tag:blogger.com,1999:blog-27065704876899631442024-03-13T23:02:48.332-07:00Prostate Cancer SupportWilliam E. Arnold, Ph.D.http://www.blogger.com/profile/08737562366083224142noreply@blogger.comBlogger14125tag:blogger.com,1999:blog-2706570487689963144.post-51164078641525728472010-04-25T10:53:00.000-07:002010-04-25T10:54:14.978-07:00Prostate Cancer 1/08/2010<strong>Prostate-screening perspectives shared as another nears <br /><br />Republic 1/8/10</strong><br /><br />Last fall I announced a prostate screening offered by Scottsdale healthcare. Robert Diepenbrock of Scottsdale sent me this follow up email. <br /> <br />“I had made appointments for a PSA test and a Cholesterol & Glucose tests, but was also able to have my skin checked for skin cancer, a test for osteoporosis, a fat percentage and waist circumference test and a review and evaluation of my test results by a physician.<br /> <br />During the event I was administered a Glucose test (the prick your finger blood test). I tested high. Based on this test result I have seen a physician and discovered I have Type 2 Diabetes. I'm treating it with a change in diet, exercise and medication (no insulin shots). If it hadn't been for the screening my condition could have gone on undetected and gotten worse.<br /> <br />I am truly fortunate to have attended this event and urge other men to attend the next event,” said Diepenbrock.<br /> <br />Phil Anderson responded as well.<br /><br /> “I had the robotic surgery in September, 2008 and I spent only one night in the hospital. I never had to wear more than a pad. That was for only about a month. My personal life with my wife has changed very little due to the fact with robotic surgery many of the nerves are able to be spared. I opted for the robotic way as I have a bleeding disorder, and this is much less invasive. I am a 70 year old man in fairly good health. My latest PSA test was in the negative zone. I know there are many options for prostate cancer and everyone must make their own decisions, but this robotic option, I feel is one of the best.”<br /> <br /> Jack Szatkowski wrote me in September too late to get his comments in my column so I checked on him a couple of weeks ago.<br /><br />“I had the seeding procedure in April, it has been and continues to be the most painful, miserable, and uncomfortable experience a person would want to go through. I am doing somewhat better; it is down to penis and urethra pain spasms and urinary retention. I just have to plan ahead when leaving the house.”<br /> <br /> <br />Hal Cope offers an interesting perspective. <br /><br />I have been living under the ax of prostate cancer for years. In brief my PSA in 1992 was 2.5. Since that time it has climbed and climbed and climbed during which time I had biopsies upon biopsies. <br /><br />Finally in 2001 with my PSA at 14.1 and with all biopsies and the Digital Rectal Examination [DRE] negative, I had the seed implant. <br /><br />My PSA dropped to 1.4 then began its steady climb to 40.7 in April of 2008. It dropped to 34.4 in August, 2009. All DRE's were clear of cancer including the granddaddy of all biopsies 29 punctures with no visible sign of cancer. My doctor wanted to give me hormone shots to lower the number which I declined.” <br /><br />Cope has his next check up this month. For many like Hal Cope, watchful waiting may be an option but you have to have regular check ups. <br /> <br />The next prostate cancer screening is January 23, 2010 from 8 AM to Noon in the US Airways Center at 201 E. Jefferson. Call (480) 964-3013 or 800-828-6139 to schedule your FREE Screening. Appointments required.<br /> <br />If you cannot get to this screening, schedule an appointment with your personal physician.<br /> <br />For both men and women, a regular physical examination with your physician is a good way to start this new decade.<br /> <br /> <br />Helpful sources:<br /> <br /> <br />Go to http://prostatecheckup.com to read other stories and learn more.<br /> <br />Go to my blog at http://prostatecancersupport.blogspot.com for previous columns and stories.William E. Arnold, Ph.D.http://www.blogger.com/profile/08737562366083224142noreply@blogger.com1tag:blogger.com,1999:blog-2706570487689963144.post-49415420429005374562010-04-25T10:52:00.001-07:002010-04-25T10:52:41.937-07:00Prostate cancer 4/9/2010PSA testing for prostate cancer debated; disease remains a killer 4/9/10<br /><br />There have been a lot of scary stories in the media about the role of PSA testing for prostate cancer. One writer told a health magazine that he wanted his cancer back. He had read the two studies published in the New England Journal of Medicine and wrongly concluded that routine screening is not necessary. Hidden near the end of the article is this statement, “Nobody wants to die of it. So I guess it was a good thing my prostate was taken out.”<br />The greatest risk factor for prostate cancer is age. This risk increases significantly after the age of 50 in white men who have no family history of the disease and after 40 for black men and men with a close relative with prostate cancer. About two-thirds of all prostate cancers are diagnosed in men age 65 and older. About 80 percent of men who have reached 80 have prostate cancer. Medicare will only cover men over 50.<br />My concern is that older men, particularly those who do not like the PSA [prostate-specific antigen] test and DRE [digital rectal exam], will see these stories and say why bother testing. We should do less treatments but better screening.<br />National Public Radio interviewed a staff member, Richard Knox, under the title: Prostate Test: Lifesaver or Big Mistake? Knox talked to Richard Ablin, M.D. from the University of Arizona. Ablin discovered the PSA or prostate-specific antigen and now says the PSA test has become a public health disaster.<br />Ablin uses the analogy of the prostate gland as a box with no top. Aggressive cancer, the rabbit, can jump out of the box and spreads. The nonaggressive cancer, the turtle, just crawls around and goes no where. He is correct that the PSA test cannot tell you which cancer it is or even if you have cancer.<br />The April issue of the Johns Hopkins Prostate Disorders Health Alert discussed the quality of life issues after Prostate Cancer Treatment. <br />“Because prostate cancer progresses more slowly than other types of cancer, men can take some time to carefully consider the various prostate cancer treatment options. A man should talk with his doctor about the relative risks and benefits of each treatment and consider consulting physicians from different fields [urologists, radiation oncologists, and medical oncologists] to get a broader spectrum of opinions.”<br />The New England Journal of Medicine published two now famous studies a year ago, one American and one European. They are still being cited to suggest that PSA testing is not that important. Dr. Ruth Etzioni in Biostatistics of the Division of Public Health Sciences at the Fred Hutchinson Cancer Research Center pointed out several issues that put the research in the proper context.