Prostate Cancer-4

2.GETTING HELP TO UNDERSTAND BIOLOGICAL PRINCIPLES ABOUT PROSTATE CANCER

Support Groups
Field Guides
Missing Link
Specialist
Patients
To master the tactical approaches and be victorious in your battle with PC is challenging. In such a context that involves a major crisis in your life, you need to have guidance in multiple shapes and forms.

The Profile of Vitamin/Mineral Supplement Users

a)Characteristic of Supplement users
Twice as likely to have had a PSA test:Odds Ratio-2.2
OR 95% Confidence Intervals:1.3-3.7

b)Characteristic of Supplement Users
Take aspirin regularly:Odds Ratio-1.7
OR 95% Confidence Intervals::1.1-2.6

c)Characteristic of Supplement Users
Statistically significantly more
likely to exercise regularly Odds Ratio:1.7
OR 95% Confidence Intervals:1.2-2.4

d)Characteristic of Supplement Users
Eat 4 or more servings of fruits and vegetables a day:Odds Ratio-2.4
OR 95% Confidence Intervals:1.6-3.8

e)Characteristic of Supplement Users
Follow a low fat diet pattern:Odds Ratio -1.7
OR 95% Confidence Intervals:1.1-2.6

f)Characteristic of Supplement Users
Believe in a connection
between diet and cancer:Odds Ratio -1.9
OR 95% Confidence Intervals:1.4-2.9

Support Groups

If you belong to an interactive support group, this can be a great beginning. These are some of the largest:

Us Too International, Inc., (800) 808-7866;
www.ustoo.com
Man-to-Man, (800) 227-2345;
http://www.cancer.org
Patient Advocates for Advanced Cancer Treatments,
(616) 453-1477; http://www.paactusa.org
Education Center for Prostate Cancer Patients,
(516) 942-5000; www.ecpcp.org
I have attended many support group meetings, and the level at which each support group functions is highly variable. Some are informal meetings--more akin to chat groups relating personal experiences. Others are more scientific, with guest speakers involved in the diagnosis and treatment of PC. I hope that more support groups evolve into workshops that focus on each of its members--one at a time--using a scientifically objective approach with working forms. In such an idealized setting, an invited professional speaker would be asked to orient his or her talk around selected case histories (called clinical vignettes) pertaining to individuals in the support group.

Let's face it. Everyone at the support group meeting is there because of a perceived threat involving his or her life as it relates to PC. They are present because they are seeking answers to their problems. Therefore, every PC patient-oriented meeting should have patient outcome as the prime directive. Patients should understand that they learn about their particular problem through the understanding of concepts that, more often than not, also apply to them. When such lessons are taught as a story of an actual human being, the lesson is reinforced and becomes memorable. Such an approach translates science into practical issues of value that are more understandable to the individual man with PC and his partner.

Resolution of problems and prevention of problems unrecognized (or yet to develop) should be the prime directive of such organizations. Working together as a team (or army) to help one another is an effective way to teach all members of this platoon some valuable lessons about PC and hopefully about the spirit of human unity. Those that approach PC in such a manner will increase the likelihood that critical crossroads will now be approached in an intelligent fashion and crossed successfully. Instead of hearing about patients and physicians making the same mistakes repeatedly, we would hear more and more success stories. We do not want to fulfill the warning that the philosopher Santayana posed when he said:

Those who cannot remember the past are condemned to repeat it.

In my 20 years of counseling patients and physicians about PC, the same mistakes are made far too often. Using an objective format to gather data and presenting such data to your support group veterans should be the modus operandi of support groups. This will be discussed later in detail.

Also, and of great importance, working together elevates the individuals and the group. The mindset of the man with PC changes from "me against the disease" to "we against the disease." This fosters feelings of human unity. It is within this human unity, or humanity, that hope for mankind lies:

Our humanity lies in our human unity.

Without it, we are all individuals fighting a lonely battle. With it, we can conquer anything. Support groups, then, should elevate and evolve the individuals within them. Support groups should have a task force mentality, objectify patient information, and resolve critical issues for the individual, while at the same time accomplishing this for the group. How can this be done?


