomy (RP) is the surgical
removal of the prostate. It has a long track record. It is not effective as curative
therapy if there is spread of the cancer beyond the borders of the surgically
removed specimen. Most commonly, lymph node biopsy is done early during the radical
prostatectomy procedure, and if evidence of spread to the lymph nodes is detected,
the surgery may be aborted in favor of other treatment options, since the procedure
is not curative. However, there are convincing studies from the Mayo clinic showing
that patients undergoing radical prostatectomy with diploid tumor do exceptionally
well with androgen deprivation therapy despite lymph node metastases and the RP
affords significant benefit in such patients. There are also studies from Duke
University that indicate that RP in the setting of no more than two lymph nodes
involved confers a significant survival advantage.
Surgery affords the
benefit of allowing assessment of the size, distribution and aggressiveness of
the cancer by doing a full pathological exam of the removed gland and seminal
vesicles along with lymph node sampling, as opposed to the tiny samples obtained
by biopsy. Although this doesn't give a full representation of the extent of the
disease (distant metastases, for example) it does provide more complete information
than other treatments can.
Surgery may result in temporary or permanent
incontinence and impotence, but some patients accept that risk in the belief that
the procedure will result in the most favorable cure rate and thus, they will
have peace of mind for their future. RP is technically difficult surgery and requires
the selection of an artist to achieve outstanding results and to minimize adverse
effects.
Both surgery and radiation therapy destroy the prostate gland
resulting in dry orgasms. There is no ejaculate because the prostate can no longer
produce the fluid that it produced when it was intact.
Nerve-sparing surgery
is possible in some, but not all cases and cannot be determined prior to the procedure.
The doctor's goal in surgery is to remove all the cancer, not to preserve erectile
ability. If one or more nerves are spared, some men are able to achieve erections
unassisted or by use of Viagra or other similar drugs being tested and approved
for treatment of erectile dysfunction. Probability of regaining erectile ability
with or without Viagra after surgery increases if the patient is relatively young
(50 and under), if he had no erectile difficulties prior to his surgery, and if
he was sexually active before the surgery.
If Viagra doesn't work or both
nerves responsible for conducting the impulses from the brain resulting in erections
are removed, options include injections of drugs into the penis (again, not as
bad as it sounds and favored by many over other options), and vacuum erectile
devices (VED's) which manually draw blood into the penis resulting in an erection.
Some men have surgery to install penile implants if they are not comfortable with
the other options.
Incontinence is due to surgical involvement of the
muscles that control urination. Urinary incontinence may be temporary or permanent.
In general, younger patients recover full continence faster, while older patients
need to be just that-patient. Stress incontinence, releasing urine involuntarily
while lifting, coughing or sneezing, can be a lingering side effect, particularly
in older men. Incontinence as a result of RP is related to the skill of the urologist
doing the surgery.
Exercises, called Kegel exercises, are done to help
retrain the muscles responsible for containing and releasing urine at will. Other
options for long-term incontinence include drug therapies, physical therapy, biofeedback
and other options, including surgical implantation of an artificial urinary sphincter
or AUS.
In general, whatever the problem, there is usually some treatment
option available to you. And in the event of recurrence, you have radiation treatment
and/or hormone treatment to fall back on. However, the fewer the intrusions into
the human body the better. Therefore, it is important to try to properly select
the patient for a treatment that is most appropriate to him and to prepare the
patient for the therapy while always choosing an artist to perform the procedure.
RADIATION THERAPY
Radiation therapy (RT) is another commonly
used treatment for prostate cancer. There are several commonly used forms.
Brachytherapy
The word "brachytherapy" comes from the Greek words "brachy" meaning
"close by" and "therapia", in this instance, referring to a radioactive source
applied in or near the tumor.
Permanent Seed Implants (SI) or High
Dose Rate Temporary Brachytherapy (HDR)
Brachytherapy is available
in the two forms mentioned above. Treatment by permanent seed implant (SI) involves
injecting a number of radioactive seeds into the prostate gland. The seeds consist
of radioactive material encased in a titanium shell smaller than a grain of rice.
The radioactive material can be iodine, with a half-life of two months, or palladium,
with a half-life of two weeks. Your doctor will help make the determination as
to which is most appropriate for your cancer and will determine how many seeds
you need to adequately treat the size of your prostate gland. The smaller the
gland size, the fewer seeds you will need to adequately treat the entire gland.
