Prostate cancer book by physician-patient duo explains disease

Right after celebrating his 50th birthday, Alex Oliver was diagnosed with prostate cancer.

Roger E. Schultz, MDNow 64, the Williamsburg resident says that the disease just wasn't part of the public discourse back then. He and Roger Schultz, an urologist with Hampton Roads Urology with the Riverside Medical Group, who operated on him, have since been instrumental in bringing the subject into the open. After Oliver's diagnosis and treatment, the duo collaborated on a book, "Humanizing Prostate Cancer," ($15.95; www.brandylanepublishers.com) which was published by Brandylane Publishers in Richmond more than a decade ago; it has just been reprinted in its third edition.

The latest edition also benefits from updates from the publisher, Robert Pruett, whose father died from prostate cancer and who was himself diagnosed with the disease after the initial publication. "It's an easy two-hour read, a manual written at a seventh-grade level. It lets people know that there's a treatment –– it's very reassuring. Alex provides insights about dealing with the stress," says Schultz, who was initially reluctant to take on the book project. The urologist's objection was that there was already so much material out there, says Oliver, who approached him about writing the book at his six-month post-op checkup.

Oliver persisted because he felt that there was "nothing out there that average people can read and understand."

Using his background in English and journalism, Oliver drafted an outline, set chapter headings and designed a cover. When Schultz saw that it was from a different perspective, Oliver says, he was convinced and the patient and doctor started work on it together, hammering out a dialogue, chapter by chapter. "A lot had to be re-written to dumb down Roger's part," he says. "It taught him how to speak more simply to patients."

The end result is a guidebook –– "it's not a medical text" –– that's intended to take the fear out of getting a diagnosis. It also doesn't have to be read all the way through. It's designed with sidebars full of tips. "It's comforting, informative and humanizing," says Oliver, who has two main pieces of advice: Pick a doctor you have complete faith in and never compare your situation to anyone else's –– everyone's experience is different.

The book describes different therapies but does not advocate one treatment over another.

Schultz notes that thanks to two new, contradictory studies, there's renewed controversy over the merits of giving the PSA blood test as a diagnostic test for prostate cancer. PSA screening was introduced as a standard procedure about 20 years ago. Its efficacy in early detection is documented –– a PSA count rises many months, or even years, before the patient shows any symptoms –– but there's not a consensus about its role in the reduction of mortality rates. Prostate cancer is the second leading cause of male cancer deaths, but it's also present in many, many men who are unaware of it and do not suffer from having it. So, on the one hand early detection can lead to effective treatment for some, and on the other it can also lead to unnecessary or over-treatment for others.

Among the issues involved, according to Schultz, are that prostate cancer tends to be very slow to develop and many diagnosed with it will die from other causes first; also, many of the therapies have major side effects that patients don't want to deal with, such as incontinence and impotence.

Schultz follows the current guidelines of the American Urological Association, which advise that screening should be made on an individual basis.

Those with the most to be gained from screening are well-informed men over the age of 40 and men who have a higher risk of prostate cancer — African Americans, those with a strong family history of the disease or those with a PSA that has been rising over time. For the most part, older men (over 75) with a limited life expectancy (less than 10 years) probably should not have it, he says. The reason for this is what Schultz describes as the "snowball effect" –– what to do with the information from a raised PSA level. The next step is to biopsy the prostate, a procedure which itself carries certain risks of bleeding and infection. A lot, he says, are unnecessary, with just one in four biopsies resulting in a diagnosis of prostate cancer. "The big dilemma with PSA screening is deciding if the cancer, once revealed by a biopsy, presents a health threat to the patient," he says.

Then, a determination must be made among available treatments that can include external radiation; the insertion of radioactive seeds, proton beam therapy, cryotherapy (freezing the prostate), or removing the prostate. The choice depends on the grade and stage of cancer, the patient's age, current health and personal preferences.

In Oliver's case, with a history of other cancer in the family, he opted for the surgery and has no regrets about his decision 14 years later. As for PSA testing, Oliver believes that it probably saved his life.

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Published: June 27, 2009



 

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