How A Couple Got Together To Fight Prostate Cancer

You’re leading a happy, healthy life. Why should you be concerned about prostate cancer? My husband, Allan, and I weren’t either, until we received the devastating news from his doctor. Out of town at an antique music box convention, our future appeared uncertain as we clung to each other in shock. But our initial bewilderment and emotion faded as we counted our blessings. His cancer was diagnosed at an early stage. In our opinion, consistent healthy lifestyle choices had delayed this diagnosis more than 10 years.

fpcAllan has been very conscientious about getting regular screenings for prostate cancer, following a healthy diet and exercise program, taking selected supplementation, and not smoking. When he was in the Army, doctors had told him that he was at increased risk for prostate problems because of the surgeries he required then.

Allan explained the health issues that he was concerned about before we got married and added, “I can’t change heredity or past health problems, but I certainly have a choice about prevention steps to lower my odds for disease, avoid new problems, and improve the quality of my life. We have each other, and there’s so much that makes life worth living.” This optimistic attitude encourages me to continue following a healthy lifestyle also, as we work together to maintain and enhance our well-being.

Most men don’t have such advance warning.

“I think a common misconception is that prostate cancer has a low threat potential and that more men will die with the disease than of it,” says Dr. James M. Kozlowski, chief of urologic oncology at Northwestern University Medical School in Chicago.

“Although this is generically true, we know that prostate cancer is a leading cause of cancer death in men … it’s a common disease; it’s a pervasive disease. When detected in relatively young men who have a significant amount of their life span ahead of them, their chances of dying from it decrease dramatically,” he says.

The prostate is a walnut-sized male sex gland under the bladder whose secretions help form the seminal fluid. It surrounds the upper part of the urethra. The American Cancer Society estimates that 198,100 new cases of prostate cancer will be diagnosed and that 31,500 American men will die of this cancer in the year 2001. That’s one diagnosis every three minutes and one prostate cancer death every 13 minutes. The incidence of prostate cancer is higher among Black men, and may be linked to higher levels of the male hormone testosterone.

Get Regular Testing

Debate continues among experts about the benefits of the PSA (prostate-specific antigen) screening test. Some physicians have raised objections, believing it leads to needless biopsies and treatment of a very slow-growing cancer. But since 1991, when PSA testing became prevalent, prostate cancer death rates have dropped by 16 percent (while there’s been an increase in prostate cancers detected).

“Curative windows of opportunity that are lost are never retrieved,” says Dr. Kozlowski. “You may live a normal life span with the disease, but it may be one adversely impacted by disease-related complications that could have been avoided if optimal treatment were provided earlier on.” He agrees with the American Urological Association and the American Cancer Society’s policy that both a PSA blood test and the digital rectal examination (DRE) should be offered annually to men beginning at age 50, and to younger men who are at higher risk.

Your internist can provide these tests, and may refer you to a urologist. If you have a family history or think you may be at high risk, it’s probably best to see a urologist for testing. It’s best not to ejaculate 48 hours before the test, as it can raise PSA levels. Since a rectal exam can also raise PSA levels, have your blood drawn for the PSA test first. It’s also been suggested that it is best not to ride a bicycle beforehand.

Many urologists now do a “PSA profile.” This consists of utilizing both the traditional PSA test and the percent-free PSA, which measures the percentage of free PSA in the blood. Then a ratio of free to total PSA in the blood is considered.

Inform your doctor of your medical history, including all supplements and medications you take. Dr. Kozlowski says it’s wrong to assume anything over the counter is simple and safe, and if not helpful, at least neutral.

Some physicians are also concerned about the “fountain of youth” hormone supplements DHEA (dehydroepiandrosterone) and andro (androstenedione) and the possibility that they may increase risk for prostate cancer by raising testosterone levels. Dr. Kozlowski advises patients to discuss any over-the-counter dietary supplements or herbs they are utilizing or considering with their physician, rather than come to them later with many complications that could have been avoided had they been more open at the outset.

Men are not as conscientious as women about getting suggested routine health screenings. Eighty-five percent of women over 40 have had a mammogram (the recommended screening test for breast cancer), while only 30 percent of men over 50 have had a PSA test. Prostate cancer strikes as many men, and causes almost as many deaths annually, as breast cancer does women.

Dr. Kozlowski says wives should encourage their husbands to have routine screening for prostate cancer–especially if they haven’t seen a physician in a long time.

