Early detection is the key to treating genital-pelvic cancers diagnosing the disease during an examination. "You have to
consider all the options, not just cutting the prostate out, because
your life may be miserable after you cut it out," he says. "Some
By CHRISTOPHER JOHNSTON older people might not care if they have to carry a bladder bag
around, but it's different for a younger person who has to go
Upon being diagnosed with prostate cancer, Kevin into people's homes or go to an office every day and is interested
Braunschweiger was less concerned about losing his life than in maintaining a good romantic relationship."
about losing his love life. The embarrassment factor, though, never really entered his
"At a fairly young age, 45, I had some special mind. "I'd probably still have an issue with testicular cancer, just
considerations," recalls the Mentor resident. "My wife is five because it's a sensitive area," Braunschweiger says, adding with a
years younger than me, and although I was done having kids, I laugh: "But since I've never seen or touched my prostate, it
wasn't done having fun." wasn't that interesting to me."
Men being men, fears of being less than virile unfortunately Considered young for the average prostate cancer patient,
often take precedence. Despite the high cure rate for prostate Braunschweiger was actually very fortunate to have it diagnosed
and testicular cancers that are detected early, most men with when he did, because the most insidious aspect of prostate cancer
genital-pelvic cancers are more concerned about the possibility is that it usually shows no symptoms in its early stages, when it is
of impotence and incontinence that may occur as a result of most treatable. He had complained of a dull pain in his. lower
surgery to remove the tumor. Then, there's always the potential back similar to the discomfort he had felt in 1992, when he had a
embarrassment because of the tumor's physical location and the kidney stone removed.
primal, psychological gravitas a man invests in his manhood. . Although ranked by the National Cancer Institute as the
Braunschweiger admits the former was his initial concern in second most frequently diagnosed non-skin cancer in American
August 1998, when his urologist prescribed surgery after men, prostate cancer stands a distant second to lung cancer as a
cause of death. Lung cancer killed 94,400 of the 98,300 men 10 years ago was approximately equal to surgery in effectiveness,
struck with the disease in 1997, vs. the estimated 41,800 deaths why not do the radiation seed therapy?"
from the 209,900 new cases of prostate cancer detected, While the surgery yields a higher risk of impotence or
according to NCI statistics. incontinence than the radiation, Ellis says, the advantage is that if
About 80 percent of men develop prostate cancer by the time there is a local failure afterward, patients can still receive the
they reach their 80s, though only 2 to 3 percent die from the radiation therapy. With radiation treatment, however, if there is a
disease. Still, the American Cancer Society recommends that, local failure within the prostate - which, Ellis argues, is less
starting at age 50, every man should have an annual check-up common than with surgery - it is difficult to then perform
that includes a digital rectal examination and prostate-specific surgery without damaging the bladder or the rectum. Moreover,
antigen (PSA) blood test, a powerful diagnostic tool developed in new surgical grafting techniques have been developed to spare
the late '80s to detect cancer activity in the prostate gland. the nerves that were most often damaged during a
That recommended starting age drops to 45 for Caucasian prostatectomy.
males with a family history of prostate cancer and for African
American males who, for reasons yet undetermined, have a SIMILAR FEARS AND psychological issues also apply in the case of
higher incidence of prostate cancer than Caucasians. For African testicular cancer, or testes tumor. Unfortunately, although only
American men with a family history of prostate cancer, the about 7,000 American men are diagnosed with this form of
annual check-up should start even earlier, says Dr. Joseph cancer each year, it can prove extremely deadly for those who do
Dankoff, member of the Department of Urology and assistant not respond immediately upon detection.
professor of clinical urology at the Northeast Ohio College of Michael Gusley, 44, of Parma, is fortunate to be recovering
Medicine in Akron. from testicular cancer. Last year, he noticed that his right
"We don't know if it's caused by a genetic predisposition or testicle had become enlarged, but he put off seeing a doctor
environmental conditions, but extensive research is being '" because he wasn't experiencing pain, and his temporary
conducted to determine the racial differences at research .' job did not provide any medical coverage.
facilitiesworldwide," Dr. Dankoff says. . This past April, when he began feeling a sharp pain
in his right side, Gusley went to the emergency room
FAMOUS FOR PERFORMING exhaustive research into purchases, at Parma Community General Hospital, where a
Braunschweiger, a financial planner for the Aid Association for CAT scan revealed a cancerous mass in his abdomen.
