At age 47, Damon Harris had three Grammys, two American Music
Awards, nine gold records, including ``Papa Was a Rolling Stone,''
and prostate cancer that had already spread to his lymph nodes.
A member of the Motown vocal group The Temptations from 1971
through 1975, Harris thought he was too young for prostate cancer,
a disease whose strongest risk factor is age, striking most often
in the late 60s and early 70s. But he is African-American, which
increases the risk of prostate cancer by at least 50 percent. And
his father died of the disease when he was 62.
When Harris' cancer was discovered in January 1998, it was too
late for many choices.
``My only option at that point was hormone therapy to suppress
the testosterone that was feeding the tumor,'' Harris, 49, said in
a recent telephone interview.
Harris ignored symptoms such as frequent urination and pain in
his lower back and hips, attributing them to the fact that he was
exercising heavily and drinking a lot of water. He cut his fluid
consumption to ``cure'' the problem and almost forgot about it
until he noticed blood in his urine.
``Men don't talk about the symptoms because of what they might
mean,'' he said. ``The side effects of the necessary treatment are
a big issue. The sexuality concerns are a lot like those with
mastectomy for women. My father had a radical prostatectomy, and he
just wouldn't talk about it at all.''
Harris said that despite all the warning signals, he never even
considered that he might have prostate cancer.
``When I was diagnosed, I realized that I had had the symptoms
for at least five years,'' he said. ``But I didn't do anything
about it, and I didn't talk about it. Nobody does.''
Which is exactly why this year the National Men's Health
Foundation has chosen prostate cancer as the focus for Men's Health
Week. In 2000, about 180,400 American men will learn they have
cancer of the prostate, a walnut-size gland that wraps around the
base of the urethra and produces the fluid that transports sperm.
An estimated 31,900 men will die of prostate cancer in this
country this year, said Tracie Snitker, spokesperson for Men's
Health Week.
For black men, the statistics are worse: African-American men
are at least 50 percent more likely to develop prostate cancer and
twice as likely to die from it as men of any other racial or ethnic
group in the United States.
But talking about the disease may prolong, and even save, lives.
Major advances in prostate surgery and radiation therapy over
the past five to 10 years mean those who detect the cancer early
enough are likely to enjoy longer lives with fewer, less severe
side effects.
For men like Harris' father, just one generation ago, treatment
almost always resulted in impotence and even incontinence.
And for men like Harris, whose diagnosis was made only after it
had spread from the prostate, there is no cure. Harris' hormone
injections help to control the spread of the disease and have
brought it into remission. But the treatment has caused weight
gain, accelerated heart disease and angina, and has greatly reduced
his sexual drive.
Today, though, for those who detect prostate cancer at its early
stages, while it is still confined to the gland, a new
nerve-sparing prostatectomy surgery and two new forms of radiation
therapy are options offering fewer side effects and higher
five-year cure rates.
Management of early-stage prostate cancer is improving, and
death rates are dropping every year, said Dr. Hugh Lamensdorf, a
Fort Worth urologist and former president of the Tarrant County
Medical Society.
Whether surgery or radiation is a better option for men with
localized cancer of the prostate is a matter of debate among
doctors, and though at least one clinical study has shown the
procedures to have competitive five-year success rates, longer-term
rates are still unknown.
``We urologists are convinced surgery is the best treatment,''
Lamensdorf said.
Nerve-sparing radical prostatectomy protects the nerves wrapped
around the outside of the prostate to preserve sexual function. It
was developed in the early 1980s by Dr. Patrick Walsh at Johns
Hopkins Hospital in Baltimore to cure the cancer while preserving
sexual potency. The treatment is now widely available, Lamensdorf
said.
``In surgery, we've lowered the risk of incontinence
dramatically and now have methods to spare the nerves,'' Lamensdorf
said. ``It depends on the age of the patient, but for those under
60, the success rate in preserving sexual function may be as high
as 80 percent. Our main job is to cure the cancer - if at all
possible without compromising sexual function.''
New twists on radiation treatment for prostate cancer include
precisely targeted external beam radiation and interstitial
brachytherapy, an internal radiation therapy that uses small,
radioactive pellets (each about the size of a grain of rice) that
are implanted directly into the prostate.
Brachytherapy, which was developed 15 years ago, is the easiest
on the patient, doctors acknowledged. It is the least likely to
cause impotence or incontinence and can be done on an outpatient
basis.
``There is a lot more enthusiasm for it than we have statistics
to support,'' Lamensdorf said. ``Results look good so far, but
doctors are not ready to abandon surgery.''
Results from one 10-year study, reported in U.S. News & World
Report, show that 85 percent of those treated with the pellets no
longer show signs of the cancer.
In applying external beam radiotherapy, radiologists now use a
computerized model that allows them to pinpoint the radiation so
the dose can be increased and applied directly to the tumor without
increasing complications.
Treatment for prostate cancer has improved because early
detection has greatly increased, thanks to education efforts and
the PSA (prostate-specific antigen) screening test, a simple blood
test used in conjunction with the standard digital rectal exam.
Today, 79 percent of all prostate cancers are discovered in the
local and regional stages. The five-year survival rate for patients
whose tumors are diagnosed at these stages approaches 100 percent,
according to the American Cancer Society. Over the past 20 years,
the survival rate for all stages combined has increased to 92
percent, from 67 percent.
And it couldn't have happened if men hadn't finally started
talking about it.
As Harris said, ``You can't cure something you don't know you
have, and you're not going to even suspect prostate cancer if
nobody ever talks about it.''