<br />The interpretations of the results of these studies are incorrect. Etzioni says, “The American trial is not a study of true screened and not screened as was the European trial.” That is because nearly one third of the supposed “not screened” did have tests so the American cancer death rates cannot be compared to the European results.<br />“There was too much focus on the American trial. You cannot just look at the number of deaths from prostate cancer, since not that many die from the cancer. You have to look at the percentage drop in the number of deaths for those who were screened. The European results showed a 20% drop in cancer deaths which I think is significant,” said Etzioni.<br />One PSA test is insufficient to recommend additional tests. <br />In early March, The American Cancer Society revamped its recommendations for prostate cancer screening. In new guidelines released the Society says that men who choose to be tested should get an annual screening if their level of prostate-specific antigen, or PSA, is 2.5 nanograms per milliliter or higher. But men whose PSA is under that threshold can be safely screened every two years. Men with a PSA level of 4.0 or higher should consider getting further evaluation, such as a biopsy. Previous guidelines had suggested that men with a PSA of less than 4.0 should be screened annually.<br />Next week: What should you do about prostate cancer screening?<br /><br />Resources: <br />http://content.nejm.org/cgi/content/full/NEJMoa0810696?query=TOC<br />This is the American study.<br />http://content.nejm.org/cgi/content/full/NEJMoa0810084?query=TOC<br />This is the European study.<br />http://www.nejm.org/perspective-roundtable/screening-for-prostate-cancer/?query=TOC<br />Go to this website for the physicians’ discussion of the studies.William E. Arnold, Ph.D.http://www.blogger.com/profile/08737562366083224142noreply@blogger.com0tag:blogger.com,1999:blog-2706570487689963144.post-67611540347336401752010-04-25T10:50:00.000-07:002010-04-25T10:51:19.799-07:00Prostate cancer 4/16/2010Prostate cancer is treatable; 27,000 men don’t have to die 04/16/10<br />Routine PSA screening a must despite advice from cancer society <br />Prostate cancer warning<br /><br />While Prostate Cancer in its early stages may not have any symptoms, you should honestly ask yourself if you are experiencing any of the following:<br />• Difficulty starting to urinate<br />• Less force to the stream of urine<br />• Dribbling after you finish urinating<br />• Frequent urination, especially at night<br />• Blood or pus in the urine<br />• Blood in the semen<br />• Pain while urinating<br />• Pain with ejaculation<br />• Hip and lower back pain that does not go away over time<br />• Pain in the lower part of your pelvis<br />• Unintended weight loss and/or loss of appetite<br />______________________________________________________________________<br />Bob King about 61 years old became concerned when he was making four nightly trips to the bathroom. His dosage of Flomax was not working so went for a biopsy. One positive finding and a suspicious second spot raised concern for prostate cancer.<br />The Scottsdale resident did not rush to surgery but discussed his options with several urologists and friends who had had surgery. <br />Ultimately Bob had the surgery with this thought, “if your body tells you that there is a problem, then you have to deal with it.”<br />Gary Cruz also of Scottsdale, at age 57 found that he has several positive biopsies. <br />“My options were to do nothing, radiation, hormone therapy, radioactive seeds, conventional surgery or robotic surgery. I hated knowing that cancer was in my body and after some emotional conversations with my wife and son and my urologist. I decided to undergo the robotic surgery to remove my cancerous prostate,” said Cruz.<br />“Was I in a life and death situation? The simple answer was no but as I stated, I couldn't mentally deal with the fact I had cancer growing in my body, regardless of how slow it may have been and there is no evidence that it was or was not growing rapidly.”<br />Cruz said early detection saved his life. “Almost 27,000 men die from prostate cancer every year. It drives me crazy that most of those deaths could have been prevented with early detection. I'm a firm believer that men should start getting tested at age 40 on an annual basis,” he added. <br />What should you do about prostate cancer screening? If you are over fifty and you get an annual physical, add the PSA test to your blood work if it is not already included. They use the same blood sample for the cholesterol test. <br />The test that most men do not like is the digital rectal examination [DRE]. It probably saved Scottsdale resident David Tucker’s life. <br />“My case was simple. DRE revealed a lump, PSA went from 2.8 (for 3 years straight) to 3.6, biopsy had 3 hits in 10, and I was just 62.” <br />He elected surgery and has been cancer-free for four years. <br />Rabbi Ed Weinsberg writes a blog on prostate cancer and notes “Prostate Cancer screening has NOT been overtly encouraged by the American Cancer Society [ACS] for the past 15 years. Now the American Cancer Society has gone even further by asking patients and doctors to consider the danger of routine prostate cancer PSA screening, since the ACS implicitly claims such testing can easily lead to over-treatment.”<br />His conclusion is the same as mine. <br />“Even though at least 80% of prostate cancers are found early, scientists have yet to figure out which are likely to become aggressive. Is the ACS asking men to avoid treatment and simply assume they won’t be among the 27,000 prostate cancer patients who die every year in the US alone? It’s true that the odds of survival are in our favor. But prostate cancer remains the second leading cause of male cancer death after lung cancer.”<br />“Whatever its limitations, until a more precise biomarker is discovered, routine PSA screening is a must for most men, followed by a biopsy when indicated to determine if a man has prostate cancer. We men have a right and an obligation to ourselves to know what’s happening inside our bodies,” Weinsberg said.<br />So get regularly testing and keep good records. Doing nothing may make you a statistic.<br /><br />Prostate cancer resources:<br /><br />http://conquerprostatecancernow.typepad.com/<br />Rabbi Ed Weinsberg’s blog<br /><br />Conquer Prostate Cancer: How Medicine, Faith, Love and Sex can renew Your life, by Rabbi Ed Weinsberg with Dr. Robert Cary<br /><br />http://prostatecancersupport.blogspot.com My blogWilliam E. Arnold, Ph.D.http://www.blogger.com/profile/08737562366083224142noreply@blogger.com0tag:blogger.com,1999:blog-2706570487689963144.post-36176043014567630642009-09-09T09:27:00.000-07:002009-09-09T09:29:00.673-07:00SECOND PSA READING POST SURGERYThe second reading remains as good as the first. I will be writing a column on Prostate cancer that should be published in the next three weeks and will be posted here.William E. Arnold, Ph.D.http://www.blogger.com/profile/08737562366083224142noreply@blogger.com2tag:blogger.com,1999:blog-2706570487689963144.post-77978128807364352962009-04-15T14:04:00.000-07:002009-04-15T14:07:03.249-07:00First PSA checkup since surgeryOn 4/14/09 I had my PSA checked. There was a negative amount. I return in 3 months. I continue to make progress on every front without any ED drugs.William E. Arnold, Ph.D.http://www.blogger.com/profile/08737562366083224142noreply@blogger.com0tag:blogger.com,1999:blog-2706570487689963144.post-35572940338496919852009-03-29T13:21:00.000-07:002009-03-29T13:22:37.275-07:00Prostate cancer screeningTESTING FOR PROSTATE CANCER IS ADVISED DESPITE STUDIES<br /> <br /> <br />Watch. Wait. Should I test or not test? Last week the results of two studies on prostate cancer screening were part of the headlines in The Arizona Republic. [3/19/09] <br /> <br />I read those studies, and I am concerned that men might get the impression that it is OK not to be given a prostate specific antigen test [PSA] and digital rectal examination [DRE]. <br /> <br />The article concluded with this thought. “The two studies were designed to give a definitive answer about the value of such screening.” Not all researchers agree that the studies do this.