Invasion of the Prostate Snatchers: An Essential Guide to Managing Prostate Cancer for Patients and Their Families [Paperback]

Prostate Snatchers, published in August of 2010, is the best book I know of to help newly diagnosed men decide what to do about their prostate cancer (PCa). Co-written by one of the best medical oncologists specializing in PCa (MOSPC) in the USA, it's filled to the brim with gems of cutting-edge, authoritative information. Below are some of these gems, which, unfortunately, only a small minority of PCa patients have seen:

There is not one but three basic categories of PCa--Low-Risk, Intermediate-Risk, and High-Risk.

High-Risk, also known as "aggressive," should be treated aggressively whereas Low-Risk often can be safely managed with no treatment.

A typical scenario after a primary care doctor refers a patient to a urologist because of an abnormal PSA test and/or digital rectal examination (DRE): The urologist biopsies the patient's prostate and finds PCa. The patient views this finding as a death sentence, panics, and feels pressured to get rid of his cancer immediately. He avoids taking time for second opinions and agrees quickly to have the urologist cut out his entire prostate (radical prostatectomy or RP)--an aggressive treatment.

Unfortunately, of the 50,000 RPs done in the USA every year, more than 40,000 were not necessary. That is, the vast majority of PCa patients would have lived as long without having their prostates removed.

RP is no longer the most effective treatment for PCa. Radiation therapy (RT), another aggressive treatment, has evolved into being at least as effective. If the patient consults a radiation therapist for help with making a treatment decision, the doctor is often, of course, biased in favor of recommending RT.

A third type of PCa doctor is a medical oncologist. They are trained to treat all types of cancer--lung, blood, bladder, pancreas, etc, Their training in PCa treatment only focuses on advanced disease. Early-stage disease is left to the urologists.

Medical oncologists treat some PCa patients with testosterone inactivating pharmaceuticals (TIP, also known as "hormone blockade" or "androgen deprivation therapy"). TIP has its own set of side effects but, unlike RP, RT, or cryotherapy, the side effects are often reversible when the medical oncologist discontinues the TIP. And he then, depending on the PCa's response to the discontinuation, may re-start the TIP a year or two or three later.

Unfortunately, only a minority of urologists are as skilled as MOSPCs in providing TIP.

Of the more than 10,000 medical oncologists in the USA only less than 100 are MOSPCs.

MOSPCs often do a more comprehensive evaluation of PCa than some urologists. In addition to PSA tests, DREs, PSA velocity calculations, and PSA density calculations, they may use spectrographic endorectal MRI (S-MRI) scans, color doppler ultrasound scans, and PCA-3 urine tests to determine whether a patient is Low-, Intermediate-, or High-Risk. These tests also help monitor a patient's PCa (known as "active surveillance" or AS).

The comprehensive evaluation helps to determine whether the patient should have an immediate initial biopsy. If the patient has had a biopsy, the evaluation may reduce the number of repeat biopsies needed for AS.

Typically, a MOSPC will offer the Low-Risk patient the option of no treatment but with AS. If the patient rejects this option because he wants to kill his PCa, the MOSPC will mention the advantages and disadvantages of aggressive treatments such as RP, RT, and cryotherapy, and with less bias than most urologists, radiation therapists, and cryotherapists, respectively.

Chapters written by Ralph H. Blum, a patient of his co-author, vividly illustrate the struggles of and benefits received by a patient who educates himself about PCa, finds the right doctor for him, and avoids blindly following his and other PCa doctors' advice. Blum's knowledge and story of his 20-year PCa journey is likely to calm many patients, instill hope, and empower them to play an active role in their journey.

Blum traveled from the USA to Holland to have a recommended Combidex MRI because it was the only place in the world that performed the scan. My guess is that no more than 10 percent of PCa patients are able to take the time off and/or pay for out-of-state/country trips for tests or second opinions. I wish the book would have acknowledged this unfortunate obstacle to obtaining state-of-the-art help.

Snatchers adds much to the meager literature on the role of the MOSPC in working with Low-Risk patients and helping patients decide on a treatment.

The preliminary international list of MOSPCs might help some patients find the "right doctor." Also helpful are a glossary, annotated bibliography, and lists of acronyms and websites.

Snatchers replaces my former #1 choice, A Primer on Prostate Cancer: The Empowered Patient's Guide (2nd edition, 2005) by Stephen B. Strum, M.D. (a distinguished MOSPC) and Donna L. Pogliano. Snatchers is easier to read and understand; more up-to-date, of course; and destined to become a classic, which is the status of Primer.

My qualifications for writing this review are 10 years of reading authoritative PCa literature; participating in PCa internet discussion forums; leading PCa support group discussions; seeing the MOSPC co-author of Snatchers every three months for nine years; consulting other PCa doctors; undergoing biopsies, S-MRIs, Color Dopplers; avoiding aggressive treatment (on light TIP--Avodart only for both my benign prostatic hyperplasia and PCa); writing my PCa story ( prostate-cancer-story.net ).

Lawrence J. Bookbinder, Ph.D.

I cannot reccommend this book too highly!...If you have just had that dark news from the medics that you have prostate cancer, then before slavishly following their very partial advice, count to twenty, then read this friendly accesible and hugely informative book around the whole topic of prostate cancer. Then try to find a specialist or GP who can help you navigate the various options and treatments that are now available. With any serious medical condition I think as a patient the more informed you are the better you are able to become an active participant in your treatment and that can only help you through what can be a terrifying and grim experience.

Any man weighing up prostate cancer treatment (or non treatment) options will soon find that there is a welter of information and advice available. Nay, more than that. He will be faced with an absolute overdose of often contradictory advice and opinion; and much of it proferred by outright snake oil salesmen

Chapters in the book are written alternately by a patient and by an oncologist and, while neither rejects conventional treatment out of hand, both clearly show that in many cases rapid and brutal radical intervention is not always in the patient's best interest

I have read several books during my past 8 years on 'active surveillance' and for me this one makes a lot of sense. These writers tell it like it is. They do not blindly regurgitate the standard cliches and views (usually edited carefully to eliminate all possibility of litigation)

I wish the book had been available back in 1964 or thereabouts when I was struggling to make sense of it all

frankpollock