Prostate Cancer

Introduction to Dr. Strum’s Prostate Cancer Update

When I was diagnosed with advanced prostate cancer in September 1991, I thought my life, as I had envisioned it, was over. Instead, I have found a whole new universe of living and, in doing so, have come to terms with my own mortality.

Transformation is what is possible when we are faced with a life-threatening illness. When the unthinkable happens to us and we are faced with our mortality, we have an opportunity to transform our lives.

Acceptance of our situation is the first milestone we must pass before we can truly begin the process of healing. For me this translates into doing everything I can to understand the entire process of my illness and what I can do to become well. While I do not blame myself for my diagnosis, it has been valuable for me to take an introspective look at my life in relation to the kinds of stressors or environmental exposures that may have played a role. Sometimes it is not until we are on the reef that we realize it is there.

Fortunately for us, the cancer patient today has many more resources available than there were just a few years ago. What follows by Dr. Stephen Strum is an update of the treatment of prostate cancer. I have known Steve for over 10 years. He is one of the precious few who have brought a new and compassionate dimension to the patient/physician relationship.

Frederick Mills
Prostate Cancer Survivor
Founding Member of Educational Council
for Prostate Cancer Patients

Prostate Cancer Update

Stephen B. Strum, M.D., F.A.C.P.

General Introduction

In this edition of Disease Prevention and Treatment, I will discuss prostate cancer (PC), using the metaphor of a military incursion–needing to have a focused, strategic approach, deployed in a systematic, problem-solving manner. The purpose of such a metaphor is to bring to the student of this disease a different perspective that will hopefully provide new insights that will lead to victories in our battles against this disease. The reason for such a departure from the conventional formal discussion of PC is that this latter academic approach is not being translated into winning strategies for the man with PC. The battle is being lost because we, the generals, are not translating what has been published in medical journals and discussed at national meetings into real-time preventive, diagnostic, evaluatory, and treatment tactics. Medical pragmatism–the art of being practical and using common sense–is not being practiced.

The battle to prevent this disease, to diagnose it earlier, and to treat it effectively is also not occurring at the proper pace largely because men are not taking an active role in winning this war. As we are learning in our war against terrorism, you defeat the enemy by recognizing their presence early (not late), preventing their buildup, learning their location, and eradicating them with the proper weaponry. There are too many men, already diagnosed with PC, who are not taking an active role in their own recovery. Many believe that because they are consulting a professional with a medical degree (who may also command a generous salary), all or part of this equates with getting the very best advice and treatment. Wrong. In today’s world of rapid pace, where medicine is practiced with 15-minute office visits and where physicians are too busy to read and translate much of what is being published, the patient and his partner must not take a passive role and assume that all that can be done is being done.

My recommendations, therefore, either to patients with PC or to their loved ones, will be those of a counselor or guide, offering practical advice based on 20 years of working on the front lines of PC management. I do not hesitate in telling you that for the vast majority of men diagnosed with PC, a successful outcome can be realized. But the principles you are about to learn must become part and parcel of the strategic approach used by the patient/partner/physician (PPP) team. The patient and his partner have the most to gain as well as the most to lose when encountering PC. They must expend serious energy to win this particular war. In doing so, they learn the art of battle; they are brought closer together and evolve in their lives; and other intertwined health issues are brought to light and healed. This is the beauty of such an approach. Are you willing to invest in the time to help yourself? Are you worth it?

The most important take-home lesson that I can relate to you within the pages that follow relates to your ability to use concepts. It is through the use of concepts–the structural framework of our thinking–that we intelligently plan a strategy of success.

Table 1 Comparison of a Military Campaign with Prostate Cancer Strategy

Winning a Military Campaign Defeating Prostate Cancer (PC)
  1. Preventing War
  2. Basic Military Training
  3. Military Information (Intel)
  4. Early Recognition of Enemy Activity
  5. Assessment of the Enemy
  6. Knowing Pros and Cons of Weaponry
  7. Understanding Enemy Vulnerability
  8. Stopping Supply Lines to the Enemy
  9. Stabilizing Key Arenas of Conflict
  10. Supporting the Troops
  11. Boosting Morale of Troops
  1. Preventing PC
  2. Getting Help to Understand Biological Principles
  3. The Importance of the Medical Record
  4. Early Diagnosis of PC
  5. Risk Assessment of the PC Patient
  6. Understanding Pros and Cons of Treatment Options
  7. Learning Principles Underlying Tumor Growth
  8. Antiangiogenesis Treatments, Dietary Changes
  9. Focus on Bone Integrity, Biomarkers, etc.
  10. Supportive Care of the Patient
  11. Fostering a Will to Live, Empowering the Patient

As stated in the introduction, defeating PC is a military campaign. Winning a military campaign, or a war against PC, involves concepts such as prevention, basic training, military intelligence (Intel), early recognition of enemy activity, assessment of the strength of the enemy, an understanding of the pros and cons of the weapons in our arsenal, stabilization of key areas of conflict, stopping supply lines to the enemy, supporting our troops, and other issues common to a military arena (see Table 1). A strategy for success, be it in a military war or a war against PC, simply involves adding factual information to a sound conceptual framework.

The approaches used in a winning strategy, whether for a military campaign or a medical battle, are superimposable. That which occurs in the life of a cell is reflected in society as well.1 Cellular battles are but a microcosm of what takes place on a more macromolecular level within the individual, his community, his country, the planet, and the universe. This is reflected repeatedly throughout the entire history of man.