“I think it’s important to have other members of the family, perhaps at a younger age, nudged in the direction of surveillance, if there are a number of first- or second-degree relatives in that family who have been afflicted with the disease,” he says.

Richard Sutera, 51, of Centerville, Ohio, was diagnosed with prostate cancer at the age of 46. There’s no history of prostate cancer in his family, but he first sought testing at age 45 after experiencing lower back pain and noticing blood in his urine. Thinking he had a bladder infection, he saw his family physician (who did only a digital rectal exam the first time). He was treated with antibiotics for an enlarged prostate (benign prostatic hyperplasia–BPH or prostatitis), a noncancerous condition very common in men over 40.

After no improvement, further testing showed he had cancer. Because of his experience, he is a believer in early testing. “A high PSA doesn’t necessarily mean cancer, but I think men should get their PSA at 40 (definitely no later than 45),” Sutera says.

Keep Your Own Records

Ask for test results from your urologist, including any percentage figure. Chart these numbers next to the date of testing (or get a copy of the actual test report). Ask your doctor questions and seek additional testing if you (or your spouse) notice increases in your PSA level over time, notice some other trend, or have a concern. No one cares about your health more than you and those who love you.

Allan kept a detailed chart of the date of his test, the number of the PSA, and when he last ejaculated prior to testing. He noticed a change in the PSA figures if he ejaculated prior to the test, and was told not to by his physician only after asking him. He keeps an updated list of all medication and supplements, and brings a copy to his doctor(s).

Allan also charted changes in urinary function in response to dietary supplements. He noticed an improvement in urinary function and a lower PSA level after supplementing his diet with lycopene. Although the United States Pharmacopeia concluded last April that there is “moderate evidence of effectiveness” for saw palmetto in men with BPH, it didn’t seem to help Allan. A lack of effect could be because not all brands contain the same amount of active ingredients.

Can Prostate Cancer Be Prevented?

Since we don’t know exactly what causes prostate cancer, we don’t know what will prevent it. However, according to the American Cancer Society, existing scientific evidence suggests that about one third of the cancer deaths in the U.S. annually are caused by dietary factors. Cigarette smoking accounts for another third. Although genetics is a factor, heredity doesn’t explain all cancer occurrences. So for most Americans who don’t smoke, “dietary choices and physical activity become the most important modifiable determinants of cancer risk, at all stages of its development,” says the American Cancer Society.

Lynn Danford, M.S., C.D.E., L.D., a nutritionist who works with a urologist at Weiss Memorial Hospital in Chicago, believes a low-fat, plant-based diet can help men who have already undergone treatment, aiding in their recovery and slowing the growth of any other cancer cells. She adds that happiness and social interaction also enhance health, such as eating out, dining with friends, and celebrating with food. She says, “As an aspect of complete wellness, no person should ever be expected to forgo the enjoyment that comes from eating.”

“I Have Prostate Cancer! What Should I Do Next?”

1. Stay positive

Dr. Kozlowski says, “Once the diagnosis is made, it’s important that wives be a calming influence for their husbands and help them realize it’s not a death sentence. It doesn’t require an immediate decision. In general there’s plenty of time to learn more about the problem, seek a variety of opinions, and come to a decision based on what feels comfortable in terms of management strategy.”

Allan maintained his sense of humor and was touched by many people who offered their prayers. I’ve encouraged Allan to pray more, with little success. But noticing the sincerity of all those praying for him, he said to me one night, “There might be something to that praying.”

2. Do your homework–research treatment options.

We methodically went about researching treatment options, a consummate team effort. Quickly finding we weren’t alone, we uncovered many misconceptions and myths about prostate cancer. Allan says, “Most of the prostate literature doesn’t make it clear, and most of the men I talk to have no idea, that hormone therapy is actually castration–chemical or actual.”

Here’s some of what we found:

* Many factors determine treatment choice

No two men are the same; the best choice for your friend may not work for you. Some determining factors to consider before a treatment decision include age, other medical problems, and the stage and grading of the cancer.

The possibility of impotence and incontinence as a result of treatment weighs heavily on most men. Even New York Mayor Rudolph Giuliani (known as a decisive man) had a tough time making a treatment decision.

* Talk to others; attend support groups

Talking to others who have experienced prostate cancer (especially in a prostate support group setting) is an excellent way to get new information and firsthand accounts of various treatments. You can also learn what to avoid from others’ mistakes.