<br /> <br />Overall one of every six men will get prostate cancer during their lifetime, most physicians recommend the PSA and DRE after age fifty. It is usually slow growing but it ranks as the fifth leading cause of death among men. At 50, your chances are 1 in 476 of having the cancer.<br /> <br />WHAT THE STUDIES MEAN<br /> <br />Dr. Ruth Etzioni in Biostatistics of the Division of Public Health Sciences at the Fred Hutchinson Cancer Research Center pointed out several issues that put the research in the proper context.<br /> <br />“The interpretations of the results of these studies are incorrect. In the American study, there were as many men who where screened in the non-screened groups as were in the screened group. In treatment research, one group gets the treatment and the other does not. You can then compare your results.”<br /> <br />In the American study, the figures are almost identical for the screened and not screened. 34.6% of the screened had a PSA test in the past 3 years and 34.3% in the not screened had the PSA test. The results of the DRE examination were 32.8% for screened and 31.9% for the not screened. <br /> <br />Etzioni says, “The American trial is not a study of true screened and not screened as was the European trial.” That is because nearly one third of the supposed “not screened” did have tests.<br /> <br />“There was too much focus on the American trial. You cannot just look at the number of deaths from prostate cancer, since not that many die from the cancer. You have to look at the percentage drop in the number of deaths for those who were screened. The European results showed a 20% drop in cancer deaths which I think is significant.”<br /> <br />PROSTATE CANCE IS SLOW-GROWING<br /> <br />Most prostate cancer is a very slow growing cancer that could take 15 years. The U.S. Preventive Services Task Force suggests that men over the age of 75 not bother with testing since life expectancy is shorter than the time it would take for prostate cancer to be your cause of death. <br /> <br />Most men who are diagnosed with prostate cancer are likely to die from something else before they die from that cancer. <br /> <br />When I was diagnosed with prostate cancer last November, only one biopsy of twelve actually contained cancer. After surgery, my surgeon told me that more than 90% of my prostate contained cancer. He also informed me before surgery that it was my decision to choose an approach. I could have chosen watchful waiting. <br /> <br />What you do not see in the media reports about the two large research studies, but is included in the New England Journal of Medicine, is that about 95% of male urologists and 78% of primary care physicians who are 50 years of age or older report that they have had a PSA test themselves, a finding that suggests they are practicing what they preach.<br /> <br />While I do not recommend that you read the two studies, I do recommend that you read the discussion by two physicians about the studies. The research may have been reported too soon. In the European trials, the researchers plan to continue beyond the current ten years.<br /> <br />MY PROSTATE CANCER EXPERIENCE<br /> <br />The results of my prostate surgery so far are very positive. One week with a catheter was followed by a full diaper pant for 2 weeks. An absorbent pad was needed for four weeks. Now there is no leakage. I took no drugs and have not experienced erectile dysfunction. <br /> <br />What I do not know and may not know for some time is whether I am cancer free. I will continue to be screened on a regular basis. <br /> <br />You must decide for yourself whether you wish to be screened and then whether to seek treatment. I made my decisions after a lot of study and consultation with friends who were diagnosed with prostate cancer. <br /> <br />Do not let headlines alone persuade you.<br /> <br /> <br /> <br />More Resources:<br /> <br />American study: http://content.nejm.org/cgi/content/full/NEJMoa0810696?query=TOC<br /> <br /> <br /> <br />European study: http://content.nejm.org/cgi/content/full/NEJMoa0810084?query=TOC<br /> <br /> <br />Physician Discussion of studies: http://www.nejm.org/perspective-roundtable/screening-for-prostate-cancer/?query=TOC<br /> <br /> <br /> <br />My blog on prostate cancerhttp://prostatecancersupport.blogspot.com/William E. Arnold, Ph.D.http://www.blogger.com/profile/08737562366083224142noreply@blogger.com0tag:blogger.com,1999:blog-2706570487689963144.post-74806961482730315242009-01-09T13:22:00.000-08:002009-01-09T13:28:37.349-08:00More stories of prostate cancer and survivalRusty Dennison wrote:<br /><br />Saw your article this week and wanted to check in with you. Removing the catheter was such a relief in one way for me though those first few weeks after its removal were a challenge too. At least at that point I felt like I was beginning to move forward and I knew I needed to honor my body’s need to have time to heal. Walking and yoga both helped a lot, especially after the first three weeks or so. It was not a linear process but the water works subsides. Best wishes and trust that it does get better.