Doctor, how common is Prostate Cancer . Prostate cancer is actually the most common silent killer in humans. There are estimated to be about 180,000 new cases diagnosed in coming year and 9 Million People in the United States that have Prostate Cancer in various stages. Does it correlate with age . Yes, as you get older being even more serious . Well, yes. The issue is that we cannot absolutely Prostate Cancer is relatively slow growing but sometimes its very rapidly growing and we cannot always tell which of those the particular cancers going to be. So if, in older men, if this is diagnosed and theres not a large amount of the cancer or it appears to be an early stage, then im sorry you have the option of just observing it or treatingt less aggressively than you would if someone were younger. What is your professional status at gwu hospital. Im head of the department of urology. Youre a member of us too, too, correct. Yes. What does that support group do . Its to help the men diagnosed with Prostate Cancer, us too is made up of Prostate Cancer survivors in total. You mean the Psychological Conditions that occur after surgery or after treatment or even acknowledge that you have Prostate Cancer . What we do primarily is offer counseling to men diagnosed with it, our case studies if you will, tell them about our situation, what we had. And primarily try to explain to them the various options that they have open for them. We have a very Close Association with urologists throughout all of our chapters. My own case, for example, i have the chapter and the urology clinic sponsors us at Andrews Air Force base. Uhhuh. They will tell a newly diagnosed patient a group in tandem a list of counselors of men who are survivors and recommend to them they contact one of us and talk to them. How withdrawed when you discovered you had Prostate Cancer. 62. How long before it took before you you underwent the total removal of the prostate gland, right doctor, and any surrounding tissue . There are small glands right behind the prostate gland that are commonly taken. We have a graphic that displays it. As we seen the screen th is peroneal surgery and the incision is made under the terre haute tim, between the scrotum and the anus . Did you have that . I had a radical operation with the incision made just below the navel to the pubic bone. We have that available, too, as a graphic, retro pubic surgery, is that what we see there . Does that pretty much describe what the location was . Yes, it does, john. Its from the navel down to the top of the where the penis joins the anatomy. Thats correct. What was that like . Well, its major surgery. I was diagnosed in february of 93 and i had my surgery on may 20th of 93. I was out of the hospital in four days. I was up and walking the day after the surgery and what have you. I was back running three miles a day a month after the surgery. Did you have full energy . Oh, yes. I i wont kid you, its a major surgery and it takes a full six weeks before youre back to what i call 100 . If you had been seven years younger would you have recovered your full quotient of energy earlier . I dont think so. I was very i ran for 1520 years before it so i was in pretty good shape so i dont think being a little younger would have made any dference in my recovery. Whats the age at which Prostate Cancers found . Theres an autopsy series from out of detroit that demonstrates that men that died of violent causes, there is actually about a 10 incidence of a tiny focus of Prostate Cancer in in men between 2029. This really raises the question about how long those cancers are there. The youngest ive ever heard of being actually diagnosed with Prostate Cancer was a 29yearold male in the u. S. Army. Is testicular cancer more common in younger men than is Prostate Cancer . Well, yes, certainly thats the most common tumor in young men. Men between the ages of 1535. However, you know, we dont know what the incidence of very tiny cancers are in other organs of the body. Is that a neglected disease . Or condition . Meaning that not enough attention is paid to it whether by budgetary funding as a matter of Public Policy or the recognition of its existence and the continued enhanced treatment of it . Prostate cancer . No. Testicular cancer . No there are only 3 to 4,000 cases of it in the United States. How many Prostate Cancer . 