3. Get other opinions.

Obtaining second opinions is a common practice and expected of a responsible patient. A recent study concludes that specialists overwhelmingly recommend the therapy that they themselves deliver (JAMA, June 28, 2000). Our experience bears this out. We saw both oncologists and urologists, and only one physician seemed to be objective about several treatment options appropriate for Allan.

Also, don’t be pressured into an immediate decision. One physician strongly encouraged Allan to sign up for a clinical trial. After declining, we felt pressure to decide right then about his treatment choice. This was not the hospital or doctor of our final choice, though highly recommended. Joe from the support group was also disturbed by a similar experience.

Also, don’t feel you must stay loyal to your current doctor, even if he/she is your friend. Although very happy with Allan’s urologist, we still wanted the most qualified person (within our means) for our treatment choice.

We successfully found our way through the daunting labyrinth of issues and information, and after careful discussions came to a treatment decision together. For Allan, this was radical prostatectomy.

During Treatment

My support during treatment was very important to Allan, who was understandably anxious. I went with him to all preparatory appointments, where what to expect during and after his surgery and what I could do to help was explained.

During his operation I was informed at every stage what was happening and how it looked. After successful surgery I stayed with him at the hospital the first two nights.

After Treatment and Beyond

Patience and consistent effort make a huge difference in recovery. Allan notices significant improvement when he does the exercises recommended to speed recovery. All his functions since treatment have steadily improved. Follow doctor’s orders and don’t get discouraged; recovery takes time.

1. Keep a sense of humor.

After six weeks we were still able to travel to Mexico as we do every winter. Though it was more difficult than usual for him, the relaxing environment helped his continuing recovery. At one point when we parked an open Jeep we had a bag stolen containing Allan’s extra incontinence articles (still needed at that point). We laughed to think how surprised the thieves must have been to find this “treasure.”

2. Spouse support is important.

Humor also helps dispel anxiety and depression–a big factor for many men after treatment. Many men become concerned about intimacy issues and their ability to perform sexually. Also, loss of bladder control (usually temporary) can be humiliating.

Katherine J. says her experience shows that “a major illness can bring out the worst or the best in someone–facing potential mortality either increases one’s fears and insecurities, or it expands their gratitude and appreciation of life.”

Dr. G. Michael Durst, a psychologist who has counseled many men in both Chicago and South Africa, says, “After a major illness (especially one as personal as prostate cancer), many men tend to be more sensitive. The family of a man recovering from treatment (primarily the spouse), should be more understanding and patient; it’s a stressful, trying time for everyone.”

Dr. Durst recommends that “the spouse should not only listen to her husband’s words, but also attempt to hear the emotions that underlie what he is saying. She can stimulate the conversation by perception-checking, such as asking such questions as `Are you really saying …’ or `Are you concerned that …’ or `Are you feeling …?’ Such questions help him to open up and talk more about feelings of inadequacy or concerns around insecurity.”

3. Continue a healthy diet.

We believe a healthy lifestyle also helped with smoother surgery and faster-than-expected recovery. Joe from the support group changed his diet to include soy beverages, soy sausages and hot dogs, and lots of vegetables and fruit. He believes this has aided his recovery and is keeping his prostate cancer from returning.

4. Help others; share what you’ve learned.

Support other men by sharing your knowledge and experience. It may also help you gain more understanding of your own recovery, and diverse methods of coping and healing. We still find support groups helpful.

5. Keep updated.

“Our insights into the biology of prostate cancer and knowledge of what makes the tumor cell react aggressively has exploded,” says Dr. Kozlowski. “New cutting-edge approaches are imminent. Utilizing our understanding of the human genome is now beginning to translate into potentially effective treatment. There’s more incentive now, more research dollars, and it’s a much better publicized disease than before. This is a good era for prostate cancer.”

We have found that a healthy lifestyle, regular testing, thorough research, a sense of humor, and lots of love helped us successfully deal with Allan’s prostate cancer. If you’re a man age 40 or over or have a husband, brother, father, or friend over 40 or with history of prostate cancer in your family, take steps now to reduce your risk. Prostate cancer can truly test the intimacy and strength of a marriage. Working together for prevention–and treatment and recovery if necessary–can also bring a couple closer together.

A Story About Alopecia

We kept reassuring him that it might grow back. What we didn’t say was that his condition could escalate into a more severe form.