Lutherans, did some checking and found Dr. Rodney J. Ellis, Surgeons also removed the enlarged testicle. Gusley
director of brachytherapy, Department of Radiation is currently undergoing chemotherapy to eliminate
Oncology at University Hospitals of Cleveland. Ellis is the abdominal tumor.
pioneering brachytherapy - the implantation of radioactive "I knew it was cancer, but I put it off, which
seeds or pellets into the diseased prostate - which was a bad thing to do," Gusley acknowledges. "I
eliminates the risk of functional problems caused by now tell people who realize they have an enlarged
damage to the nerves during surgery. The procedure testicle to get it treated as soon as possible, so the
has been used in the U.S. since the early 1980s. cancer doesn't spread as it did with me."
"Generally, a prostatectomy is the number Testes tumor strikes men between their late teens
one recommendation that most of the and early 40s. (While older men can get a tumor in the
urologists will make," Ellis says. "But now testicle, it is usually a lymphoma, which is treated
the data for radiotherapy looks as good as differently and does not always require removal.)
it does for surgery." Physicians tell too many tales of young patients too
Advances in computer technology embarrassed by their condition to report it - long past the
let surgeons pinpoint the cancer's early stages of the cancer, which is defined as before it
location; doctors can more accurately progresses beyond the testes - even to the point where the fast-
insert the radioactive seed implants or growing tumor, which doubles approximately every month or
focus the external radiotherapy beam closer to two, had reached the size ofa softball.
the center of the tumor and provide a higher dose of radiation The irony is that testes tumor is highly treatable in its early
where it is most needed to eradicate the tumor. Depending on stages, especially due to advances in chemotherapy over the past
the volume of the tumor, the implants typically average around few decades. To enhance early detection of testes tumor, the
100 tiny seeds of either an iodine or a palladium isotope. American Cancer Society recommends monthly self-exams,
"By sparing all of the other tissue from getting a high dose of starting in the early teen years.
radiation, we can deliver the treatment more safely because it's "Testes tumor represents a very small percentage of all
less toxic, and we can give a higher dose so that our cure rates malignancies, and it's highly responsive to chemotherapy," says
improve," explains Dr. Ellis. Dr. Michael Oefelein, assistantprofessor, urology, Case Western
Those advances factored into Braunschweiger's decision to go Reserve University School of Medicine and University Hospitals
with the seed implants. "We looked at the statistics of of Cleveland.
implantations that were done 10 years ago, which weren't even Again, the recently developed nerve-sparing technique can
the state-of-the-art procedures," he says. "So if what was done mitigate impotence and incontinence caused during the removal
84 NorthernOhioLive : August 2000
of lymph nodes around the retroperitoneum or the aorta and
inferior vena cava in the upper torso, which are the first places
testicular cancer spreads to after leaving the testes. Damage to
these nerves can cause impotence by impairing the reflex
contraction that normally occurs during ejaculation, which closes
the bladder neck and forces the semen to discharge through the
urethra rather than into the bladder.
Treatment of a new high-dose chemotherapy, followed
by a bone marrow transplant to replace damaged blood cell
producers in the marrow, is available for patients with
Perhaps most important, for both prostate and testicular
cancer, increased awareness is the key to ensuring earlier
detection that can significantly raise cure rates. Today, physicians
applaud the impact of major celebrities going public about their
cancers - golfer Arnold Palmer and New York Mayor Rudolph
Giuliani for prostate cancer, and skater Scott Hamilton and
comedian Tom Green for testicular cancer - as the most
powerful form of awareness-raising publicity.
Ultimately, Dankoff says, early detection is essential for saving
a patient's life. "You can invent all the new chemotherapy and
other treatments you like, but without early detection, once the
cancer has metastasized, the newfangled stuff isjust like spitting in
the wind," he says.
Christopher Johnston Ulges fnend and foe alike to undergo a yearly check-up.
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