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Don’t Panic

For the last 10 months or so, I have been writing about prostate cancer for the Prostate Cancer Foundation, for a new website and movement to give men the best information that’s out there so that they and their doctors can determine the treatment that’s right for them.  The program is called MANy Versus Cancer. 

I have noticed, over the last 24 years that I have been writing about prostate cancer – nearly half my life, starting with that first article I wrote for Hopkins Medical News magazine trying to understand why my father-in-law died of this “old man’s disease” at age 53 – that men are still way behind women when it comes to health care. 

They don’t want to think about it, and they don’t want to talk about it.  I am really hoping that this MVC movement will help change this, and I am going to be sharing what I’ve learned from interviews with top urologists, oncologists, radiologists, pathologists, and basic scientists from around the world. 

On a personal note, the PCF is the real deal; I wouldn’t write for it otherwise.  Its goal is to fund research and streamline the process; grants are limited to 10 pages, and scientists who apply for them hear back in 90 days.  The government doesn’t do this.  The PCF also funds young investigators in the U.S. and other countries, and these young scientists tend to defy the odds of academic medicine and stay in research, most of them getting their own labs and training the next generation of investigators. 

It’s a good organization, and the science is top-notch.  I hope you will go to pcf.org and see for yourself.  Most of what I’ve written is under “Understanding Prostate Cancer” and “For Patients.”  There has never been more hope for this disease than there is right now.  Now, let’s get started, with an interview I did with Cornell urologist Chris Barbieri, M.D., Ph.D. 

You’ve Got Prostate Cancer. Now what?

You’ve had the PSA test – or more likely, several of them – plus the digital rectal exam, and one or both of these suggested that you needed a biopsy.  The biopsy was not fun, but you did it, and then you waited for a pathologist to look at the tiny, needle-sized cores of tissue removed from your prostate.  Maybe you managed to forget about it while you were waiting – maybe you feel perfectly healthy, and this all seemed surreal.  Or maybe you let some dark thoughts creep in, and you started thinking about cancer and remembering everyone you ever know who has had cancer and not done very well.  The waiting’s over now.  Your doctor has just given you the news:  there’s cancer in there.   What are you going to do?

The very first thing you should do is, don’t panic. 

christopher_barbieriIf you have cancer in your prostate, it didn’t just spring up like a mushroom.  It has been there for years, maybe even a decade, growing very slowly, taking a long time just to get big enough to be discovered.   “Even in a fairly aggressive form, prostate cancer grows slowly compared to other cancers,” says urologist and molecular biologist Christopher E. Barbieri, M.D., Ph.D., on the faculty Weill Cornell Medicine at New York Presbyterian. 

What this means for you is: brush the dark thoughts away.  Nobody wants to have cancer, but if you have to have it, there has never been a time of more hope.  There have never been better treatments.  There have never been so many men not dying of prostate cancer, and not having bad side effects from treatment. 

You are going to get through this. 

If your cancer was diagnosed through regular screening, that’s an extra reason to be upbeat:  Just a couple of decades ago, before the PSA test and regular screening became widespread, most men didn’t know they had prostate cancer until it was often too late.  Either it had gotten advanced enough to cause symptoms like back pain or urinary problems, or it was big enough for a doctor to feel it during a rectal exam.  Many men used to be diagnosed when cancer was no longer confined to the prostate and was more difficult to treat. 

That’s no longer the case.  Thanks to regular screening, most men are diagnosed at least five years earlier than they used to be.  Most men are diagnosed with cancer that is very curable.  In fact, many men are diagnosed with cancer that maybe shouldn’t even have been found – cancer that doctors call “incidental,” which means it’s just there, but it doesn’t do anything.  It just sits there in your prostate, just a few very slow-growing, not aggressive cancer cells, and you could have lived your whole life never knowing they were in there.  Many men die with prostate cancer, not of it.   

So the second thing you need to do – the first, remember, is do not panic – is figure out just what kind of prostate cancer you have

If you were diagnosed at a smaller medical center, doctor’s office, or hospital, it’s a good idea to have your biopsy results sent out to another pathologist at a large medical center, where they see a lot of men with prostate cancer, for a second opinion.  Prostate cancer can be tricky to interpret, and it’s a good idea to get a second opinion from somebody who specializes in looking at it – not breast cancer, not ovarian cancer, not colon cancer, just prostate cancer. 

The third thing:  Take your time

pexels-photo-53918Once you know what you’re dealing with, your first reaction should not be, “Oh, my God! I’ve got to get this out of here!” or other words to that effect.  Do not feel rushed to get treatment right away.  First of all, your body needs several weeks to heal from the biopsy.  Second, now is the time – for you to figure out which treatment is right for you

Remember, that cancer has been in there for a long time.  It’s not going to grow very much over the next few weeks; in fact, it may not grow at all.  If you and your doctor decide you need surgery or radiation to kill the cancer you then need to find the best place – it may be nearby, or in another city in your state, or even further away – for you to have this done.  It is far better to take a little while – not much time at all in the greater picture of your life – and make a decision that is right for you than to rush into treatment and later regret being so hasty. 