Field Guides
If we are striving to develop a group mentality and can pool our individual talents, we can now enter the phase of synergy. This can be facilitated by using the skills of those who can organize thought and details and share such organizational thinking with others. Manifestations of this are in books, medical articles written for the PC patient and partner, PC-specific newsletters, websites, and Internet-based tools. Suggestions for these elite materials, the field guides, are provided at the end of this protocol.

To summarize these points, a winning strategy for the individual soldier and his corps is to understand as much as possible about his situation in the context of the battle. His PC-fighting training, if you will, mandates his reading the manuals and doing his homework.

The only place where success comes before work is in the dictionary.

The concept of synergy empowers this foundational tactic. Therefore, the individual man with PC, his partner, and corps of patients in his support group must be working in the spirit of harmony. In essence, at this crossroads, the motivation for the patient and his partner is simply survival and quality of life. It comes down to the same old story: "We are only as strong as we are united, as weak as we are divided."70


A Key but Often Missing Link
There is no doubt whatsoever that the outcomes of patient longevity and quality of life can be changed for the better with the relatively simple first steps described earlier. The major drawback, as I see it, is bringing the professional healthcare team into the equation: the third element of PPP. There are reasons for this difficulty that are worthy of some speculation.

The education of the physician is based on competition for scholastic grades in college and in medical school. The ego--the unhealthy aspects of ego--is encouraged by repetitive challenges to the student, intern, resident, and junior staff regarding esoteric information and medical trivia. Individuals selected out of premedical candidates are often those who are accomplished at memorization of such material. The deans of medical schools are not accomplishing their mission in finding great numbers of outstanding physicians. This lies in the failure of not selecting more students who are driven by the passion to fix the individual and society. True physicians--sincere healers--all have a common denominator: a caring soul that is awed by the wonder of creation and the study of life. With such a constitution, these individuals have a passion to fix problems. This said, the fortunate patients are those able to find the real physicians.

Added to this demanding situation is another serious issue. A physician involved in the totality of cancer medicine cannot adequately cover the waterfront as it relates to all the different types of cancer. A physician must realize his limitations. In the first 10 years of my life as a general medical oncologist diagnosing and treating adult malignant conditions, I have strived to succeed in the impossible task of understanding how to best treat cancers of the breast, colon, lung, stomach, pancreas, ovary, head and neck, and brain, as well as sarcomas, lymphomas, and leukemias.

A man has got to know his limitations.

I should have realized from my medical school and postgraduate work on Hodgkin's disease that understanding one malignancy was in itself a formidable task. Becoming a master of 20 different malignancies is an impossible task that does not allow for an optimal outcome for the patient presenting with one particular type of cancer. How can this not be realized by the medical profession and the medical societies? It is as clear as day. Therefore, my advice to the man and his partner faced with a diagnosis of PC is to undertake the challenge of learning as much as possible about the disease, ideally in concert with a proactive and interactive support group and to do this while working with an M.D. copartner who is hopefully specialized in the management of PC.


What Specialist to Choose?
Patients and their partners routinely ask me, "Should I seek care under the aegis of a urologist, medical oncologist, or a radiation oncologist?" My initial response is to select an outstanding physician (no matter what his or her label or tag is) who manifests the characteristics of a real healer. With this said, I must be forthright in stating that there is a reality--in general--that the amount of time and focus spent on the patient will be such that the following ranking will most often be found to be true.

Medical Oncologist > Radiation Oncologist > Urologist

Medical oncologists and radiation oncologists are internists who have subspecialized in medical oncology and radiation oncology, respectively. Urologists are specialists in surgery. The nature of these specialties, their modus operandi, is quite different. During the junior and senior years in medical school, while we puzzled about which specialty to choose, one of the classic jokes was

Surgeons do everything, but know nothing.
Internists know everything, but do nothing.
Psychiatrists do nothing and know nothing.
Pathologists know everything and do everything,
but too late.

As silly as these stereotypes are, this joke always brings smiles to the faces of all physicians because there are inherent elements of truth present; surgeons are indeed oriented around operating--that is their modus operandi, literally and figuratively.