For as long as I could remember, my son, Nick, had been missing a spot of hair about the size of a quarter on the back of his head. I assumed it was some kind of birthmark and never really paid much attention to it. When he was 4, a second spot appeared, so 1 asked our pediatrician about it during a regular checkup. The doctor told me that Nick probably had alopecia areata, something I’d never heard of before. She also said not to worry, because many kids with the condition lose small patches of hair that later grow back for good.

asaaA few months later, not only had his two bald spots not filled in, but a new one had appeared. My pediatrician referred me to a local dermatologist, who confirmed that Nick had alopecia areata, an autoimmune disease that affects four million Americans and causes loss of hair not only on the scalp but also on other parts of the body. It was possible, she explained, that Nick would lose all of his hair, or no more at ail. Alopecia areata, she said, was utterly unpredictable. It came and went, as if on a whim. No one understood it–or was able to fully cure it.

This may have been old news to the dermatologist, but it was shocking to me. So was her seeming indifference: I landing me cream to rub on Nick’s head every night, she said it might help but emphasized “there were no guarantees.”

On the way home, looking at Nick in the rearview mirror, I saw a cheerful, outgoing boy. Would he still be that way, I wondered, if his dark, lustrous curls fell out? I envisioned him as a bald kindergartner and worried how he would fit in. By the time I turned in to our driveway, tears welling in my eyes, I’d moved ahead 14 years to his senior prom: Would he have trouble getting a date? Could I protect him at all from being hurt?

My husband, Frank, who lost his hair in his twenties, couldn’t believe how upset I was.

“It’s only hair,” he kept saying as I told him the news that night.

“Yes, but everyone else his age has some,” I repeated. Frank, the oldest of 11 children, and one of the least vain people I know, honestly didn’t understand what I was worried about. Losing hair in adulthood, I told him, is different from losing hair at age 4. Nick’s self-image was still forming, and, this, I argued, could hurt it.

As it turned out, the cream did its job–for a time. Nick’s patches filled in, and he started kindergarten with nearly a full head of hair. But three years later, when Nick was in the second grade, another small bald spot appeared on the side of his head. This time the cream had no effect. Two new dermatologists gave me two new creams. But the spots just kept on coming.

At first they stayed hidden tinder Nick’s still-heavy layers of hair–unless a really strong wind came tip. To keep the gusts from revealing his baldness, Nick, who had never been interested in wearing a wig, begged me to take him shopping for a hat. Though I told him he had nothing to hide, neither of us really believed it; soon we were at the mall looking for his “disguise.” It took hours, but Nick’s final choice was a blue snap-down cap with a neon-green Nike logo in front. He got special permission to wear the hat in school every day, but it wasn’t a magic cure. Instead, it caused new anxieties: Nick could hardly concentrate on his soccer game for fear the cap would fall off. Whenever our doorbell rang at home, he’d fly off to find it before letting anyone open the door.

His hair was now falling out in clumps. Every time I looked at his pillow in the morning, I wanted to weep. I couldn’t deny that my little boy was losing his hair. Hat or no hat, it became a struggle to get Nick out of the car when I dropped him off at school each morning. He resisted; he cried. When I pulled away, I would cry, too, knowing that he’d spend the next six hours trying to keep his hat on his head.

“It might grow back,” we kept reassuring him. This was true. But it was also true that the condition might escalate into a more severe form of the disease that would take every hair from his head and body, leaving his scalp unprotected from the sun and elements, his eyes and nose without filters for dust and bacteria. Naturally, we didn’t mention that prospect. We wanted to accentuate the positive; but to a distressed 7-year-old, “might grow back” didn’t do it.

One of many tough moments that year occurred during a day of bike riding I’d planned with a family who lived near us on California’s Monterey coast. With his safety helmet on, Nick was free to enjoy the outdoors as he used to. It was wonderful to watch him racing along the Pacific. But the joy was short-lived. When Nick took off his helmet at the end of the day, it was filled up with his hair. I could tell by the look on his face that he was as startled as the rest of us. I ached for him, but could do little.

About a week later, Nick’s sobs woke me up at three in the morning. I went into the bathroom and found him looking in the mirror.

“I don’t look like myself anymore!” he cried.

I held him in my arms and tried to soothe him. “But you are yourself,” I told him. “You’re still Nick Ratto.”