180,000 per year. What are the lifetime odds of getting it for Prostate Cancer for a male, of course . Its about one in six. I mean, to put it in perspective, a man who is diagnosed with Prostate Cancer about every three minutes in the United States. And if a man it going to die of cancer after the age of 50 or in mid life, this is the cancer that is most likely to kill him, correct . Actually i think lung cancers a little higher numbers but Prostate Cancer is certainly one of the top ones. Should we also take note of the fact that if its one in six lifetime risk of getting Prostate Cancer, its one in eight of getting maam mary cancer, Breast Cancer, correct . Yes. So the odds are slightly enhanced meanwhile that theres slightly lower level at risk for maam mary cancer. Does it seem to you odd then that the funding for, were getting a little ahead of ourselves but well turn to more fundamentals but while were on subject does it occur to you that it is odd that the funding for, annual funding for Breast Cancer is 600, what, 98,000, million dollars. And for Prostate Cancer its 100, and, what, 38 . I believe thats correct, john. So thats a factor of more than about three to one favoring Breast Cancer even though theres a higher risk. What about the incidence of Breast Cancer, 180,000 for Prostate Cancer, what is it for Prostate Cancer, what is it for i believe its slightly less than Prostate Cancer. Is slightly high incidence of less than that. I believe with all due respect does Sexual Activity correlate with a healthy prostate . Well put that question to our guests but first, here are their distinguished profiles. Born, flint, michigan, 49 years of age, wife, rebecca, three children. Roman catholic, republican, university of notre dame, b. A. University of the east, the flu vaccines, doctor of philippines, biotech knowledge fellow, George Washington university seven years, George Washington chief of urology five years. Mens health magazine, contributor. Hobbies explorers club, a National Exploration society. Chairman of expeditions. Michael john manyak. Born, jersef age. Wife, mary. Seven children. Roman catholic. Republican. St. Peters college, b. A. Auburn university m. A. , public administration. United states air force, colonel, 31 years. Chrysler technologys electrospace technology nine years. Us Cancer SupportGroup Regional director two years and currently. Hobbies working in his yard, photography. James robert anderson. Couple anderson, what symptoms did you experience that helped you detect that you had cancer of the prostate . Thats whats so alarming about this john, i had no symptoms. No symptoms, zero. Had you been getting your p. S. A. Annually . I get one annually with my physical. Lets talk about psa, a blood test, stands for what. Prostate specific antigen which means theres a protein released. And the protein determines what your level is. And when you get up to, what, four or five, then you have to proceed with caution but dont get unduly alarmed, is that right . Well, there are some people that are starting to feel that even at those levels it should be investigated more closely such as biopsies. Most important thing about the psa is the rate of change of the psa. You cant just take it as one particular test but rather as a series. He means, i believe to say its constant at year to year. If you come in at a four one year, you should come in at a four the next year or drop, if or drop, if you go up youve got a problem. Did you get the psas every year. I did. The doctor who did this for me, god bless him, he gave me my physical in 91 and my bsa was 9. 2 and he called me up at work and said, get your butt out to the urology cling were goinged to do a sonogram on you. They did and they found nothing. There are three tests for maybe theres more but there are three tests that i know of, thats the psa, thats the blood test, the sonogram, which is the introduction of a scope rectally to examine the outer layer of the prostate to the extent they can get to it, twothirds of the prostate . Actually it images the entire prostate so you can look at the internal structures as well. Can you see much with it . You can see the prostate. The problem is you cant really detect cancer tha cancer frequently looks the same as normal tissue. You can see texture . Yes. If you can improve the image would you be able to tell more . Yes, theres a lot of Research Going on in that arena now to increase not only the resolution of the ultrasound but also to add things that might be able to be detected in cancer as opposed to normal the third thing that mention to have is the digital examination, the digital probe, the doctors finger. What is he looking for with that probe . Well, the actual digit tal rectal exam, Prostate Cancer arises 7080 of the time in the outer portion of the prostate so the closerrest thing you can get to is your finger softness or hardness, is that the key, if its hard youre in trouble, soft youre ok . Thats one of them. And also if theres an irregularity. What does that mean . A bump, a nodule. There are presumably an experienced doctor who has conducted many rectal, digital rectal exams has a greater its like the doctors hands on the body, some of the are terrific at that, diagnosticians, is that right. Thats right. So there is the development over time of making that skill and making that determination whether we should be concerned, right . Most people can feel a nodule but the subtleties is where the experience comes in. What im getting at is that there is the possibility that were getting hyperconscious of the of this disease and its ok to take note that there are 180,000 cases a year and theres one chance out of six but not every single symptom, like a certain hardness at a certain part of the gland, necessarily means that you have cancer and you dont have to get alarmed by it. Now, do you run into people that think that there is just too much high per bowly or exaggeration and that it breeds suspicion where there ought not be that . Yes, youre on to something for that. There are men, for example, think the psa is overused, it puts men at unnecessary risk for biopsies and what have you but i dont agree with that, john. I had, as i mentioned to you, i was diagnosed in 81 with a 9. 