Therefore, in the best of all worlds, find a medical oncologist whois intensely focused on PC. Such a physician must have the patient's best interests at heart. This is the ideal teammate for the PC patient and his partner. To paraphrase Scott Peck, M.D., in A World Waiting to Be Born, a good act is that which appears good to an ideal observer, "a being who is more knowledgeable than you, more objective than you, yet who still cares."71

As with breast cancer care or any life-threatening illness, the primary intervention of the man diagnosed with PC or suspected to have PC should be with an objective, caring, and highly informed physician--the medical oncologist trained in the area of PC. He or she is the least biased concerning which treatment the patient should be considering. He or she has a broader scope of knowledge regarding oncology and internal medicine. He or she will spend more time dealing with concepts as they relate to PC rather than with procedures.

The good physician knows his patients through and through, and his knowledge is bought dearly. Time, sympathy, and understanding, must be lavishly dispensed, but the reward is to be found in that personal bond which forms the greatest satisfaction of the practice of medicine. One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.
- Sir Francis Weld Peabody, Lecture to Harvard Medical Students, 1927

Some of the statements made above will meet with disapproval by some of my colleagues. Nevertheless, they are true. In today's world, we desperately need more integrity.

Assuming that medicine evolves to a point where physicians specializing in areas such as PC become more plentiful, the PC patient and partner must find a like-hearted and like-minded physician.

The real challenge then is for the medical profession and society to foster an increasing population of physicians meeting these qualifications, for the number of such physicians is far too small to meet the demands of 170,000-200,000 men in the United States each year who are newly diagnosed with PC. An estimate of the number of men with PC in the United States today is somewhere in the 6-9 million range.


What Does This Mean for Patients?
To win this battle, you must foster an understanding of the basic biological principles involved in PC. Just as a new recruit into the army becomes savvy by means of education from experienced field officers and fellow soldiers, the new patient with PC (the newbie) needs to obtain information from a supportive cast.
The PC patient and partner must act as a team, reinforcing its growing understanding and, in time, sharing its knowledge with the community of other PC patients and partners.
Reality is a tough concept, but an understanding of the limitations of the current medical care of the PC patient is mandatory to prevent major and minor casualties. The diagnosis and initial care plan is often made by the urologist and not a more integrative physician such as a medical oncologist focused on PC. To win a war, one needs a strategist familiar with all aspects of the battle.
PC necessitates organizational thinking, with strategy and serious focus on biological events as they relate to tumor/host interactions. A successful military campaign requires sound military intelligence. Similarly, a successful medical campaign requires organizational thinking which is rooted in solid medical intelligence.

3. MILITARY INFORMATION (INTEL): THE IMPORTANCE OF THE MEDICAL RECORD
1)Organizational Thinking
2)Basic Information
3)Prediagnostic History
4)Diagnosis and Staging
5)Algorithms and Nomograms
6)Clinical Chronological Review
7)Flow Sheets
Summary/Surveillance Sheets
Patients

The Medical Record--The Key to Organizational Thinking

Ask a captain of any ship or airplane about the importance of a detailed log or ask a real physician about the crucial role of the medical chart or record and you will get the same response:

The Chart is a must to ensure the integrity of the Ship.
The medical record is the patient's story. More important than that, it is the chronology of medical events put to music, and the music is reflected in the biological expressions of the health and disease processes. It is simply a statement of whether or not the orchestra is in harmony or in discord.

The entire clinical story of the patient informs the listening physician; it provides clues to elucidate a fuller story--a closer approximation to the truth--as well as the caring and informed physician can understand it. This really is a manifestation of medical common sense. But, as Thomas Paine once said:

Common sense is not so common.
When the PPP team is involved in a logical and common sense approach to analyzing and resolving the patient's problem, a medical symphony evolves. This medical symphony has different movements to it. These movements are separate, and yet they overlap at the same time. The following discussion is described and illustrated fully in Appendix F (starting page F27) of A Primer on Prostate Cancer, The Empowered Patient's Guide (the Primer) by Strum and Pogliano. The Primer is available through Life Extension Foundation at 1-866-820-7457 or www.lefprostate.org, through Amazon.com, Borders, and Barnes & Noble. A review of the important movements is described below.