POSTED ON JANUARY 12, 2011:
A Probing Look at the Possibilities and Realities of Fighting Prostate Cancer
Curveballs are a natural part of life. Children get sick and keep parents home from work, the car breaks down right as the bank account is drained or day one of a ski trip results in an unusable broken leg.
Usually, there is no foresight to delay or lessen the blow of life's little trickeries and though effort to contain the uncontainable often seems futile, there are moments in a lifetime to charge, full-steam ahead in defense of the unforeseen.
Most are not aware of the health battles they will face later in life, but imagine knowing in advance if a flu was creeping in or an infection was about to invade. A warning of impending ailments long before symptoms set in would make quite a difference in everyday living.
While it may not be possible to accurately predict colds, infections or cancers, science does afford us some options of early detection for certain ailments, if pursued.
Prostate cancer is among these, but despite recent scientific advancements, the disease remains the second leading cause of cancer-related death among men.
The American Cancer Society estimated that 2,400 men in Oklahoma were diagnosed with prostate cancer in 2010, and that 320 would likely die from the disease.
Now that the reality of the disease has parked itself in Oklahoma's backyard, it's time to dig a little deeper and uncover the truth behind this hush-hush topic. Men are far less likely to discuss their health concerns than women and ignoring the issue does not make it go away. It's time to man-up, get the facts and start doing something about it.
For anyone not residing under a rock, other than Halloween and the long-awaited welcome of cool fall weather, what does October represent? Pink ribbons ¬-- ring a bell? While the research, funding and media attention for breast cancer is much needed and greatly appreciated, it overshadows prostate cancer awareness by leaps and bounds. This is a warning, the sounding of an alarm, and a call to arms for men that assume 'it can't happen to me.'
Recognizing prostate cancer is the first step. Unlike breast cancer, prostate only affects men. While the disease is no respecter of economics or genealogy, some men are more likely to contract it than others.
"There is an inordinate amount of prostate cancer seen in African American men," said Dr. Ritwick Panicker of Tulsa's Cancer Treatment Centers of America. "It can occur at any age between 40 and 80 but is more common as men age."
Between 2002-2006, the average age of diagnosis was 68. In modern terms, 68 is still relatively young, and with at least half of the diagnoses coming at or before the age of 68, it is increasingly important for men to be aware of the risks.
"It becomes more common with age but that doesn't mean that younger men cannot receive prostate cancer," Panicker said. "In real life, having seen patients in the 40 to 50 age group, even though it's uncommon, I would recommend that screening starts at age 40. Now all experts don't particularly agree with that."
Some studies suggest that 1 in 6 men will be diagnosed with prostate cancer in their lifetime and that 1 in 36 will die from this the disease. The earlier men are screened, the better the chances of catching the cancer early in its development. Only lung cancer surpasses these grim statistics in men.
"If you have a family history, if you're of African American descent, if there is a family history of breast cancer, you may have an inherited tendency to develop prostate cancer earlier," Panicker said.
Now, it is easier said than done when trying to convince men to be checked for potential health problems. Screening for prostate cancer is simple, though uncomfortable.
"The way we screen for prostate cancer in a man is to do a digital rectal exam, even though it's uncomfortable," Panicker said.
The physical exam is followed up by a PSA test, a blood screening named for a prostate-specific antigen, the detection of which is a biological marker for the cancer. A primary care doctor should perform the PSA test at annual physical exams. Men without symptoms should still be physically examined.
For those without symptoms -- which include difficulty with urination, frequent need to urinate with an inadequate results each time or waking during the night to urinate -- should address the possibilities of cancer immediately. Men should be aware that while many of these symptoms could point to prostate cancer, the symptoms can occur for other reasons as well and do not necessarily mean the patient has prostate cancer.
"When patients present these symptoms to a doctor, we need to do a digital rectal exam and a PSA. If either is abnormal, follow it up with a biopsy and if you're not sure, have a urologist come in," Panicker said.
While some exhibit signs of infection, most men diagnosed with prostate cancer are asymptomatic. By the time symptoms do develop, the cancer has often progressed to more severe stages of the disease.
Comfort-wise, the embarrassing annual screening is far less invasive and painful than the treatment options should the cancer advance, so take a deep breath and book an exam every year.
What To Do Next.
There is no general rule for treatment as individual factors such as age and cancer aggressiveness come into play. It is important to understand that the stage of the cancer will play a life or death role in the outcome. The three stages include early, locally advanced and metastatic prostate cancer.
Faithful Friend. Dr. Todd Brookover, without initial reason, was the first to explore Yates’ prostate and discover the growth. Though he does not continue to see Yates’ through these current stages of treatment, Brookover has remained close with his former patient.