<br /><br />The waiting game was hard for me at first and now that I am on a six month cycle instead of three month cycle, it is a lot easier but not still not easy. The first three month cycle I was convinced that based on my pathology report (nearly 100% positive surgical margins and Gleason 7) that I would need radiation right away. I was nearly sick to my stomach waiting for the results and cried with relief when the doc told me the PSA was undetectable. The second three month cycle was equally hard because I couldn’t believe I could be so fortunate to get two in a row. For these first two cycles, I started getting anxious about half way through the three months and built to a peak at the time of the test. It didn’t help that I got my blood work two days before the doc visit each time and had to wait. Those 48 hours were just miserable for me the first two times. Then, by talking to the lab tech at Mayo, I learned that the blood results were in the computer record within 2 hours of the blood draw and that the Physician Assistant would call me that very night if I wanted. That helped me so much because I knew I only had to wait a few hours and could get myself pulled together well to actually ask questions by the time I met with the doc. Now, I’ve refined it even better and schedule my blood and doc visit on the same day with only three hours in between the two appointments. Works well and cuts down on the waiting tremendously. <br /><br />Lastly, I don’t know about your personal style but my general approach to the doctor was to try to be a good patient and not ‘bother’ him in between appointments. Dumb idea. Once I learned that the Mayo docs didn’t consider it a bother, I did much better at calling the Urology office, leaving a detailed message and asking either the doc, the resident or the PA to call me back. I would always get a call by the early evening of the same day and they always answered every question patiently. I learned that so many of my new ‘symptoms’ were quite normal and some required intervention but were not abnormal. It was so much better than psyching myself out that everything was some new cancer symptom. I limited the drama on the calls, but I was clear about my fears too. It was a new behavior to learn to call more readily but well worth it.<br /><br />Take care, be patient with yourself, and on a daily basis find things for which you are grateful (some days for me it was as basic as ‘one pad instead of three’!).<br /><br />Mike Martinelli wrote:<br /><br /> I have read your article on Prostate Cancer in the Chandler Republic and found it very informative. PSA Results should be scrutinized carefully and utilized in conjunction other tests and rectal examinations. .<br />In early 2000 my PSA went from 1.6 to 4.2 which was a dramatic increase in only one years time. NOTE; I never had any of the usual signs of Prostate Problems. My Physician told me to wait a couple of months and then have it checked again. Because of the anxiety, I decided to have it checked sooner, and the results were 2.3. Although I initially viewed this decrease as good news, something told me that it didn't make sense. I waited a couple of months and had it checked again; however, this time it showed 9.7.<br />I immediately went to a Urologist who scheduled me for a biopsy. He took eight biopsy's which showed Cancer in four of the tissues. I was 63 years old at the time and decided to have "Radical Surgery" for the removal of the Prostate. The post-operative biopsy showed a Gleason of 6. After only three weeks after surgery, I was driving, playing golf and doing light workouts at the gym. Two weeks after surgery the catheter was removed and I never had a problem with incontinence. It has been over 8 years since my surgery; my PSA has remained at close to<br />"0". PSA is only part of determining Prostate health and after age 50, semi-annual rectal examinations is certainly recommended.<br /><br />Dave Rushlo of Scottsdale:<br /><br /> HI I AM ONE OF THE 35000 IN THE SELECT CANCER PREVENTION TRIAL WE WERE USING VITAMIN E& SELENIUM PLUS A MULTI- VITAMIN. THREE YEARS INTO THE STUDY MY PSA WENT FROM .5 TO 4.5 IN SIX MONTHS. AFTER TWO PSA TESTS & ONE BISOPY I MADE THE DECISION TO HAVE SURGERY USING THE ROBOT. I WAS IN THE STUDY AT MAYO CLINIC SO I WAS REFERRED TO DR. ROBERT FERRIGNI WHO DID MY SURGERY AFTER ABOUT A FOUR WEEK WAIT TO GET ON HIS SCHEDULE. THINGS WENT VERY WELL UP & WALKING NEXT MORNING & OUT OF HOSP. & HOME ON SECOND DAY. HOWEVER ONE WEEK LATER RUNNING A HIGH TEMP. WITH INFECTION IN AREA OF SURGERY BACK INTO HOSP FOR FOUR DAYS FINALLY HOME AND ONE WEEK LATER BACK INTO HOSP WITH SAME PROBLEM & 104 TEMP. AFTER FIVE DAYS FINALLY HOME. THINGS WENT FINE FROM THERE. THIS FEB. WILL BE FOUR YEARS WITH A PSA OF .0 AND THE ONLY PROBLEM IS MINOR BLADDER LEAKING WHEN I LIFT TURN REALLY SHARP OR SQUAT & LIFT. I GUESS AT 75 YEARS OF AGE IF THAT IS THE ONLY PROBLEM VS CANCER I CONSIDER MYSELF VERY LUCKY. THE STUDY WAS A DOUBLE BLIND STUDY SO WILL NOT KNOW FOR THREE MORE YEARS WHAT I WAS TAKING. HOWEVER THE STUDY HAS BEEN STOPPED BECAUSE "THE DATA TO DATE SUGGEST, BUT DO NOT PROVE, THAT VITAMIN E MAY SLIGHTLY INCREASE THE CHANCE OF GETTING PROSTRATE CANCER, AND THAT SELENIUM MAY INCREASE THE CHANCE OF GETTING DIABETES MELLITUS. WE WANT TO EMPHASIZE THESE FINDINGS ARE NOT PROVEN."William E. Arnold, Ph.D.http://www.blogger.com/profile/08737562366083224142noreply@blogger.com2tag:blogger.com,1999:blog-2706570487689963144.post-50633122078360689562009-01-09T12:53:00.000-08:002009-01-09T13:01:29.647-08:00More storiesCarelton Moore, retired ASU professor:<br />Anyway I did/do have prostate cancer butam glad to report that I am now entering my 6th year with PSA <0.1. I chose IMRT radiation with David Beyer . I was able to do this because I lived within driving distance of his facility and could take the time do do this for two months. I was sent to him by my urologist Robert Shahan who didn't push instant surgery even though my Gleason score was reported to be 9 in the single positive of 12 needle biopsies. I too have visited off and on the UStoo meetings in Scottsdale and Tempe. A problem in my opinion is that the UStoo attendees tend to be people in post treatment not pretreatment . My post treatment opinion is that more patients should consider varios options and for example request a second biopsy scan by a noted pathologist etc. these options are often spelled out in the references such as those you have listed. PS I have had no post treatment problems or at least haven't been aware of any. <br /><br />Max Levine, Sun City<br /><br />I read your article regarding prostate cancer in the Phoenix Living section of paper 12/26 and found it interesting. I am a 5 year survivor of prostate cancer and a 1 year survivor of lung cancer and doing very well on both counts. You talk about the biopsy in which they take 12 samples to test, thus leaving the possibility of missing the rest of the prostate. Am certain that you have heard of a Color Doppler Ultrasound in which the chances of detecting any cancer is much better as it is not a blind test. I have attached some info regarding the Color Doppler Ultrasound by Dr Duke K. Bahn, Ventura, California, whom you also may have heard about. At one time my PSA was 125 and it is now 0.03. I still have my prostate. My treatment consisted of approx. 2 years of Hormone Treatment along with Casodex and 43 IMRT Radiation treatments. The results have been excellent, but I am left with anemia which may have been a side effect of the radiation. I was 73 years old when I started treatment. The most important treatement that I had is the love and support of my wife, Inez and my family, along with Ralph Valle and Tom Brodzeller at our "Lunch Bunch Support Group". They are the reason that lead me to the realization that I own the cancer and it does not own me. They made me realize the importance of going to a Oncologist that specializes in prostate cancer and who than acts as my "Coach". Will admit my wife and I had to travel, but we wanted the best, so we went Dr Lam and Dr Shultz in Marina Del Rey, both Prostate Oncology Specialists. Many of our group have done the same and have had fantastic results. It was their office who insisted that I have a chest Xray as had smoked for many years, stopping approx. 