COVER
Upfront
March 1999
Round & About This Issue
Backlash
PSA, ACS, and the Media
Men: The Disorganized Majority
Gender and Clinical Trials
Dr. Feldman's Sound-Bites
BACKLASH
Former U.S. Senator Bob Dole's TV ad for Pfitzer's Viagra brings the term ED, short for erectile dysfunction, into Americans' living rooms. Men affected by prostate cancer (and their partners) seem pleased; but columnists Maureen Dowd and Arianna Huffington think it's a hoot. ABC-TV medical columnist Nicholas attacks Dole for plugging the PSA test and early detection. Are these media pundits ostriches? Did Bob Dole pick the wrong way to speak out?
PSA, ACS, and the Media
Which of these remarks were made by Dr. Gabriel Feldman of the American Cancer Society:
"Since some men may have prostate cancer and live a very long life and never be bothered by it, itÂs very difficult to say to any particular individual whether or not itÂs the right thing for you to be tested."
"We do not support mass screening for this disease based on the evidence in 1999."
Click here for answers
Larry Katzenstein's report in the The New York Times special Men's Health Issue Can the Prostate Test Be Hazardous to Your Health? and ABC-TV's The Prostate Controversy cause consternation, dismay, and even anger.
(If you want to read the Times article online go to The New York Times on the Web and choose a name and password. Then go to their Science/Health section or click on our links above. You might also be interested in Don't Take Your Medicine Like A Man by Robert Lypsite.)
This crisis-of-the-week reflects a major ongoing problem in the prostate cancer community, lack of patient-run organizations powerful enough to:
Men, the Disorganized Majority
Speaking of controversy, this month we're featuring an article by Gláucio Soares and Marilia Coutinho, a PCa husband and wife team from Brazil now teaching at the University of Florida. Marilia was the first person to write a letter to this magazine. Their article Men: The Disorganized Majority shatters a taboo of prostate cancer officialdom -- that you must never make comparisons with breast cancer and AIDS funding.
We publish whatever seems of compelling interest to the prostate cancer community. To see Marilia and Gláucio pursuing the fundamental fact that prostate cancer is a male disease is "somewhat shocking" (as Marilia said of our layout when she first saw it). Grasping how that fundamental fact makes a difference is. in our opinion, liberating. We'll forward your responses to this article to the authors.
Gender and Trials
If you're trying to get a drug to help with osteoporosis of prostate cancer; or therapy for lymphedema of prostate cancer, or chemo for prostate cancer, you may hear, XYZ is controversial. Usually this means no studies have been done on XYZ for PCa, although they may have been done for breast cancer. You may end up taking a drug that has never been tested on men.
This month a large study found no link whatsoever between dietary fat and breast cancer. Does this apply to prostate cancer or does it explain why fat seems to be bad for prostate cancer? No comparable evidence yet -- no such study completed.
Large, well-designed studies reported lately that Fosamax and Aredia help with the bone problems of breast cancer. Your endocrinologist (if you can afford one) may recommend Fosamax or even switch you to the more powerful Aredia. Your oncologist may tell you, reasonably, that although Aredia has been shown to work on lytic lesions (as in BCa) it's not yet been shown to work on prostate mets. You may want to yell Why has it not yet been shown? Now it's been shown for women, will they test it and comparable drugs as thoroughly for men with PCa who have the same need?
As Coutinho and Soares (above) would agree, this is not some mysterious controversy, it's medical science responding to organized demand from breast cancer activists.While researchers were finding drugs to treat ordinary osteoporosis in women and trying them on women with breast cancer, only exceptional doctors "saw" oesteoporosis of PCa castration as treatable and dared imagine treating bones crumbling from PCa mets.
Dr. Feldman's Sound-Bites
We need to know whether Dr. Gabriel Feldman, national director of prostate cancer control at the American Cancer Society, is the right person to speak to the media about prostate cancer. Too much passion can be blinding, but he seems awfully detached. All of the quotes at top of this page are his. What Feldman failed to get across to the national media is that ACS does recommend screening for all men between ages 50-59 and for African Americans and men at genetic risk..
Dr. Feldman E-mailed us, you may read his explanation in full. We're contacting him and ACS to ask for improvements in their position on prostate cancer. Our coverage of African American prostate cancer, sparked by ACS's press release last year about a disgraceful tragedy, has been taken up by a newsletter for 36 Black churches. After seeing Feldman's remarks we had no idea whether ACS still holds to its recommendations -- PSA tests between ages 50-59 for all men and annually from age 40 for African American men and all men at genetic risk on account of family history.
Feldman's primary duty with respect to prostate cancer is to aid efforts to prevent, detect, treat, and lower the death rate. He must speak to and on behalf of men already diagnosed as well as those who may need to be tested. Warning away those unlikely to need or benefit from testing is secondary.
If Dr. Feldman can't get the media to convey messages about prostate cancer without gaps and distortions, he can hire a good press officer. If he is ambivalent about his commitment to prostate cancer, he should step aside and concentrate on his other task, raising awareness for screening for colon cancer.