The seeds are inserted through hollow needles, under anesthesia, through
the perineum (the space between the scrotum and the anus). This is usually "day
surgery" or done as an outpatient procedure and normally does not require an overnight
hospital stay. Some doctors place seeds in areas outside the prostate, such as
the seminal vesicles, if they are considered to be at high risk for cancer spread.
Sometimes external beam radiation in addition to seeding is necessary to kill
any cancer thought to have escaped the capsule and still be contained within the
pelvic region.
A major disadvantage of this form of treatment is inability
through the procedure itself to obtain evidence as to whether the cancer has spread
beyond the capsule to an area that the radiation from the seeds cannot reach.
Proper testing prior to the procedure is therefore very important. In addition,
patients considering either form of brachytherapy or considering surgery need
to refer to the Partin Tables and Bluestein predictions to obtain their percentage
for risk of extra-capsular penetration and lymph node involvement. You or your
doctor can determine these figures. The Partin Tables are also available on the
Internet. See the Resource List later in this primer under "Quick Reference."
The Partin Tables were compiled by analyzing prostate glands removed during surgery
to determine the spread to lymph nodes and seminal vesicles.
Treatment
by seed implantion can result in bowel and bladder problems, usually temporary
and treatable with medication. The urethra goes through the prostate gland and
the insertion of the seeds or wires can cause the prostate gland to swell, which
can cause in varying degrees, restriction of the urine flow from the bladder.
In severe cases a catheter may be used to overcome difficulties in urination that
arise as a result of brachytherapy. Self-catheterization kits are available for
home use if urinary retention problems persist for an extended period of time.
The procedure has the advantage of being inherently nerve-sparing, which
means that Viagra or new medications that act similarly will produce erections
in most patients. Incidence of at least partial impotence seems higher than usually
disclosed, especially in patients 70 and older. Longer term follow-up of patients
having brachytherapy and its effect on erectile function is needed.
Many
patients experience a rising PSA at some time after having brachytherapy. The
average time to this PSA "bump" is 18 months. This phenomenon is thought to be
the result of radiation-induced prostatitis, a reasonable explanation for this
bump in PSA. This stressful event can be avoided if patients know that a rise
in PSA may not necessarily indicate a recurrence of the cancer, pending the timing
of the PSA rise and the history of having received brachytherapy.
If however,
testing indicates the treatment has failed, traditionally the salvage treatment
is hormone therapy, but High Dose Rate (HDR) temporary brachytherapy is now also
being used for failed treatment by permanent seed implants. Surgery after radiation
is seldom done because of the high incidence of severe complications. Many men
prefer to avoid the increased risk of complications and elect hormonal therapy
instead. Cryotherapy (freezing the prostate) is now being used by some as a salvage
therapy after failure of primary treatment.
High Dose Rate Temporary
Brachytherapy (HDR)
High dose rate (HDR) brachytherapy is the other
form of brachytherapy. Unlike permanent seed implants, no "seeds" remain in the
prostate after treatment. The procedure usually involves an inpatient hospital
stay of about two days. Tiny plastic catheters (hollow tubes) are inserted into
the prostate gland and the tumor. The patient is then placed on a very high powered
CAT scan to aid in refining the position of the catheters to ensure there are
no cold spots. A computer-controlled machine then pushes a single highly radioactive
iridium wire into the catheters one by one. The wires are left there for a few
seconds, then removed.
The computer can control the length of time a single
wire remains in the catheter and therefore precise dosages to different areas
of the prostate and the tumor are possible. The tumor itself can be treated with
a higher dose of radiation, while sparing healthy tissue and surrounding organs,
thus bowel and bladder complications are more likely to be minimized. Patients
report that no urinary catheter was necessary after this treatment.
The
goal of this procedure is to destroy the cancer quickly, with higher doses of
radiation than could be permanently implanted. Ideally, placement of the radiation
is very precise, leaving no cold spots. HDR, in use for over ten years, is gaining
acceptance as a highly effective alternative to conventional permanent seed implants.
It is presently done in just over a dozen places in the United States. (See the
Resource List.) The equipment and training are very expensive, but the cost of
treatment is competitive.
HDR is usually combined with external beam radiation
therapy to destroy cancer that may have escaped the capsule yet still remains
within the pelvic region.
External Beam Radiation Therapy
Another
type of radiation is external beam radiation therapy (EBRT). Some radiation oncologists
use EBRT in conjunction with treatments to the pelvis in an attempt to cure prostate
cancer that is not organ confined. Full pelvis EBRT seems ineffective in curing
the cancer and may result in bowel and bladder problems due to radiation being
poorly directed and affecting healthy tissue.