16 years earlier. Well, I did and they found on spot which was malignant and fortunately was stage 1a. Had a portion of upper lung removed and am doing well as no further treatment necessary at this time. It is so imporant to have a coach to explain the various treatments so you are informed and can make the correct decision. Not only must you be informed, you need all the support you can get, maintain a positive attitude and be your own advocate.<br /> <br />Well, that is my story and I am sticking to it. You are certainly welcome to contact me anytime you wish, if you would like to talk further. You are welcome to join us for lunch at our Lunch Bunch meetings on Tuesdays at The Old Country Buffet at 11:30AM, 9820 West Parkway West, Metro Center, Phoenix.<br /> <br />Yes, you may post my story on your blog and it would be greatly appreciated if you would mention our "Lunch Bunch" prostate support group, which does meet weekly. If you need any further information regarding our group you can call either myself 623 931 0418, but probably would do best calling Tom Brodzeller 602 944 2338. Tom is a fountain of knowledge, as is Ralph Valle, when it comes to PC. <br /><br /><br />Pete Freeman wrote: <br /><br />As the year comes to an end, I celebrate my first anniversary after having treatment for prostate cancer. I stand in awe at the thought of what could of happened and how this fear and worry turned into nothing but a true blessing.<br />I will be forever grateful to my friend who told me about proton therapy and the wonderful staff at Loma Linda Medical University in Loma Linda, Ca where I received my treatment .Without their intervention my life would have changed but not for the better. I feel the Platinum Standard for the care of prostate cancer is the proton beam therapy available at Loma Linda.<br />I do have to say that it saddens me to have read in this blog about the men who have gone through various types of treatment and are still suffering from the side effects of those treatments. I would find it interesting to know if any of those individuals knew about the option of proton beam therapy at Loma Linda.<br />As I reflect upon this past year I think about the many ways that I have grown. I am physically healthier, wiser and forever thankful for my new friends that I met during this journey. My wife and I often refer to it as our "Radiation Vacation". I have a lot to be thankful for as I look forward to the next year and my family feels the same. <br />As we move towards the year 2009, my goal is quite clear to me.I want to "pay it forward". I want to let other men who have prostate cancer know that they can survive this cancer without surgery. My hope is that by sharing my story another man will benefit. <br />During my treatment I was interviewed by a writer for the New York Times and he asked why I chose this treatment rather than the typical radical surgery? I told him "I was 67 yrs old and did not want to wear a diaper the rest of my life" as so many who have had radical surgery are doing.<br />I welcome your readers to contact me if they would like additional information.<br /> pfreeman1940@gmail.com ete Freeman wrote:William E. Arnold, Ph.D.http://www.blogger.com/profile/08737562366083224142noreply@blogger.com1tag:blogger.com,1999:blog-2706570487689963144.post-4861637732495554482008-12-23T11:42:00.000-08:002008-12-23T11:45:23.431-08:00Post prostate cancer surgery<strong><span style="font-size:130%;">Lessons learned in prostate situation</span></strong><br /><strong><span style="font-size:130%;"><br /></span></strong><a href="http://www.azcentral.com/community/scottsdale/articles/2008/12/22/20081222sr-aging1223.html#comments#comments"></a>by William Arnold - Dec. 22, 2008 10:26 AMSpecial for The Republic<br /><br />When I went for my post-prostate surgery consultation with Mayo's Dr. Paul Andrews, I got both good news and bad news. Good news, the catheter was removed, and I was given a supply of adult pads because incontinence will be a factor - only for a few weeks I hope.<br /><br />The bad news was that the entire prostate contained cancer, not just the 3 percent as determined by the biopsy. How could this happen?<br /><br />Let us assume that biopsies can be taken in 100 different points in the prostate. Each biopsy collects just 12 of those hundred, and I had cancer in one biopsy sample. Unfortunately, there could and probably was cancer in the 88 samples not taken. I had no outward symptoms and a small, smooth prostate. If that one cancerous sample had not been found, I might have gone on to believe I was cancer-free.<br /><br />Lesson to be learned: Work very closely with your urologist and keep tabs on your PSA and digital rectal examination.<br /><br />Given all of the biopsies taken during my surgery, there is a real possibility that some cancer remains at the edge of the urethra. Only monitoring and testing will provide the answer. In the meantime, I have an additional three months to deal with the unknown.<br /><br />Waiting on the unknown can be an issue. With each waiting period, I had time to think. I tried to think positive.<br /><br />Is it scary? You bet it is, as you have an invader in your body, and you do not know what it is doing. Perhaps it is also a wakeup call to help you enjoy the rest of your life. As Dr. Andrews suggested, "Do the things you enjoy. Take some long walks and enjoy nature."<br /><br />I cannot conclude this series on prostate cancer without saying that there are numerous treatments for prostate cancer not included in this four-part series. I will come back to the topic in a few months.<br /><br />Many stories from my readers are posted on my blog. Go to: http://prostatecancersupport.blogspot.com/. Hopefully their stories can give you inspiration to deal with your situation should you face prostate cancer. Their stories and mine are my Christmas present to you.<br /><br /><br /><strong><span style="font-size:130%;">Here is a wife's perspective:</span></strong> Jennifer Szakach of Scottsdale remembers: "The diagnosis was a shock to me because while we knew John had a high PSA reading, his brother had had false readings in the past, and we thought that would be the case with John.<br />"Dr. Darson was emphatic that John have the surgery within 2 months, so everything happened very fast. I was only involved with one meeting with the doctor and relied mostly on John's explanations for what to expect. . . .<br />"You can imagine my concern when 3 1/2 hours went by, and he still wasn't out of surgery. It was about 5 hours before Dr. Darson came out to tell me that John was fine, but the cancer had been more widespread that he expected, and it required a lot more work to remove it all. He said that we were very lucky to have had the surgery when we did."<br />For the rest of her story, go to the blog.<br /><br />William Arnold can be reached at <a href="mailto:william.arnold@asu.edu">william.arnold@asu.edu</a>.