"The doctor's job is to catch it early. For early prostate cancer, we try and identify people or categorize them with a risk of recurrence: very low, low, intermediate or high risk," Panicker said. "These risk categorizations are based on the Gleason Grade, which tells us how aggressive the cancer will behave and certain other criteria. Based on those we divide them up into these risk categories and based on individuals risk, the treatment is coordinated."
Most men in the United States who have to deal with prostate cancer are diagnosed at the locally advanced stage. Even then, at this second level stage and certainly with an early prostate diagnosis, the survival rate can approach 100 percent in a 5-year period. The survival rate for men with metastatic or distant stage cancer drops to 31 percent.
The three basic options for treatment are surgery, radiation and chemotherapy. Each one will be approached differently depending on the needs of the patient.
"Surgery and radiation is good in early prostate cancer but radiation is better because it avoids certain side effects like impotence and the complications of surgery," Panicker said. "In locally advanced disease we do hormonal therapy which is to switch off testosterone production and combine that with radiation."
Radiation can include Brachyatherapy, which involves a combination of both radioactive "seeds" injected into the prostate and external radiation. Calypso, a technique currently only available in Oklahoma at the Cancer Treatment Center of America's southwestern branch, 10109 E. 79th St., serves as a sort of TomTom navigation to guide radiation delivery.
"These beads serve as GPS monitor for the radiation machine which allows the radiation machine to give very pinpoint and focused radiation just to the prostate," Panicker said. "As a result of that, the duration of treatment is decreased and the side effects are decreased."
Once the disease has moved into the advanced status, chemotherapy is a more likely course of treatment. There is also an expensive therapy, Provenge, used to treat advanced patients.
"It (Provenge) costs $90,000 and extends survival by four months," Panicker said. "It is just so expensive and there are very few centers doing it, it hasn't taken off in a big way."
Upon diagnosis, some men want to aggressively attack the cancer with every form of available scientific miracle. However, it is prudent to seek the right medical counsel to develop a battle plan that is conducive to the intensity of the cancer.
"Aggressive treatment is OK if the disease is aggressive," Panicker said. "You don't need a boulder to kill a fly. We have to tailor the treatment or the intensity or the aggressiveness of the treatment based on the stage or aggressiveness of the cancer."
There is more to a good battle plan than just the guns and tanks. Technology has improved the way prostate cancer is approached but there are several other factors that come into play.
"Managing cancer is not just technology; it requires a lot of human touch," Panicker said. "Technology is good and very helpful but human touch is where the doctors come in and the integrative approach."
The medical oncologist, radiation oncologist and surgeon are just a few important pieces to the puzzle while fighting prostate cancer. While these professionals are needed to fight the cancer, naturopaths, nutritionists and counselors can be just as much a part of the healing process.
Research is progressing each day and though not all men survive this disease, there is headway being made. Preventative measures are being studied and many men are reaping the benefits of drugs such as Proscar, which is used when there is a benign enlargement in patients.
"This can be taken even if there is not a benign growth but there are side effects so everyone should not take it and it still has not been FDA approved for prostate cancer but there is strong evidence to support that it probably helps in prevention, or at least reduces the incidence of prostate cancer," Panicker said.
With all the scientific advancements in treatment and the continually improved screening methods, one would think that this nasty little creeper would begin to disappear more quickly.
"(Prostate cancer) is still the second leading cause of cancer related death among men but compared to years ago, we have made significant progress," he said. "So yes, prostate cancer is curable if detected early. It is not curable if it is metastatic and there is an in-between stage called locally advanced; some of those are curable and some are not. And the stage determines what treatment I give them."
A Flesh and Blood Reality
The technical terms of prostate cancer can dehumanize the disease and feed the thoughts of men who really believe it won't enter their lives. Beyond every doctor's wise and educated words, there are men facing this disease everyday. Each day, a new diagnosis is made and another man faces his mortality.
United in Battle. The Yates family has bound together through the years and continues to grow stronger through the impending nature of Dale’s prostate cancer. Wife, Laura and children, Zach, Josh and Ali support dad on his journey while maintaining a daily routine of normalcy.
The men who agreed to share their stories with Urban Tulsa Weekly aren't after free publicity; these men just want to stop the cycle. They want their children and their children's children to not be bothered with silly little cancer cells growing where they don't belong.
Dale Yates was an average man living in Claremore, going to work, attending church, loving his wife, Laura and raising his three children, Zach, Josh and Ali. Upon visiting his doctor on an unrelated matter, the decision was flippantly made to have a prostate exam.