However, there is new technology
in the field of external beam radiation. 3-D conformal beam radiation therapy
(3D CRT) comes highly recommended and is widely used, particularly in conjunction
with brachytherapy to be sure any cancer which has spread to the immediate area
surrounding the gland is also killed. In this procedure, marks are made on the
body, or a custom-made body mold is made for positioning the patient during the
treatments to help insure that the radiation is delivered precisely to the intended
area. Various other techniques are employed in modern beam radiation treatment
to control for such factors as the movement of the prostate and variations caused
by fullness of the bladder or bowel.
Intensity Modulated Radiation Therapy
(IMRT) is another major advance in treating prostate cancer that minimizes radiation
to the normal tissues. IMRT uses sophisticated computer planning that allows the
radiation oncologist to designate how much RT he wants administered to both malignant
and normal tissues. The IMRT hardware allows variation of the dose of RT while
the equipment moves around the patient to fulfill the equation determined by the
computer. This is a serious advance in the technology of RT and should be the
basis for all radiation in the near future. See the July, 2000 issue of Insights
(PCRI) for a full discussion of IMRT. (See the Resource List under General Information.)
Proton Beam Therapy
Proton beam therapy is a lesser-known
radiation therapy done at only a few centers in the United States. It does not
currently have a long track record, so long-term cure rates are uncertain. It
uses the proton instead of the photon for the treating particle. Protons have
the ability to be more sharply focused and their energies fall more within the
target tissue (the prostate and seminal vesicles) than outside the gland. Comparison
studies of proton beam vs. 3D CRT or IMRT have not yet been done.
ANDROGEN
DEPRIVATION THERAPY (Hormone Therapy)
Hormone therapy is recommended
for patients whose prostate gland is too large to be effectively treated with
EBRT, brachytherapy or cryosurgery, and needs to be reduced in size before these
procedures can be performed. Hormone therapy can thus make these local therapies
more effective and reduce their side effects.
Hormone therapy is sometimes
used in conjunction with various radiation therapies for the purpose of limiting
testosterone production and reducing tumor volume, since this will increase the
effectiveness of RT and yield a higher disease-free rate. EBRT of any kind, brachytherapy
and cryotherapy are all volume-dependent treatment modalities. If there is too
much tumor volume, they will not be effective.
Some patients who feel
the need to buy time for one reason or another-to research their options for treatment
or because of some other pressing life issue that prevents immediate treatment
may initiate ADT. ADT is sometimes used for this purpose, but it may not be necessary
and may preclude treatment at some centers.
For men with advanced prostate
cancer, ADT is the only currently recognized effective treatment option. For some
men with distant metastases, this therapy can work for many years. Intermittent
androgen deprivation therapy can have a positive impact on quality of life because
in off cycles, the patient gets a break from the side effects of treatment.
This
therapy typically uses drugs to eliminate the production of testosterone by the
testes, thus removing the nourishment to the cancer. Some patients choose this
therapy as primary treatment because they are unwilling to undergo a more invasive
treatment for health reasons, due to advanced age, or other factors. However,
be aware that the side effects of ADT are many and varied, although not all patients
experience all of the possible side effects. One common side effect of long-term
ADT is osteoporosis, which compromises the integrity of the bones and can result
in fractures, bone pain and shortening of height due to compression fractures
of the spinal vertebral bodies.
Younger men typically wish to avoid ADT
because it results in decreased libido (sex drive). However, some informed younger
men are using hormone therapy as primary treatment, with the idea that there are
many fall-back options if it is not effective. If the disease is brought under
control, a patient may be able to stop the medication intermittently for long
periods and would still have his prostate. Once the prostate is destroyed, orgasms
are "dry", that is, without ejaculate. Some men report that the sexual experience
is thus permanently diminished for them.
Effects of temporary ADT for
a short term (less than two years) are typically reversible once testosterone
production is naturally resumed by the body, or resumed by introduction of testosterone
drug therapies.
Cancers that have spread to the bone can be dramatically
halted or slowed by ADT resulting in almost immediate pain relief. Testosterone
production can also be halted by surgical removal of the testicles (orchiectomy)
and by drug intervention to block male hormones (androgens) produced by the adrenal
glands as well as the testicles. Agents like Ketoconazole (Nizoral) have this
ability.
Orchiectomy is a surgical procedure in which the testes are removed
from the scrotum surgically, so the testosterone they produce is unavailable.