Do not despair.  Take heart, take a deep breath, and figure this thing out. You are not alone.  There are millions of us here in the “reluctant brotherhood” of prostate cancer (and plenty of sisters, too – wives, daughters, sisters, girlfriends, mothers – who have shared this journey).  Reach out to us.  We have been where you are now, and come through it.  You will, too.

Coming up next: Chris Barbieri talks about active surveillance.

Charred Food Bad, Veggies Good for the Prostate

grilled meatGood news for people who love barbecue, hot dogs, burgers, and steak cooked on the grill: It pays to eat your veggies.

The key to this story is something called “PhIP.” A few years ago, noted Johns Hopkins scientist Bill Nelson, M.D., Ph.D., director of the Sidney Kimmel
Comprehensive Cancer Center, began investigating its role in cancer. PhIP is a funny little word. (Pronounced “fipp,” it’s a short name for a long chemical
compound.) It sounds so harmless: “Hey, let’s get PhIP and go over to the club for some tennis,” or “I don’t give a PhIP what you do,” or “Let’s do some
PhIP shots!” But it’s not.

PhIP is found in meats cooked at high temperatures. It is a “pro-carcinogen,” a chemical that turns into something that can attack and mutate DNA, and is
known to cause prostate, breast, and colorectal cancer in rats. Unfortunately, we create carcinogens, or cancer-causing agents, with every steak we grill
or piece of chicken we fry, and PhIP is one of them. In 2007, Nelson and pathologist Angelo De Marzo, M.D., Ph.D., reported in Cancer Research
that when rats are exposed to PhIP, DNA mutations occur in the prostate. Since then, they have learned much more about this little sucker’s role as a
dietary contributor to cancer. I recently wrote about Nelson’s work for Discovery, the research magazine for the Brady Urological Institute at Johns
Hopkins.

The scientists have discovered that veggies help counteract the effects of PhIP. “When we fed rats tomato and broccoli along
with PhIP, the animals lived longer and showed reduced incidence and severity of prostate neoplasms (new, abnormal cell growth; particularly of PIN,
prostatic intraepithelial neoplasia – funny-looking cells that are linked to prostate cancer), intestinal cancers and skin cancers as compared to rats fed
PhIP alone,” says Nelson. “This provides even more evidence that eating vegetables may protect against cancer-causing agents like those in overcooked
meats.”

grilled veggiesThere is a twist to the story: Food safety pays off, too.
Nelson, along with De Marzo and scientist Karen Sfanos, Ph.D., has also explored the idea that prostate cancer may involve a combination of “environmental insults” – bad things in the diet, plus something else that weakens the body, like an infection. They wondered whether chronic inflammation, caused by bacterial infection, would make a difference in rats that had consumed PhIP. Using a specific strain of E.coli isolated from a patient with chronic prostatitis/chronic pelvic pain syndrome, they found to their surprise that the charred food plus the nasty bug seemed to have a systemic effect.

Together, E.coli and PhIP caused an increase in the development and progression of cancer in the skin and digestive tract. (Note: many people have E.coli in their gut and it is harmless, but some strains can get into meat when it’s processed and can survive if the meat is undercooked.) The rats that received the double punch of E.coli plus PhIP fared worse than rats that ate the PhIP alone. In one study, the bacteria- and PhIP-consuming rats developed more precancerous lesions within the prostate and might have developed even more problems – except they also died sooner.

In further experiments, they found that “when we inoculated PhIP-fed rats with E.coli in the prostate, the animals developed acute and chronic
prostate inflammation out of proportion to that seen with PhIP ingestion or E.coli inoculation alone, and had more prostate neoplasms, intestinal
cancers, and skin cancers,” says Nelson. “This hints that prostate infections and dietary carcinogens might interact to promote chronic prostate
inflammation and prostate cancers, and that prostate infections might augment carcinogen effects on other tissues, as well.”

What does this mean for you? One, that if these things cause changes in the prostate, it’s a pretty good bet that they are hurting you elsewhere, as well,
so take precautions: eat a veggie in addition to a potato. Potatoes are delicious, but they don’t help fight cancer the way green, leafy vegetables and
tomatoes do. Two, tomatoes and broccoli probably aren’t the only vegetables that can help diffuse the bad effects of charred meat; these are just the ones
that were studied in this particular investigation. Three, don’t eat undercooked meat. You’re not just risking food poisoning, which comes in like a
freight train and goes away quickly; you may be adding to your risk of developing cancer.

Nelson, along with De Marzo, Sfanos, and Hopkins colleagues recently published two papers on these striking new findings in the journals PLoS ONE
and Cancer Prevention Research.

©Janet Farrar Worthington

Regular disclaimer: This is a blog. It is not an encyclopedia article or a research paper published in a peer-reviewed journal. If a relevant
publication is involved in the story, I mention it. Otherwise, don’t look for a lot of citations, especially if I’m quoting from a medical
professional.