<br /><br /><br /><strong><span style="font-size:130%;">More on this topic<br /></span></strong>Prostate cancer resources<br /><br />• Conquer Prostate Cancer: How Medicine, Faith, Love and Sex Can Renew Your Life by Rabbi Ed Weinsberg and Robert Carey, M.D. provides detailed coverage of the issues related to prostate cancer and survival. The subtitle lets you know that it is more than surgery. Published in October, it comes with 13 pages of references. Available at Amazon.com.<br /><br />• Promoting Wellness for Prostate Cancer Patients by Mark A. Moyal, M.D. is another good short book that can guide you from diet choices through prostate surgery. Ask your urologist for a copy of this book.William E. Arnold, Ph.D.http://www.blogger.com/profile/08737562366083224142noreply@blogger.com3tag:blogger.com,1999:blog-2706570487689963144.post-46953750460013345282008-12-17T10:47:00.000-08:002008-12-17T10:48:27.887-08:00More Unpublished storiesThese have not appeared in my column:<br /><br />I too had PC and had it removed by the Da Vinci Robotic Prostatectomy Surgery. My PSA levels were between the range of 1.5 to 1.9, but my physician felt something while doing the DRE and sent me to an Urologist. Dr. Bombino who has done more than 200 of these types of surgeries did my surgery. Mine was done in April of this year. A friend of my also had his done two weeks before mine. We both concurred that the two weeks after the operation is the hardest time because of the catheter. Had the operation in the morning and was up walking around by five in the afternoon, the operation itself was a breeze!<br /><br />The incontinence, as the Dr. said, it is going to take a year or more. So get a good supply of men’s guards to help. I still play golf at least five times a week , work out in a gym three times a week and play softball twice a week in a league.<br /><br />Bob Colli<br /><br />From a reader who does not have prostate cancer:<br /><br />It has been my experience that the subject of prostate cancer commands immediate attention in any conversation among men over, say, 40 years. I have noticed that it gets every guy’s full attention regardless of how macho they perceive themselves. I am fine with you sharing anything I could offer, but I am not certain I bring anything of value since my latest PSA test was 1.2 and my digital exams have all been unremarkable.<br /><br />I will add that my brother, 59 years old, underwent massive prostate surgery (removal) about 18 months ago and it was pure hell for him. Not only was the surgery painful and debilitating, but the post op follow up was very time consuming. Likewise, I have two friends who both opted for radiation seed implants and their procedures were very successful. Finally, my 87 year old father was diagnosed with prostate cancer approximately two years ago. He elected to do nothing and is fine, with no negative effects other than a high PSA count. We no longer have him checked since it is certain that he will not die from the prostate cancer but eventually something else.<br /><br />Bob Slider, Mesa<br /><br />A source of information:<br /><br />A friend of mine had the traditional operation in 2003. He (Norman Susser) documented his experience in a book titled AT FIRST YOU'RE AFRAID, published in 2005 and available at www.iuniverse.com . The reason I know about the book is because of my own background in writing and editing. Norman asked me to look it over before he submitted it for publication. To be honest, I read it through superficially at the time, pointing out minor errors. After getting a catheter and following my operation, I read parts of it over and over again. He didn't have the same operation that I had and you will have soon, but he did have many insightful experiences and observations that I found more than useful. I don't even know if the book is still available and a sale of it is not my intention here, but believe me that parts of it would be useful in your post-operative period.<br /><br />Mel Cebulash, ScottsdaleWilliam E. Arnold, Ph.D.http://www.blogger.com/profile/08737562366083224142noreply@blogger.com0tag:blogger.com,1999:blog-2706570487689963144.post-90618732785090462142008-12-16T10:00:00.000-08:002008-12-16T10:01:26.968-08:00A wife's perspective on prostate cancer<strong>Jennifer Szakach of Scottsdale provided a wife’s perspective on prostate cancer</strong>. <br /><br />“The diagnosis was a shock to me because while we knew he had a high PSA reading, his brother had had false readings in the past and we thought that would be the case with John. Dr. Darson was emphatic that John have the surgery within 2 months, so everything happened very fast. I was only involved with one meeting with the doctor and relied mostly on John’s explanations for what to expect. As you can imagine, he kept most of his deepest concerns to himself. We did not know how widespread the cancer would be. You can imagine my concern when 3 ½ hours went by and he still wasn’t out of surgery. In all it was about 5 hours before Dr. Darson came out to tell me that John was fine but the cancer had been more widespread that he expected and it required a lot more work to remove it all. He said that we were very lucky to have had the surgery when we did.”<br /><br /> John was very uncomfortable when he came out of surgery and it was difficult for me to see him in such a vulnerable state. Little did I know that he would be needing my help for quite some time after the surgery. Because of the catheter, John wasn’t allowed to ride in a car. He couldn’t move around very well and getting out of bed was very difficult and painful for him. He couldn’t lift anything, which was good for him because we had moved into a new home 3 days before the surgery! He recovered on schedule and was back to work in a few weeks. <br /> John’s first reaction when he received to diagnosis was to keep it to himself. He is an extremely private person. I told him that I understood and respected his choice but I hoped he would reconsider. In his current job he is one of the oldest in an office full of mostly young men. I encouraged him to think about all of the good he could do by talking openly about this to the people that he works with, especially emphasizing the importance of the PSA test. Also, I thought it would be important to have the support of our friends and family while we went through the experience. To my surprise, he did think about it and embraced the idea. He told everyone at work about it and became a mentor of sorts to friends of friends who were also going through the first scary stages of the diagnosis. As you know, he also rewrote a “what to expect” type brochure for the doctor’s office. I truly believe that being helpful to others has been therapeutic to him during his recovery. We have a close friend who is a testicular cancer survivor and he once told us that he didn’t feel right getting involved in cancer support groups because he didn’t feel like he had a “real” cancer. When there are no outward signs, no chemotherapy, hair loss, or weight loss, I think that men tend to downplay the seriousness of these cancers. It’s easy to pretend that you didn’t just have a brush with mortality when you didn’t feel sick to begin with. I’m proud of the way John has helped others and in turn has helped himself. The recovery process is not an easy one and it really helps to know that there are others out there who have walked down that road before.William E. Arnold, Ph.D.http://www.blogger.com/profile/08737562366083224142noreply@blogger.com0tag:blogger.com,1999:blog-2706570487689963144.post-47593806788602369032008-12-15T15:24:00.000-08:002008-12-15T15:26:34.541-08:00Other prostate storiesProstate patients offer insight<br /><a href="http://www.azcentral.com/community/scottsdale/articles/2008/12/15/20081215sr-aging1216.html#comments#comments"></a>by William Arnold - Dec. 15, 2008 11:26 AMSpecial for The Republic<br /><br />Not every prostate procedure is perfect. You are warned that there can be side effects. Here is what some of my readers report:<br /><br />Andy Tedesco of Scottsdale makes a very important point about PSA scores.