This is an irreversible method of depriving the body of testosterone. It is sometimes
done for reasons of economy, because the drugs involved in hormone therapy are
very expensive. Both orchiectomy and drug ADT are capable of reducing the testosterone
to castrate level.
The use of ADT is complex and controversial. The options
for specific drugs to be used alone or in combination need to be thoroughly discussed
with your doctor. If you are a candidate for this therapy, it is recommended that
you research all of your options very carefully.
WATCHFUL WAITING
Watchful
Waiting (WW) is an option for some cancers. A cancer that appears to be slow growing
and organ confined may require no local treatment for some time, if ever.
Some
patients feel that they can preserve their quality of life by avoiding more aggressive
treatment and proper testing can help determine if this is an option for any specific
case.
Watchful waiting does not mean doing nothing. It implies that the
patient is embarking on a regimen of diet and exercise best suited to his condition
in consultation with his doctor. See the Resource List later in this primer under
"Diet & Lifestyle" for specific information on what the experts recommend in this
regard and what current research indicates. Some patients using watchful waiting
are using herbal supplements, meditation, exercise, prayer, humor and a variety
of other methods in concert, in an attempt to control the disease. It is wise
to closely monitor the cancer in the event that more aggressive treatment seems
indicated.
CRYOTHERAPY
Cryotherapy is a lesser-known therapy
that is gaining some acceptance. Hollow needles are inserted through the perineum
and liquid nitrogen is used to freeze the prostate and destroy the cancer. This
therapy is being used as a salvage procedure in the event of recurrent cancer
after EBRT or brachytherapy has failed. However, it is a reasonable primary therapy
for prostate cancer that is organ confined or that is associated with minimal
disease extension into the capsule. This therapy mandates the choice of an artist.
MICROWAVE THERMOTHERAPY
New on the horizon is microwave
thermotherapy, just recently approved by the Federal Drug Administration for use
in the U.S., offering an alternative for those men who are not good candidates
for surgery. This therapy heats the gland, thus killing the cancer. There are
also no established cure rates as yet for this relatively new treatment.
TREATMENTS
ON THE HORIZON
There is currently no "magic bullet" to cure prostate
cancer. However, research and clinical trials are proceeding to develop medications
that will search out and destroy cancer cells in the body by various methods.
In the future, some of these therapies may gain approval by the Federal Drug Administration
and be put into use by the general public.
Aptosyn (Exisulind) is a drug
that has been successfully used in clinical trials and is undergoing further testing.
It theoretically directs precancerous and cancerous tissue to self-destruct without
harming healthy tissue. This is one of a number of "smart bomb" drugs in clinical
trials. The FDA is expected to give approval on this drug manufactured by Cell
Pathways, Inc.
There are also numerous other drugs under clinical testing
that may hold promise for future treatment. Anti-angiogenesis drugs (Endostatin,
for example) may eventually be available to "turn off the switch" in molecules
that signal blood vessels to develop and nourish tumors. Without nutrients, the
tumor shrinks.
Vaccines are also being tested which use the body's own
immune system to cause death of cancer cells.
Chemotherapy is used in
the treatment of prostate cancer in advanced stage disease in the hope of slowing
the growth of the cancer and prolonging life. There is an experimental treatment
currently being investigated, using imaging with vitamin B-12 to detect tumors.
This could be used as a vehicle to destroy tumors by attaching a lethal anti-tumor
agent to vitamin B-12, which tumors use to build their network of cells and blood
vessels. Tumors are detected by use of vitamin B-12 because of higher B-12 concentrations
than in normal tissue, since tumors require more of this vitamin than normal tissues
require.
CLINICAL TRIALS
Drugs being tested and other experimental
therapies are the subject of clinical trials. Clinical trials are not usually
a preferred primary treatment option. But for patients who feel they have few
options left, clinical trials may be appropriate.
These trials are done
in Phases, with Phase I being the most experimental, to determine proper dosages.
Phase II is usually a trial done on a limited number of patients, once optimum
dosage is determined. Phase III is usually a widespread test population which
precedes the application for approval by the Federal Drug Administration to make
the drug or treatment available to the general public.
If you are considering
becoming involved in a clinical trial, you need to research thoroughly and ask
questions. Will you get the drug or will you be part of a double-blind study in
which a control group does not get the medication or treatment? What will the
side-effects likely be? Will you be able to leave the test at any time if you
choose? Will you be eliminated from the test under certain conditions? Do you
fit the criteria for involvement in the test you are considering?