“No, my new name’s Ugly Ratto! I’m not Nick anymore.”

AFTER PUTTING HIM BACK TO BED THAT night, I lay awake wondering how much my own insecurities might have contributed to Nick’s fears. At that time in my life, I was incredibly busy managing a full-time job as an executive-search recruiter and being a mom to Nick and his two older sisters, Jenna and Shelby. Yet, whenever I put on a few pounds, I felt like “Ugly Ratto” too. What kind of message had I sent to him (or, for that matter, to my daughters) about not accepting your own imperfections?

What’s more, I literally could not say “alopecia” aloud without crying. And even though the National Alopecia Areata Foundation is right here in San Rafael, CA, I hadn’t been to a single support-group meeting. I’d mark the dates on my calendar, then find a last-minute excuse not to go: Nick needs help with his homework. I had a rough day. Don’t like driving at night. Too much laundry. I knew my attitude needed to change.

But Nick’s changed first–on its own–just before second grade ended. “l want to get it over with,” he announced at dinner one night. “Let’s just tell everyone,” he said, “so they don’t keep asking why I wear a hat.”

His sister Shelby, who was in eighth grade and student body president at the same Catholic school as Nick offered to help him talk to their classmates. She also volunteered to have her friend Jon, a popular, athletic eighth grader, accompany them. Nick was thrilled: Jon was his hero. And right then, Shelby was mine.

Joined by the school counselor, Nick, Shelby, and Jon spent a day giving presentations to every class in the school. Shelby would begin by explaining what alopecia areata is. After her talk, kids raised their hands to ask Nick questions. (“Can we catch it?” “Could your hair grow back different? Curly? Green?”) Shelby reported that by the end of the day, Nick was clearly enjoying calling on his classmates one at a time and giving them answers. Dispensing information gave him back some control.

Still, “outing” himself at school wasn’t the same as facing the world at large. I was reminded of this the following summer, when we went to Hawaii for a family vacation. On the flight over, I reprimanded Nick for standing on his seat to get a better view of the movie screen.

“Let that poor boy do whatever he likes!” a woman sitting next to me whispered. Suddenly I saw Nick as this stranger did: a cancer-stricken 7-year-old who’d lost his hair to chemotherapy treatments. I ignored her and made him sit down immediately. But Nick continued getting stares all through our vacation; little kids would point and ask, “What’s wrong with that boy?” It was upsetting to us all, but most painful to Nick. And it made us all too aware that he’d be vulnerable every time he went somewhere new.

At home, we tried to make things as comfortable as possible for him. For instance, when Nick joined a new soccer team, his father went with him to the first practice to explain to the parents, team, and coaches why he didn’t have hair. Once their curiosity was satisfied, the boys went back to focusing on playing the game, something Nick excelled at.

Through all this, I never gave up hope that his hair would ultimately grow back. And it did, partially, several times. Nick’s head would be bald one week and sporting little blond hairs the next. When this baby hair then became coarse and dark, our whole family prayed it was all growing back for good. And when it fell out a few weeks later, we were crushed. The summer before fourth grade, my son went to basketball camp with his eyebrows half gone. By the time school started, they were back in full.

By the time Nick entered fifth grade in the fall of 1998, all of us had stopped reacting to each change with such strong emotion. By then, I had also come to terms with the fact that we could benefit from outside counseling. I found out that a National Alopecia Areata Foundation meeting was going to be in San Francisco that November. I wanted to go, and so did Nick and his sisters. With no idea what to expect, the four of us made the hour’s drive to the city.

It was strange to face a hotel conference room full of people without hair. But I soon realized that these were happy, accomplished adults. I met a woman who had started her own wig business, a man who was president of a software company, and dozens of people with a healthy sense of humor about their condition. Nick’s future started to scare me less.

Nick himself was in his element. A CNN reporter who was covering the meeting asked him what he told people who wanted to know why his hair was gone. “I got in a fight with a lawn-mower,” he replied, earning a big laugh from those standing nearby.

At the last session of the day, when people shared their personal success stories, Shelby, now 17, and Jenna, now 15, both fierce mother bears when it comes to Nick, literally burst into tears. “I’m just so relieved!” Jenna told everyone in the room. Turning to Nick, she added: “I don’t have to worry about you anymore!”

