Prostate Cancer Has A History

 

Helen Valier, A History of Prostate Cancer, 2016, Palgrave MacMillan.

This is the best book I’ve found that covers the scope of prostate cancer—history, treatments, and research. While quite a few articles exist elsewhere that deal with the topics in specific ways, Helen Valier has brought everything together, and her book answers most of my questions. I say most because her book came out in 2016, and medical advances have continued to occur over the last nine years. One example is the development of the PSMA-PET scan that can detect trace amounts of cancer cells that traditional scans like the MRI and CT miss.

The book covers the entire history of prostate cancer, what physicians in ancient times suspected what was going on, how the cancer was treated through the centuries, the struggles of doctors to find solutions and a cure, and the big debate that we continue to struggle with is over whether it’s better to catch the cancer early through prescreening and use of the PSA blood test, and get some false-positive results, or wait until symptoms show up, when the cancer might have already spread into the lymph nodes and bones. Doctors have differences of opinion about this. So do patients.

The chapters cover the problematic prehistory of prostate cancer, surgery and specialization, sex and hormones, clinical trials, screening and the politics of prevention, and radiation therapy.

The main drawback with the PSA is the false-positive result, which cause men anxiety. Yet if your PSA is high, then doctors do a digital exam, and if that indicates something, then they do a biopsy to find out what you’re dealing with. The Gleason score that comes out of this determines the level of treatment you need to get. If it’s a low score, you probably have the wait-and-watch variety of prostate cancer and nothing needs to be done. A high score indicates that your cancer is aggressive and something does need to be done now.

The risk with having a higher than normal PSA is that some men overreact when they’re told they have cancer and demand treatment right away, when in reality their cancer is actually low-risk and they simply have to watch to see if their PSA number jumps. There are definite risks to the treatments because they can have serious side effects, some that do not go away. Doctors can also over-diagnose and do more than is necessary as they try to be proactive. Patients need to be aware of these matters and decide the level of risk that they are willing to take on.

If the cancer has remained within the prostate, the standard course of action is surgical removal of the prostate. If cancer cells have moved locally outside of it, like into a seminal vesicle, then doctors do a combination of hormone therapy, brachytherapy, and several weeks of daily external radiation. If cancer has metastasized into your lymph nodes or bones, then you head off on a different course of treatments, with genetic and genomic / somatic testing to help determine your specific therapies.

While the book focuses on the diagnosis and treatment of prostate cancer over the years, the patient side of the equation is not often dealt with. Valier acknowledges this and says that other historians can explore this aspect. She does provide one example, though, which is enough to give me hope for my aggressive cancer. Her father’s cancer wasn’t found until it was Stage 4 and in his bones. He began treatments and was doing well ten years later.