<br />"Twelve years ago at age 67, my PSA was 0.7. The next year it rose to 1.1.Then to 2.0 followed by 3.4 and then 4.0. At that point my doctor sent me to a urologist. A 12-point biopsy revealed 12 positives and a Gleason of 8. I opted for radiation and seed implant surgery which required seven weeks of daily radiation treatment.<br />"Fortunately, I did not have any problems with incontinence. Five years later my PSA is steadily rising although it is still only 0.7. I will probably outlive the <a href="http://www.azcentral.com/community/scottsdale/articles/2008/12/15/20081215sr-aging1216.html" target="_top">prostate cancer</a> which still exists.<br />"The problem is that most physicians believe that there is nothing to worry about until the PSA reaches 4.0, when in reality it is the steady annual increase which indicates the cancer.<br />"It is the annual increase in PSA that really indicates the problem exists and not the magic 4.0.<br />"One concern with the seed/radiation treatment is that there is no visual examination of the prostate/bladder area."<br /><br />Mark Kucera of New York City says “I'm 59 years old, had a Gleason score of 3+3, 6 total, and a PSA of 4.9.<br /><br />“I had my prostate removed on August 6thof this year and was out of the hospital on August 7th. I was up walking about 7 hours after the surgery. I felt good enough on August 8th after being released to walk around New York for about an hour, per doctor’s orders.<br /><br />“The catheter was removed after only 7 days. I had minimal incontinence at first during the day, but that went away after a couple of weeks. And I've had some leakage at night on 3 nights in the 2 weeks since taking out the catheter. <br /><br />“By six weeks I have regained bladder control completely.<br /><br />“I've been able to achieve erections sufficient for intercourse and had orgasms. But the erections are slower to develop and take more stimulation than before. I've talked to several of my physician’s patients, and they all have similar stories of excellent results.<br /><br />“It hasn't all been easy or fun, but I'm thrilled with the results so far because I've heard so many tales of men fighting incontinence and struggling with sexual function for long periods after prostate surgery.”<br />Mel Calabash of <a href="http://www.azcentral.com/community/scottsdale/articles/2008/12/15/20081215sr-aging1216.html" target="_top">Scottsdale</a> recalled: "I had the robotic procedure at Mayo Nov. 5, and I can say it was a great success. My physician was Dr. Andrews, and I sing in praise to him every day.<br />". I had a PSA over 30 for better than three years and had 3 biopsies before cancer appeared. Because my prostate was so enlarged and stopped my ability to urinate, I had to wear a catheter for over 60 days prior to my operation. Today, I go like a 12-year-old."<br />Jim Blum of Scottsdale said: "I was operated on Nov. 22 at Mayo by Dr. Paul Andrews who performed the robotic procedure. I was released after one night's stay. My recovery has progressed well every day, and I received the great news that the pathology report confirmed that no cancer had entered the margins or outside the prostate.<br />"I also had an enlarged prostate that would have required 2 to 3 months of hormonal treatment before seeds and radiation could take place. I have also heard some not too pleasant examples of problems with seeds-radiation. For example, I have a very good friend who had the seeds, but had to keep his catheter in for 7 months.<br />Jerry Zuba of Scottsdale said: "I never felt during the post-prostate surgery that I was improving. It was like Groundhog Day every day. I had to wear a Foley leg bag for months even at work. Talk about embarrassing, and then I graduated to pads which I seemed to use at least 3-4 a day.<br />"Here it is 3 1/2 years after surgery and I still wear a pad because leakage still occurs on a small scale. I have been to the doctor many times, and unfortunately this is the best I can hope for. What a nightmare.<br />"I do feel doctors gloss over the fact that there might be a 10 to 20 percent risk factor. That might be OK for the 80 to 90 percent that things go OK, but if you are in the other category you really suffer mentally and emotionally. I think (doctors) truly believe that because of their skill level problems will not occur. This surgery was tough, and (I) would not wish it on anybody."<br />Next week: My postoperation review.<br />William Arnold is a professor emeritus at Arizona State University. Reach him at william.arnold@asu.edu.<br />Information and support services<br />• www.ConquerProstateCancer.com. Rabbi Edgar Weinsberg, who wrote Conquer Prostate Cancer, has numerous stories and helpful guides on this site.<br />• www.yananow.net/Links.html can give you useful information on procedures and treatment. You can order a free booklet, "A Strange Place," on the site. It's an information guide written by Terry Herbert, a longtime prostate cancer survivor who operates the site.<br />• For peer group support through UsToo, go to Mayo Hospital Room #MCH1-212, 5777 E. Mayo Blvd., Phoenix 85054, or call Ted Hinderman at 602-569-7536 or Chuck Voinovich at 602-953-4000. There are other UsToo support groups in Arizona and the rest of the country. More information: www.ustoo.com.William E. Arnold, Ph.D.http://www.blogger.com/profile/08737562366083224142noreply@blogger.com0tag:blogger.com,1999:blog-2706570487689963144.post-12058570300763005072008-12-11T12:07:00.000-08:002008-12-11T12:09:31.711-08:00Men tell storiesProstatectomy patients share surgery stories<br /><a href="http://www.azcentral.com/community/scottsdale/articles/2008/12/08/20081208sr-aging1209.html#comments#comments"></a>by William Arnold - Dec. 8, 2008 11:03 AMSpecial for The Republic<br />In response to my recent column on prostate cancer, I decided to do a follow-up using the responses I received from the men who have had some form of treatment or are contemplating a treatment.<br />Let me begin with the choice that I made. Remember, it's a personal decision, and the choice is up to you.<br />Why did I select the robotic DaVinci procedure? First, I wanted a proven treatment that would be less invasive.<br />Second, I wanted a treatment that was available locally.<br />Third, I wanted a treatment that my insurance would cover.<br />Finally, I wanted the cancer removed as soon as possible. As you read this, I will be post surgery.