We all still worry about Nick, but no more than we do about each other. Well, not much more. Nick himself was concerned about starting sixth grade in a new, much larger school this past fall. But as he walked out the door on his first day, he said, “You know what? I’m not going to wear this,” and flung his hat right off of his head.

I used to pray for that day to come. Now that it has, I’m obsessed with getting him to use sunscreen where his hat used to be. I keep some in the glove compartment of the car in case he forgets, but so far, so good–in more ways than one.

Looking Into Prostate Cancer

Prostate cancer usually–but not always–grows slowly. It is best treated if still prostate-contained, but it usually manifests no symptoms until it’s spread beyond the prostate. Fortunately, medicine has developed early screening tools. In a digital rectal examination (DRE), the doctor inserts a finger into the rectum (often after an embarrassed apology) and feels for enlargements or other abnormalities.

Only some tumors can be felt. About 1990, doctors added a PSA (prostate-specific antigen) test. PSA, measurable through a blood test, is produced only by prostate cells. Cancerous cells produce more than normal cells. PSA level can be a red flag long before other symptoms develop. (1)

Based on my PSA; the type of cancer found in my biopsy; and my age, health, and best-guess life expectancy, I was a candidate for virtually every major treatment: surgery, external beam radiation, proton beams, brachytherapy (implanting radioactive “seeds”), freezing the prostate, hormones, “watchful waiting” (monitoring but doing nothing else). No treatment is unequivocally regarded as “best.” Each has advantages and definite side effects and disadvantages.

SELF-EDUCATION

pcI began to seek every source of information and support. I’m grateful for all of them. But each can also provide biased, incomplete, or misleading information. Here’s my experience:

* MDs. Choosing the practitioner may be more important than choosing the treatment. I want my only body worked on by someone who’s competent, experienced, up-to-date, well-practiced. The best books and websites (see access) offer good guidelines and questions to ask when choosing a doctor, but they can’t make the choice for a person.

Caveats: Urologists are trained as surgeons, and usually recommend surgery if it looks viable. Radiologists tend to favor radiology. Etc. Getting additional opinions is crucial. Doctors sometimes understate problems (“this may hurt a little”). Nurses are often better sources of information about how much it will hurt, how long it will take, what to expect.

* My partner. Along with all the other support she gave me, including camping out on the hospital room floor after my surgery, my wife Pat became part of my decision process. We attended medical consultations together, compared notes, and weighed options. She’s the person who knows me best, and sees through me best. Fairly early, we began to talk about “our prostate.” And she was going to live with the consequences of my decision, which could be short- or long-term impotence, loss of libido, depression, even the small–but real–chance I could die during treatment.

There’s another good reason to include partners; they often have as much difficulty dealing with PCa as do patients. In a recent Memorial Sloan-Kettering study more wives than patients displayed a host of stress indicators, including fatigue, worry, depression, loneliness, and trouble sleeping (the studies I’ve read about all focus on wives; I haven’t seen any that address unmarried male or female partners).

* PCa survivors. Some of my very best sources of information were PCa survivors, who were generous enough to talk frankly, knew what I was feeling, and knew the answers to questions they wished they had asked.

Sharing the news of my cancer was not easy for me. But time after time, someone replied, “Oh, I’m a survivor,” or “I know someone you can talk to.” I talked with friends and friends of friends who had chosen every major therapeutic option.

I also found a PCa support group that meets weekly at our local hospital, The group includes veterans of just about every procedure–some with better results than others. Some members have made a near vocation out of tracking new PCa research. All are forthright, openly sharing intimate details and feelings.

Survivors caveat: Some people get defensive about the procedure or practitioner they chose. Others are just angry. Support groups can be skewed toward people experiencing problems (men often stop attending if they aren’t having complications). I learned to talk to as many people as I could, and to take no one’s experience as “typical.”

* Internet self-help groups. Tom Ferguson (“Online Health,” Whole Earth, Winter 2001) was right. Web-based groups can be an excellent way to contact a large circle of highly motivated fellow inquirers, pick up strategies, learn about new research, or post specific questions.

Same caveats as above, without the chance to read expressions and body language.

* Reading. The material available in books, articles, and the Internet can be overwhelming, and it keeps growing. My best tips on what to read have come from survivors.

Caveat I: The field keeps changing. Anything (especially a book) more than about five years old is likely to be out of date.