The
costs of clinical trials are not currently covered by most insurance plans, but
new legislation may bring changes in this policy, making participation in clinical
trials possible for more patients, resulting in faster progress in developing
new medications and treatments.
RESOURCE LIST
Books,
Web sites and e-mail mailing lists
The information provided in this
Resource List is included in an attempt to provide prostate cancer patients and
those who love them with help in their search for information about their disease.
This list in no way is intended to be all-inclusive and it certainly could never
exhaust all the information available on any particular topic. Some of the resources
included are commercial sources, since the profit motive in many cases has provided
the impetus for the existence of the material.
It must be recognized that
the people responsible for providing this Primer on Prostate Cancer and its informational
content have no financial interest or connection with any person, product or institution
included in the Resource List, nor are they endorsing any particular product,
institution, person or treatment modality. Inclusion of a resource does not imply
or constitute any endorsement, and conversely, omission of any product, institution,
person or other resource does not imply or constitute a negative endorsement.
BASIC INFORMATION:
"Prostate & Cancer, A Family Guide to
Diagnosis, Treatment and Survival" by Sheldon Marks, M.D., specifically recommended
for it's good organization and completeness. This book may be a little outdated
in terms of newer treatments such as high dose temporary radiation therapy and
cryotherapy, since these procedures are in more widespread use since the book
came out, but it is still a valuable resource.
A book that can be read
on line A Revolutionary
Approach To Prostate Cancer by cancer survivor Aubrey Pilgrim
QUICK
REFERENCE
Full description of TNM Staging
designations
A discussion of Clinical Stage with color illustrations is
to be found in the July, 2000 issue of INSIGHTS,
published by the Prostate Cancer Research Institute (PCRI) with the financial
support of the Life Extension Foundation. Call to be placed on the mailing list
at (310) 743-2116, or Fax your request to (310) 743-2113. Or look for Newsletter
at the PCRI home page.
Information
on Markers and Tests for prostate cancer.
The
Partin Tables
Expert
pathologists to confirm Gleason score.
Questions
to ask your doctor.
HIGH DOSE RATE TEMPORARY BRACHYTHERAPY (HDR)
Listed
below are some of the links and web sites relating to HDR. This is not intended
to be a complete listing of all manufacturers, hospitals and centers involved
with HDR, nor is it to be construed as an endorsement of any product or treatment
center. These resources are listed to provide an overview of HDR and how it is
performed.
These Cancer
Treatment Centers of America at Tulsa (CTCA) Web sites have explanations of
HDR while the web
site of the California Endocurietherapy
Cancer Center in Oakland, California also gives good information and
Brachytherapy/Seed Implants provides some thought provokong material.
DIET
& LIFESTYLE
The Prostate Cancer Protection Plan - The Food, Supplements,
and Drugs that Could Save Your Life by Dr. Bob Arnot. This is a new book that
includes nutritional and lifestyle recommendations for use in preventing and controlling
prostate cancer.
Choices
in Healing: Integrating the Best of Conventional and Complementary Approaches
to Cancer by Michael Lerner. Available on line.
Eating Your Way to Better
Health: The Prostate Forum Nutrition Guide, by Charles E. Myers, Jr., M.D., Sara
Sgarlat Steck, RT, and Rose Sgarlat Myers, PT, PhD.
Dietary advice is
available through the Prostate
Cancer Foundation.
GENERAL INFORMATION
The American
Cancer Society phone number is 1-800-227-2345. The American Cancer Society
has a free program called "Man to Man" where survivors offer support to the newly
diagnosed. There is also an interactive section in which people can e-mail oncology
nurses with questions and obtain referrals.
Prostate
Cancer Research Institute (PCRI) is a non-profit educational and research
organization with valuable information regarding prostate cancer. PCRI publishes
Insights, a newsletter covering in-depth areas of key science and key concepts
in prostate cancer. PCRI is at: Helpline number is 800-641-PCRI or 310-743-2110
EMail address is help@pcri.org
TREATMENT
DECISIONS
A helpful guide to determining appropriate treatment options
(a Decision Tree) is at the National Comprehensive
Cancer Network site
Also consult: National
Cancer Institute at 1-800-4-CANCER.
RADICAL RETROPUBIC PROSTATECTOMY
SURGERY
The Prostate: A Guide for Men and the Women Who Love Them,
by Patrick C. Walsh, M.D. and Janet Farrar Worthington.
PERSONAL ACCOUNTS
Surgery:
Man to Man: Surviving Prostate Cancer by Michael
Korda. This is a book specifically dealing with a patient's experience with surgery.
