April 17, 2010

My book, How We Survived Prostate Cancer:  What we did and what we should have done, has been out a little over a year.  The book has a life of its own; it has already helped quite a few people sort out the tricky issues surrounding treatment and its aftermath–especially as a couple.  When I was writing it, more than once I–we–said, “If only one person finds this book helpful, it has been worth all the effort…”  We’ve had the reward of hearing from many strangers and not a few friends for whom the book has made a difference.

Therefor, celebrate with Dean and me the second year of this book’s life.  The Graedons, a couple who host  one of my favorite radio shows, The People’s Pharmacy, originating out of UNC in North Carolina, interviewed both of us via satellite in January.

The interview goes live today, saturday April 17 on WUNC (available via the web at www.wunc.org). It will be broadcast at 3 PM, with a podcast available from wwwpeoplespharmacy.com on monday (show #765). The moment it is available on the PP website, there will be a link to victoriahallerman.com

The show will also appear on radio stations throughout the country (see affiliate list on http://www.peoplespharmacy.com).

An interview with Dr. Ablin, one of the discoverers of PSA, who wrote a controversial Op Ed in the New York Times about the subject, and whose editorial I blogged about in this very column, will also be posted on http://www.peoplespharmacy.com, if you’d like to follow the controversy.

Join with us in celebrating what this book’s mission is:  to share the news about the effects of PCa and treatment, for individuals and for couples. Let us know what you think.  More importantly, please pass the news on to anyone you think may find it useful.

It is fitting that this program airs in April; this month we are celebrating Dean’s 7th anniversary free of prostate cancer.

Thanks for listening–
Vicki & Dean


Medical Fashion

March 12, 2010

Medicine has its own fashions, and while they rule, they rule.  The healthcare fashion runway (medical journals or labs, clinics, newspapers, websites), features models of its own (the people whose lives have been saved or improved in a noticeable way by one or another treatment or device).  But ways of thinking, like fashions, turn, sometimes on what seems like a research whim, and this year’s wonder device, supplement or brilliant treatment strategy may end up suddenly in the has-bin. 

That’s how it shook down a year or two ago for Hormone Replacement Therapy, last decade’s fountain of youth for menopausal women, now widely considered risky business.  Vioxx went that direction. Antioxidents and Vitamin C. have lost their pizazz, as has glucosamine for arthritis.  Even the unassailable mammogram, once important at forty is considered questionably useful at fifty or beyond.   

Add to the list “P.S.A.,”an acronym that once stood for “Public Service Announcement,” until it became a synonym for worry in men of a certain age whose prostates might possibly harbor cancer. Prostate Specific Antigen, a normal protein in men’s blood that, when elevated, can signal prostate cancer, might also indicate Benign Prostatic Hyperplasia–or nothing. The often painful prostate biopsy that usually follows an elevated PSA, even when it yields positive results, won’t tell you or your doctor whether the prostate cancer in question is one of the fast-moving variety or the other far more common one you’ll die “with, not of.”  

 Mammograms, PSA–these tests cost us all a lot of money, and money is something we ought to be saving, isn’t it? ( starting with overinflated executives’ salaries might be more prudent). But what has really happened is that the optimism surrounding the tests’ universal use has begun to fade. Suddenly it isn’t clear if or why most of us should get them, and statistics aren’t making a case for continuance.

 Well here are two cases:  my sister, whose breast lump was removed at 71, and my husband, whose rapidly escalating PSA might have indicated virulent cancer (we’ll never know).  Almost everybody knows someone who might have died if he or she hadn’t been tested.  But these days,  a kind of “ignorance is bliss” approach surrounds both these cancers; it’s almost  “don’t ask, don’t tell.” 

What’s changed?  Our optimism concerning survival and treatability?  Out with the old  and in with the new:  float another dress down the runway.


Life Without P.S.A. Screening: Russian Roulette?

March 10, 2010

Millions of men woke this morning to the news that what had been done to their bodies in the name of stopping prostate cancer, may after all have been “a mistake.” Writing in The New York Times (Tuesday, March 10, 2010), Dr. Richard J. Ablin, who discovered prostate specific antigen in 1970, calls the routine use of P.S.A. to screen for prostate cancer “hardly more effective than a coin toss.” He points out (as many health-care professionals have been unwilling until recently to admit) that men, post treatment, “…in all likelihood can no longer function sexually or stay out of the bathroom for long.”

American men have, according to recent statistics, a 16 % lifetime chance of receiving a diagnosis of prostate cancer, but only a 3 % chance of dying from it, because most prostate cancers are slow-growing:  the cancer you die with, not of.

Dr. Ablin admits, as we all know, that, so far, we can’t distinguish between the cancer that will kill you and the one that won’t.

Who is the “you” in the previous paragraph?  A statistic or a real flesh-and-blood man?

How does Dr. Ablin imagine it feels to wake up and read that your life-altering treatment has been a mistake? What is a statistic to a life?  How many men with rapidly-escalating P.S.A.’s had Gleason Scores of 7 or above and are alive today as a result of this test? Admittedly, my own husband, whose Gleason was a routine 6, might well have been unnecessarily treated, although his P.S.A. velocity at the time of prostate cancer diagnosis was notable.

It may be that Dr. Ablin’s metaphor, the coin toss, is off the point. It has been said that generally one in ten men with a positive biopsy has a fast-moving prostate cancer that will kill if left untreated.

Universal P.S.A. screening may be a coin toss; but its absence returns us to Russian Roulette. P.S.A. tells us that it might be cancer, and if so, a virulent bullet might be in one of several chambers. Surely knowing this is so, and going for a biopsy, painful as it is, is more valuable than ignorance. If, as Dr. Ablin suggests, “testing should absolutely not be deployed to screen the entire population over the age of 50,” then my husband, among others, might have waited long enough to hear the word “metastasis,” or the even more chilling, the words, “your cancer has gone to bone.”

If P.S.A. as a universal screening tool is inappropriate, then rather than scrapping it for the general population, perhaps doctors should learn to educate their patients and partners to the real truth about the likely sexual, urinary and even bowel consequences of treatment. Then men can make a truly informed choice, as many European men do, who choose to watch and wait.

As long as men are alive who have received these treatments in good faith, Dr. Ablin’s argument stands as the ultimate insult to their experience. He shames what he calls profit-driven public health initiatives, but there are men whose lives have been spared, and those lives are worth something after all. The real shame lies in valuing statistics over individuals.