Caveat II: It may be that people with more dramatic problems are more likely to want to write them up. In any event, everyone’s experience is different. Virtually every account I read contained at least one bad experience that I didn’t have. On the other hand, if I ever write up my surgery and recuperation, I’ll be able to tell some scary stories I haven’t heard from anyone else.

Pat and I eventually chose surgery. Part of our decision was rational: If the cancer was contained within the prostate, surgery offered the best chance of getting it all. Comparable long-term survival statistics aren’t yet available for many other treatments. Surgery allows examination of the prostate to get the most accurate picture of the cancer’s spread. Treatments such as radiation can usually still be tried after surgery, but often not vice versa. Part of our decision was not so rational: we both just felt more negative about being irradiated than being cut.

Was I right to go for a “hit it with everything you can” strategy rather than hope the cancer would be slow-growing? Post-op pathology of my prostate revealed some much more aggressive cancer than the biopsy had showed; it had extended into, but not through, the prostate’s capsule. I’m glad I didn’t wait. Two months post-surgery, my PSA is undetectable. I’ll need to keep monitoring it forever, but it’s where I want it to be now. Continence? No real problem. Potency? It’s too early (I hope!) to know; the nerves were spared, but they can take months to heal. Did I make the right decisions? I’ll never know. I made the best one I could, with the information at hand and the help, love, and prayers of lots of friends. I couldn’t ask for more.

PROSTATE CANCER FACTS

About 190,000 men in the US will be diagnosed with prostate cancer this year. 31,000 are expected to die of it.

One in six American men can expect to be diagnosed with prostate cancer during their lifetimes.

Asians have the lowest prostate cancer rates in the world, but their risk increases dramatically when they move to Western cultures.

African Americans have the world’s highest prostate cancer rate. The percentage of African-American men who develop prostate cancer is 40 percent higher than that of white Americans. Black Americans die from PCa at double the rate of whites.

The risk of prostate cancer is twice as high when one close relative has it; five times as high when two close relatives do.

In one study of autopsy results, 30 percent of men over 50 and 80 percent of men over 80 had cancer in their prostates, though many were never aware of it.

Research continues on diet and lifestyle factors that might encourage or prevent PCa. High-fat (especially animal fat) diets seem bad. Selenium and Vitamin E, and perhaps soy, appear to help, but nothing is definitive.

You Can Beat The “Blues”

We all get the occasional blues–when we can’t fit into last summer’s swimsuit, for example, or after we’ve fallen out with an old friend. As human beings, it’s only natural we should feel our of sorts from time to time. It’s part of the light and dark, the yin and yang, of our nature.

ycbtbWhat’s more, these melancholy hours can be seen as a positive time for reflection. Depression, according to many holistic physicians and therapists, is like the proverbial canary in the coal mine–a warning sign that something is out of balance in our lives. “We need to go inside and see what’s happening,” says James S. Gordon, M.D., a clinical professor of psychiatry and family medicine at the Georgetown University School of Medicine. “What is disturbing, agitating, and overwhelming you? For most people, the answers aren’t such a terrible mystery after all.”

What follows are simple, side-effect-free approaches that will help you tackle your case of the blahs.

Note: If you are seriously depressed–or suspect you could be–seek the help of a medical professional; you may need the kind of immediate intervention that drugs offer, as well as intense inner work that can be difficult on your own.

Express yourself: Healing can occur only when we allow ourselves to release long-suppressed emotions. Christiane Northrup, M.D., the author of Women’s Bodies, Women’s Wisdom, likens this process to the treatment of an abscess: “Any surgeon knows to cut open [the abscess], allowing it to drain. When this is done, the pain goes away almost immediately and new, healthy tissue can re-form where the abscess once was. It’s the same with emotions. They become walled off, causing pain and absorbing energy, if we do not experience and release them.”

To channel your feelings, you might join a support group, talk to a friend or therapist, or keep a journal.

Get physical: Natural-health expert Andrew Weil, M.D., prescribes aerobic exercise for fast relief from mild depression. What should you shoot for? Weil recommends 30 minutes of continuous activity, five days a week; a brisk walk or bike ride will fill the bill. This regular activity will boost endorphins, the body’s own feel-good chemicals, and distract you from negative broodings.