People report that it frightened them, but they were glad they read it. Your library
may also have this book on cassette tape.
Prostate Cancer, A Survivor's
Guide by Don Kaltenbach
My Prostate and Me by William Martin
Brachytherapy:
Seeds of Hope by Michael
Dorso, M.D. may be available on line, but is now available as a paperback. This
is a personal account by a doctor who had permanent seed implants (brachytherapy),
hormone therapy and conformal beam radiation. Cost was $6 to obtain it on line.
DISCUSSION GROUPS
If you have e-mail access, there are
a number of discussion groups available to you for support and technical information,
sharing experiences and asking and answering questions. All are free of charge.
Prostatepointers offers mailing lists specific to various treatment modalities
and a support list called "Circle." Address an e-mail to: Majordomo@www.prostatepointers.org
leaving the subject line blank, and write "subscribe" in the body of the message.
In a few minutes, you will be sent information on which discussion lists are on
the system and how to subscribe to them.
An extensive network of discussion
groups, archives, encyclopedia of information, practitioner lists for various
therapies, lab recommendations for second opinions, Partin Tables, you name it,
its there, at Patients Helping
Patients.
SUPPORT GROUPS
You may or may not wish to
join a formal support group and attend their meetings. If you have the need or
the curiosity, or just want to go to see what help you can be to others, your
local hospital can probably put you in touch with your local chapter of US
TOO! International, Inc.
A support group affiliated with the American
Cancer Society is "Man to Man." Contact your local hospital or the National Cancer
Information Center at 1-800-ACS-2345 to get information about your local chapter.
SHARING AND CARING
A website dedicated to helping men and
their companions with the deeply personal issues created by prostate cancer is
Phoenix5. This site also features an excellent
interactive glossary of terms.
Another excellent and highly recommended
support and information network is called "You Are Not Alone" (YANA)
with a wealth of good advice and information
HELPLINES
Physician to Patient (p2p) is a mailing list which allows patients
to ask specific questions related to their case of doctors who volunteer their
time to write answers which are posted to the for the education of all. It can
be accessed through: Majordomo@www.prostatepointers.org
Address an e-mail as shown above, leaving the subject line blank, or show a dash
(-) if required, and write "subscribe p2p" in the body of the message, and under
it, write "end." In a few minutes, you will receive a welcome memo and instructions
on how to present your prostate cancer digest.
Prostate Cancer Research
Institute (PCRI) has a telephone Helpline at (310) 743-2110.
PRACTITIONERS
The Prostate
Cancer Address Book (PCAB) lists outstanding people in the world of prostate
cancer.
SO...
You will change as a result of having prostate cancer touch your life.
It's not ALL bad. You are a member of the fraternity now. And you have opportunities
born of adversity to change the lives of others.
Many people report oddly
incongruent benefits of having been diagnosed with cancer as they progress down
this road. Some say that life seems more precious, their relationships improve,
they find new joy in simple pleasures, they become more spiritual, they live each
day as if it were their last, they appreciate everything more, they have found
a new intimacy with their partners, they define sexuality in a more mature fashion,
they have found new friends, formed new attitudes, embarked on healthier lifestyles...the
list goes on and on.
We hope the information contained in this prostate
cancer primer will be helpful to you and that you will discover additional information
through your further research. Your first task is to educate yourself about your
own condition, then hopefully, you will be in a position to educate other men
and their families about prostate cancer and to urge them to have regular annual
screening in the form of PSA testing and digital rectal exams.
We wish
you low PSA's, and may your days be good, and long upon the earth.
-------------------------------
Compiled
and written by: Donna Pogliano Partner of a warrior in the battle against prostate
cancer. E-mail address: dpogliano@core.com
You
may print one copy of A Primer on Prostate Cancer for your own personal use. The
entire document is available for easy printing as a Word.doc
file (98 KB) or in Adobe.pdf (150 KB)
My
special thanks to Georann Whitman and her family who provided the inspiration
for the primer.
My thanks to the following men and women who reviewed
the document, contributed material or provided moral support:
Grayson
S. Young
Terry Herbert
Aubrey Pilgim
Michael Dorso, M.D.
Jim Lamberth
Joe Armon
LaVonda Hurlbut
Esther Kutnick
Howard Waage
Ann
Salvato
Rip Rinehart
Ramon Henkel
Stephen Strum, M.D.
Robert Vaughn
Young
Copyright
Donna Pogliano © 2000. All rights reserved.