Up to this point, Yates had been having his annual PSA test but hadn't had his prostate examined in nearly 20 years. His 2005 PSA exam hadn't come around yet, so upon the suggestion of his urologist, Dr. Todd Brookover, to have it checked, there was no reason to fear a negative outcome.
"He said your prostate should feel kind of like the end of your nose, walnut size, should be firm and you can push on it," Yates said. "He said, 'I expected yours to be spongy feeling because I thought you might have a prostate infection but your prostate is hard and there is a bump on one side and that concerns me.'"
Rumble and Tumble. Getting dirty with sons Zach, 16 and Josh, 14, Dale Yates’ continues to live a relatively normal day-to-day life. Showing his boys that dad can still hold his own, Yates’ wrestles around with his teenage sons.
A normal PSA result for a man of 45 should have been between one and two. Yates' was 7.5. Now this didn't automatically mean he was facing cancer at such a young age but did give reason for concern.
Yates immediately underwent a biopsy and ultrasound. The tests were run the week before Memorial Day and weren't expected to return with results during the holiday weekend.
The day after Memorial Day, Yates' doctor called with news that would change Yates' life forever. He had cancer.
"You think in terms of prostate cancer as something that happens in older men; it's a slow moving form of cancer and in most cases you'll die of old age before the prostate cancer has any effect on your life," he said.
This was not the case.
Dr. Brookover explained that they had to move quickly due to the aggressive form of prostate cancer that was taking hold of Yates' body. The immediate suggestion was to remove his prostate because it was believed the cancer was contained and hadn't spread at this time.[imgae-5]
The Gleason Scale was a term that Yates' would become very familiar with. The score classifies two different aspects of the cancer cells. They are each graded on a one-to-five scale and then added together. The best one can hope for is a one; a score of 10 represents the most aggressive and fastest moving form of the cancer is attacking. Dale Yates received a score of eight.
Surgery was scheduled immediately, and the doctor was confident that a bullet had been dodged and the cancer had receded.
After several months of further PSA testing, Yates' PSA finally reached zero. Nine months after the surgery, it returned to 6.8. After several confirmations, Yates went back to his urologist and decided to begin hormone therapy.
"Initially prostate cancer cells require the presence of testosterone to be able to grow, so if you take the testosterone away, in a matter of speaking, they (prostate cancer cells) go to sleep," he said. "Still there and alive but not active."
The cells independent of testosterone still continue to grow and when they become the majority, the hormone therapy will no longer be effective. Still, doctors were confident that Yates could live another ten years with intensive hormone therapy.
After a short period and a trip to Houston to visit MD Anderson Cancer Center, it was confirmed that the prostate cancer had metastasized and spread to his rib and L5 vertebrae.
Mincing words and wasting time at this point seemed useless. Yates went on a self-search in hopes that he could find the cure that doctors were missing.
That panic that sets in at the mention of cancer overwhelmed Yates and he spent hours on Internet research and reading books about the best way to kill the cancer.
"You know at first when they tell you, you got about 10 years, the first analogy that came to my mind was that somebody took a mason jar, screwed a lid on it and this is all the air you get," he said. "When this air is gone, you die. You won't make it past the contents of this jar. That's a definite brick wall, no way to put any more air in that jar. So it was very emotionally devastating as you can imagine."
His studies led him to take on a drastic diet as he cut processed sugars out his system. This merely left Yates exhausted and drained.
"One day I just got tired of trying to find something that wasn't there and I just said, look, it is what it is. It's the hand that's been dealt me, how am I going play these cards," he said.
After seeking the advice of oncologist, Dr. Joseph Lynch, his case went before a tumor board -- a panel of specialized physicians that convene to discuss and consult on unusual cancer cases -- in Tulsa. He would continue hormone therapy, a different form but the same approach.
"They started me on a pellet that's injected into my belly every three months and over a period of time, it breaks down so I get a constant dosage of the medicine throughout the 90-day period," Yates said.
Until six months ago, this was his regimen. The frequency of the injection has since reduced to six months but the effect is the same.
As a result of the therapy Yates experiences menopause as a woman would. He has hot flashes, mood swings, tenderness in the breasts and has lost body hair on chest and underarms.
A Closer Look. Looking at Dale Yates, one would never guess he was going through life with a foreign cancer growing inside him. He stands just under 6 feet tall, appears healthy, smiles and laughs as if today and tomorrow hold nothing but promise.
Yates faces each day knowing that there is a time bomb inside of him, but there is a bit of comfort in realizing that happenstance led his doctor to perform a seemingly unneeded prostate exam. Yates says with certainty, had he waited to until he experienced symptoms, it would have been too late.
Now that Yates' cancer has metastasized, there is no going backwards. It will remain in his body, dormant, waiting for a window to spread.