Get some supplemental help: A natural antidepressant that’s garnering rave reviews is the amino-acid derivative SAM-e (S-adenosyl-L-methionine). It works as well as some prescription drugs do, according to Richard Brown, M.D., an associate professor of clinical psychology at Columbia University College of Physicians and Surgeons and the co-author of Stop Depression Now. Patients have reported feeling better within 7 to 10 days, he says. Work with a physician to get the right dose (the average dose is 200 mg, three times a day). Be sure to buy enteric-coated SAM-e in a blister pack, because SAM-e oxidizes rapidly and, unless enteric-coated, can be destroyed in the stomach before it’s absorbed. Nature Made is a reliable brand.

Nurture yourself: For those of us in the “sandwich” generation–tending children, careers, and elderly parents–taking care of ourselves is a luxury we rarely have time to indulge. But we may be paying a heavy price for that. Depression is directly linked to the lack of self-nurture in our hectic lives, says Sarah Ban Breathnach, author of Simple Abundance: “When I get into funks, I do one thing for my body, like buying a new bath gel; one thing for my mind, maybe finding a fascinating movie or book; and one thing for my soul, like raking a walk or listening to beautiful music.”

Whatever helps add an extra skip to your step, go our and do it today. You’ll feel the weight of the world begin to slip from your shoulders.

Shaking That Baldness Stigma

If your crowning glory isn’t so glorious anymore, don’t panic. You can look to new and better treatments to give hair loss the heave-ho.

stbsABOUT 40 PERCENT OF WOMEN over 50 suffer the demoralization of thinning hair, according to the American Hair Loss Council. “By the time you’re 50, you have roughly 50 percent of the hair you started with,” says John E. Wolf Jr., M.D., chief of dermatology at Baylor College of Medicine in Houston. While men experience receding hairlines and bald spots, for women it’s diffuse thinning all over the scalp, usually the result of declining estrogen levels and other normal changes of aging. Here’s what to do if you notice a thinning pate:

GET EXPERT HELP See a dermatologist who’s treated plenty of cases of thinning hair. “Women tend to consult a doctor very early, so most of the therapies are very effective,” says Patricia Wexler, M.D., a New York City cosmetic dermatologist.

The doctor will take a medical history. Pregnancy, childbirth, birth-control pills and menopause can cause shedding, as can diseases of the scalp and some medications, especially blood pressure drugs, antidepressants, anticoagulants and thyroid medications. Stressful events, including surgery, can also play a role.

The next step is a blood test to check for excess testosterone. Iron-deficiency anemia, thyroid conditions, diabetes and lupus also need to be ruled out, as does alopecia areata, believed to be an auto-immune disease, which can bring on partial or complete hair loss. Fortunately, many of these conditions are reversible.

REWRITE YOUR GENETIC LEGACY Androgenic alopecia, a hereditary form of hair loss, accounts for 95 percent of balding in men and women. But a family tradition of hair loss doesn’t mean there’s nothing to be done. Minoxidil, available over the counter as Rogaine, among others, is an excellent line of defense against hair loss, says Maggie Greenwood-Robinson, Ph.D., author of Hair Savers for Women: A Complete Guide to Preventing and Treating Hair Loss (Three Rivers Press/Crown, $14; to order, call Books Now at 800-962-6651). It can take up to four months to see results from a twice-a-day scalp treatment using 2 percent minoxidil, and you must use it for the rest of your life. The data on hair regrowth with minoxidil, however, are much less encouraging, making early intervention crucial. Another drug option for some women may be Aldactone (spironolactone), a diuretic used to treat high blood pressure. While it isn’t approved for use in regrowing hair, some dermatologists prescribe the drug, particularly if a patient is allergic to minoxidil and has a hormone imbalance (the drug decreases testosterone levels).

TRY A LITTLE TENDERNESS Avoid submitting your tresses to aggressive styling techniques, harsh chemicals, and the perils of sun and wind. “Use a gentle shampoo, then a protein conditioner,” says Dr. Wolf. And stick to natural products whenever possible, suggests Jennie Ann Freiman, M.D., a gynecologist in New York who embarked on a search for a better treatment–to the point where she concocted her own–when she continued to lose her hair long after the birth of her second child. “Sprays and gels can clog the pores of the scalp” she says, “so use a mild herbal shampoo on a daily basis.”

Supplements may help, too, but the evidence is sketchy. Stinging-nettle extract (Urtica dioica) has a long tradition as a hair grower, but to date no scientific data back up that claim. Dr. Wolf says there’s a possibility that biotin, an amino-acid supplement, may help hair and nails grow.