<br />What do my readers have to say?<br />Rusty Dennison of Scottsdale recalls, "Being 47 years old, with no family history of prostate cancer and otherwise healthy, both my wife and I were shaken to the core by the diagnosis.<br />"Given the stage of my cancer, 90 percent on one side, stage 3a, Gleason score of 7 and my age, surgery was the only option that seemed reasonable. Surgery went fine. although I found the recovery process was far more protracted and difficult than I had understood.<br />"In the first few weeks after surgery, I was at times discouraged by what seemed like my slow recovery process, including general lack of stamina and an initially free flowing bladder. It was really quite quick, but didn't seem so at the time.<br />"I can remember my initial dismay at trying to figure out what kind of 'diapers' to get from the pharmacy, and then laughing through my tears when my wife brought home one package of every type Walgreens had so I could have my choice - I had no idea there were so many styles!<br />"By six weeks post surgery I had decent bladder control and only dripped upon physical exertion. I credit this pretty rapid resolution to the quality of my surgeon's skills and to yoga, which does wonders on the muscles that help with bladder control.<br />"It was close to 12 weeks before I felt generally safe not wearing some type of pad, but this was more for my peace of mind than for true need."<br />John Szakach says, "I was 53 years old. Never been in a hospital. Ever. I am an early retired airline pilot, and I've had PSA tests religiously since my mid-40s. My PSA has never been an issue until last year when it jumped from less than one the previous year to almost four.<br />"During the six months preceding the biopsy, we tried antibiotics and other measures to hopefully reduce the readings or attribute them to benign prostatic hyperplasia or some other cause. No such luck.<br />"My readings continued to climb at a fast rate, eventually reaching almost 9. The biopsy confirmed the reading, and I was a Gleason 7.<br />"I was incredibly impressed by my surgeon, Dr. Micheal Darson and his staff. I was also extremely impressed with every single person at Scottsdale (Healthcare) North. They made the entire process as comfortable as possible given the circumstances.<br />"After all, men don't talk about this stuff. Men always say everything turned out OK, because who wants to admit an incontinence issue or an erectile dysfunction issue?<br />"Somebody told me that if you want to know how men really recover, ask their wife."<br />Next week: More men respond.<br />William Arnold is a professor emeritus at Arizona State University. Reach him at william.arnold@asu.edu.<br />More on the topic<br />• For more information on the DaVinci robotic procedure, visit www.davinciprostatectomy.com/index.aspx.<br />• In addition, Gene Felker of Mesa, an 11-year prostate cancer survivor, created a non-profit organization to provide information and screening for prostate cancer. Visit www.prostatecheckup.com.William E. Arnold, Ph.D.http://www.blogger.com/profile/08737562366083224142noreply@blogger.com0tag:blogger.com,1999:blog-2706570487689963144.post-77913519854648094702008-12-11T12:01:00.000-08:002008-12-11T12:02:56.959-08:00Cancer DiagnosisProstate cancer diagnosis allows choices for columnist<br /><a href="http://www.azcentral.com/community/scottsdale/articles/2008/11/24/20081124sr-aging1125.html#comments#comments"></a>Nov. 24, 2008 10:44 AM<br />Perhaps because I was an academic researcher, my initial response was not one of "Why me?"<br />I did every thing that I could to stay in shape - eat the right foods, take the right supplements. But the fact of the matter is, prostate cancer can hit every man if he doesn't die from something else.<br />My cancer doesn't cause me to fear that my life is over. I have a 3 percent cancer in the For me, it's time to face what to do next.<br />What are my options? I can do nothing, or find a treatment that works best for me. From the time of diagnosis to a visit last week with a Mayo Clinic urologist, I had time to think it over.<br />No one can make the decision for you. As I did, you have to weigh the available options.<br />You also can listen to what your friends did when they confronted the issue. Five had the traditional radical prostatectomy, two the robotic procedure, one had radiation implants and other had the proton treatment. All treatments had their pros and cons.<br />Surgery and other treatments might leave you with some incontinence and erectile dysfunction that can last for a year or more. Permanent problems can occur, but the outlook is better every day. Again, for me, these were less of a concern than getting rid of the cancer first. Later, I will face what comes after.<br />So what did I decide to do? I selected the less invasive robotic procedure by a physician who already has completed more than 500 such surgeries, as well as more than 1,200 radical prostatectomies.<br />Men are advised to get a regular prostate-specific antigen (PSA) test and digital rectal examination (DRE) after age 50. Do you? As unpleasant as it might be, I've been faithful in getting the examinations. Hence, I got an early diagnosis.<br />What does your physician look for in the examination? The PSA blood results will provide a number from 0 to the thousands. It's not uncommon for patients with advanced prostate cancer to have high PSA levels.<br />Fortunately, diagnostic procedures have improved over the years, so urologists look for more than a high number. They look at the fluctuation of the score. Does it go up and down over time?<br />I was fortunate that my physician and urologist both felt that the fluctuation in my PSA warranted an ultrasound and biopsy. Over a period of 18 months, my PSA went from 4.1 to 3.9 to 4.1. I'm thankful that they made the recommendation.<br />There will be a column after my surgery, so I can share my experiences.<br />William Arnold is a professor emeritus at Arizona State University. Reach him at william.arnold@asu.edu.<br />Just the facts<br />• Prostate cancer is the second-leading cause of cancer death in American men, behind only lung cancer. The American Cancer Society estimates that 28,660 men in the U.S. will die of prostate cancer in 2008.<br />• Prostate cancer is the most common cancer, other than skin cancers, in American men. The American Cancer Society estimates that during 2008 about 186,320 new cases of prostate cancer will be diagnosed in the U.S. About one male in every six will be diagnosed with prostate cancer during his lifetime, but only one in 35 will die of it.<br />• The American Cancer Society recommends that both the PSA and DRE should be offered annually, beginning at age 50. Men at high risk, such as African-Americans and men with a strong family history of the disease, should begin testing at age 45.<br />Source: American Cancer Society<br />On the Web<br />For information about prostate cancer, visit:<br />• www.mayoclinic.com/health/prostate-cancer/DS00043/DSECTION=symptoms<br />• www.prostatecancerfoundation.orgWilliam E. Arnold, Ph.D.http://www.blogger.com/profile/08737562366083224142noreply@blogger.com0