His PSA remained stable until August 2010, when it gradually began to increase again. He has developed another tumor. For the time being, the reason is unclear why it still continues to rise even now but doctors are waiting to send him for more radiation.
Yates' remembers his father having early stage prostate cancer but dying of unrelated causes. The thought that it would latch onto his own body and be the subject of his everyday thoughts was inconceivable.
His children and wife face this nightmare with him everyday. The first realizations of the impact the disease would have, caused complete emotional distress.
"My wife, when we found out the cancer had returned, got back to the parking lot (from the doctor's office) and broke down," Yates said. "You think about it so much, you begin to deal with it. No matter whether it's in a good or bad way, time is a great healer. It gets to a point where, it's not that it doesn't bother you, it's just the effect that you show from it bothering you is not as great."
Looking at Dale Yates, one would never guess he was going through life with a foreign cancer growing inside him. He stands just under 6 feet tall, appears healthy, smiles and laughs as if today and tomorrow hold nothing but promise.
"We've become active in church and that's helped greatly with peace of mind," he said. "It's not something we sit around as a family and talk about as far as what are the possibilities for dad but when and if that time comes, that there is a change, we'll deal with it when it happens. My mission right now is to let as many men know about prostate cancer as possible."
Having met this head-on for nearly six years, Yates has come to terms with how he lives each day.
"We go camping once every summer and all those moments, untangling the fishing line or getting them (the kids) unhooked from a log in a creek, they're going to remember that stuff," he said. "Anytime there's an opportunity to do something like that, I try to make sure I do whatever it takes to live my life and make those memories with the kids."
The battle is far from over for Yates. He will continue to live life all the while knowing there is a deadline. Everyone will face mortality at some point but few face it daily. Most make plans for the future without any reason to suspect they won't occur; Yates makes plans for today and is cautious in looking too far ahead.
"It's one day at a time," he said. "When you're going to go from here to California, you don't look at California through your windshield; you look at the part of the road that's in front of you."
Yates' battle with prostate cancer is much more rare than the average diagnosis. Prostate cancer, if caught early, is usually very treatable. Mike Qualls, driver for Cancer Treatment Center of America's Southwestern Regional Medical Center, was diagnosed with prostate cancer in 2008. He happened upon his screening through a life insurance requirement.
"It was right at the early stages. The urologist said, 'this is not going to kill you, we caught it early,'" Qualls said.
Working at one of the nation's renowned cancer facilities, Qualls encounters it daily. He still sees the terror it brings to people at the mere mention of the word.
"Just a little simple blood test saved my life. I was very fortunate," he said. "The sneaky thing about prostate cancer, there's certain symptoms but I never had them, not one of them."
Men are often hesitant to get checked because they are afraid of the outcome. Prostate cancer often results in impotency and gives men a feeling of inadequacy. In the grand scheme of life, men need to understand that this is a small part of the disease and being present for the family you have is much more important.
Qualls didn't waste any time. Upon discovery of the cancer, he was ready get serious.
"I think you have to have a positive mind and get done what you have to get done. You have the resources here in Tulsa to do something local," he said. "It's a good feeling to know that you can beat this thing. It can be beat."
The Call to Arms
While breast cancer and prostate cancer are not really comparable in a medical sense, each gender faces its own battles in relation to these two diseases.
Medical Miracle. The Calypso GPS System allows radiation to hone in on the cancer cells, reducing the effects of the treatment on other organs and outlying tissues. This is a one-of-akind device in Oklahoma.
The amount of money spent on breast cancer research far outweighs that spent on prostate cancer. Even if research dollars were not a factor (they most definitely are), the sheer dollar amount spent on awareness is astronomical in comparison.
"I think it's because, to the credit of breast cancer survivors and women in general, they have been very involved in breast cancer research, especially through institutions like Susan G. Komen," Dr. Panicker said. "You don't find equally vocal public partisans amongst the men folk for prostate cancer."
There is also an age gap that separates the women from the men. The number of young women contracting breast cancer far outweighs the number of young men, and, often young women are vocal and driven.
So the call to arms goes out to men and women.
Men: It is time to take care of yourselves, plan, donate and pursue a better future for your children. It is time to suck it up, make the dreaded yearly appointment and get checked. Here at UTW, we like to have a good time and we usually prefer the lighthearted conversation but this is not a lighthearted matter. Take care of business.
Women: It is just as important that you push and prod your men to take action. Keep at it and don't take 'No' for an answer.
"Do it for your family, your wife, your children," Qualls said. "Most of all, if you're 50 years old, you might be working on having grandkids, so you want to be there for them. It's not a selfish thing, it's just something that needs to be done."
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