UPFRONT opinion New York, April 28, 2000. Mayor Rudolph W. Giuliani is a brave man for going live with his prostate cancer diagnosis. Everyone who has ever had a positive biopsy will support Mr. Giuliani as he forges ahead on his quest for information and best choices -- which treatment, when, where, from the hands of which prostate cancer specialists.
Control the flow of information in times of crisis is one of the tasks of the mayor of New York. Although he is the patient, and may be shaken up, Mr. Giuliani is doing a better job of sharing information about prostate cancer than are some in the media.
Mayor Rudolph Giuliani
"I would urge everyone to get the P.S.A. test, there's nothing painful about the P.S.A. test. It's a blood test ... You should have it tested and find out."As for friends -- Giuliani is an opera buff and among his friends is Beverly Sills. Sills says that Rudy's prostate cancer is just a "glitch." She probably meant well. But would she have said the same if she'd heard that Hillary Clinton had breast cancer?
"My husband had prostate trouble, you know, and I had an uncle who died of it," Joan Rivers said on CNN's Larry King Live. "But of course that goes back to different times when it was a long time ago, and that was what you died of."
Oh, please. Isn't it time people in TV land learned it's not a good idea to bring up "prostate trouble" when a guy has prostate cancer? And yes, this is the 21st century, and only around thirty-nine thousand men in the USA are expected to die this year of prostate cancer.
After a few minutes' chat with two doctors, Larry King calls in Sam Donaldson to talk about melanoma and cancer in general. Donaldson says prostate cancer is different, almost not really cancer at all.
"If you have cancer -- excuse me, and prostate is a little different," Donaldson says, "because if it's confined to the prostate and you remove the prostate and it hasn't spread, you're home-free, I mean, from the standpoint of starting even."
That's a lot of if's, notably if it hasn't spread. And it doesn't mean prostate cancer is different, less of a threat. It's the same with melanoma, with colon cancer, breast cancer, if they haven't spread. Donaldson had survived melanoma, he knows the score. We salute him. But why react to Giuliani's diagnosis by minimizing the danger from prostate cancer?
In 11% of the men found to have prostate cancer today, the disease has already spread to distant parts of the body by the time of diagnosis.
Giuliani's openness about his diagnosis has brought out some closet ignorance and almost callous detachment about the realities of this disease. "Prostate cancer," Gail Collins wrote in the New York Times, "that bane of middle-aged males, is a particularly curable, and common, affliction among public personages." "If you put all the well-known prostate cancer survivors in one place," Collins adds, "you'd have a celebrity golf tour."
Everyone wants to see more survivors. But the men we don't see, too sick to play golf, are missing from her mind's eye.
If prostate cancer were particularly curable, why is it, next to lung cancer, the commonest cancer killer of American men? Part of it is that medical authorities have been taking a calculated risk with those men's lives. Most medical organizations in the USA oppose early detection by means of the P.S.A test.
"The tests have a downside," the New York Times intoned this week, "often triggering needless and risky treatment for tiny, languid tumors that might never have grown into medical threats. But the upside can be a timely warning of potentially aggressive cancer in men who felt no sign of it."
The fact is, men need even more sensitive tests to detect differences at a biochemical level between relatively non-threatening tumors and tumors that are more dangerous, however tiny. The "free" PSA test can help. So will advances such as the HK2 test under development in Germany for improving prediction of organ-confined disease.
"When will we make quality of care," a friend asked this week, "as big a deal as early detection?" Early detection, Burns Mixon wrote in an e-mail to other advocates, is "the easiest and safest issue for those who have been 'cured' or those left behind to speak to. Through no fault of their own, and with God's limitless grace, they haven't been down the path traveled by a few hundred thousand guys" on any day in America.
"These are the men who have not, will not be cured. For them, PSA testing is overshadowed by the reality of prostate cancer as a killer."
