Invasion of the Prostate Snatchers: No More Unnecessary Biopsies, Radical Treatment or Loss of Sexual Potency Hardcover – 24 Aug 2010
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About the Author
MARK SCHOLZ, MD, 54, is board certified in medical oncology and internal medicine. He has been treating men with prostate cancer exclusively since 1995. Medical Director of Prostate Cancer Specialists, Inc., and Executive Director of the Prostate Cancer Research Institute, Dr. Scholz is also an associate clinical professor at the University of Southern California School of Medicine's Department of Oncology and a consultant to the "Journal of Urology." Dr. Scholz volunteers for the Internet list "Patient to Physician," found via Resources at www.pcri.org.
RALPH H. BLUM, 77, a cultural anthropologist and author, graduated Phi Beta Kappa from Harvard University with a degree in Russian Studies. His reporting from the Soviet Union, the first of its kind for "The NewYorker "(1961--1965), included two three-part series on Russian cultural life. He has written for various magazines, among them "Reader's Digest," "Cosmopolitan," and "Vogue." Blumhas published three novels and five nonfiction books on the oracular tradition, beginning with "The Book of Runes." He has been living with prostate cancer, without radical intervention, for twenty years.
Top customer reviews
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.
If you're reading this, then I assume you're in the same situation I was in back then. I'll tell you what happened to me, and this might comfort you bit. I was diagnosed with the aggressive form, after a few months observing my PSA level increasing from 4.2 to 6.7, together with two biopsies. The second biopsy was a "saturation biopsy", 48 needles inserted into an area the size of a walnut. Both biopsies were done under general anaesthetic, and I felt little discomfort after the procedures. I was told that if untreated the cancer would kill me within ten years, the second half of which would be miserable and painful.
In May 2006 I had a radical prostatectomy. It was very painful for a couple of days, and quite painful for a week or so after that. But I was out of hospital after four days, and back to work in a month. My PSA level dropped to zero, and has stayed there ever since. I'm still alive after ten years!
I'm really glad I took the RP option, because the whole thing was out of the way a month after the operation, and I hardly think about it any more. It always gives me a shock when filling in insurance forms etc, when I have to say that I'm officially in remission from prostate cancer. I look on it as me being fully cured, and safer than any man who has still got a prostate.
So, buy this book and other relevant books. Read as much as you can. Take onboard what the medics tell you. Be an active participant in the decisions on what happens to you. But remember that prostate cancer, caught early enough, needn't be a death sentence.
The subtitle "No more unnecessary biopsies, radical treatment or loss of sexual potency" could be misleading though. The keyword here is "unnecessary". There is also the problem, especially for those dependent on the UK Health Service, of finding medics with the up to date views and equipment described in this book.
Don't think this is a relaxing read. Some of the stories in the book are quite scary; and that's just the ones from the doctor! Overall though this is a cracking book that, despite the offbeat title, is full of solid good sense.
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