2, no cancer, though. I did biopsies and came back negative. The following year my psa jumped to 17. 2 and found four hits on the left side. If it hadnt been for that psa and it hadnt been for the pier sis tense of my doctor and my urologists i would have never caught that and i know that from the pathology report after they took the thing out that i had a serious Prostate Cancer problem. Did you experience any period of incontinence . No. Any impotence . In the beginning there was certainly a problem with that. Are you helped by viagra . I cant really say i am. You cant say because youd prefer not to say . Oh, no, no, no. Well, ive used it but and i it hasnt helped me that much. Has not . No. Whats the percentage of help . Estimated 2530 of men helped by viagra. Whats coming on stream . There are other drugs looked at. One in particular that will be released later this year, i believe, we tested in Clinical Trials and that acts centrally in the nervous system in the brain. And this would be additive we believe let me get this straight now. This is not physiological so its not well peyton ill oriented its cerebral, is that correct. Thats correct. It affects something in the brain. Thats correct. And the brain sends a message. Thats correct. And if Everything Else is functioning, if the plumbing is good then the message gets through and youre in business. Thats the theory, thats correct. And so these what is the what is this brain situation . Well, i think everybody understands that erectile dysfunction is complex. Theres a psychological component to it as well. Do you believe that . Yeah, i do. No question about that. No question. People were in the early stages of viagra would give us believe automatic, almost a pneumatic thats a good word. Function, right . Thats not true. Not true. What else is coming on stream . What about a salve applied externally . There are medications that increase blood flow into the penis that are administered through creams and salves like that and there are devices that are being looked at to help drive those medications in through the skin at a greater rate. Is the farms company thats producing viagra coming out with a quicker effect producing viagra. There are several pharmaceutical Companies Looking at that issue, youre exactly right, anything to improve that, rather because its usually about a onehour wait time from the time you take the medication until the effects can be noted. Before you had your real bout with serious cancer, did you experience knock turnal urination of a higher frequency . Or any kind of no, no. You did not not . No. Did you have an enlarged prostate. Yes, i did. Did the doctor tell you there was no relation between an enlarged prostate and a cancerous prostate . Enlarged prostate can cause a rise in psa and my father had an enlarged prostate before me so i was not at all alarmed by the fact that several doctors had told me my prostate was enlarged over the years. What do you conclude when you see an enlarged prostate, doctor . Several things, first of all, the size of the prostate gland doesnt necessarily correlate with the symptoms a patient may have. We know Prostate Cancer frequently does not have symptoms. So doesnt an enlarged prostate cause frequent urination . It can, it can be one of the things that leads to the frequency of your own nation. The most serious thing you can say about enlarged prostate is you have to go to the bathroom more often and particularly at might and thats unpleasant . Not really. If the prostate gets large enough it can completely block the urinary stream and thats an emergency. Youre still not in the cancer zone. No, youre not. Theres no diagnostic value to enlarged Prostate Cancer as to determining if a cancer exists. I wouldnt say that, if you have greater amount of tissue theres more likelihood there would be small focus of cancer in there at least. Is it fair to say what you look for in these three fundamental diagnostics that is the digital, the rectal, the sonar, and the whats the third the psa, that you look for a confluence of those, they all have to Work Together for you to determine probability of cancer . Yes, thats correct. And then you cross the line and you say, ok, now is the time to have a what . Well, the first thing is you have the blood test and the digital exam. Right. And if either one of those are abnormal that raises suspicious. If theyre both abnormal theres a much higher likelihood of cancer then the next step you go to is an ultrasound with a biopsy. The ultrasound is not good just to look for cancer alone but its very good to get little samples of tissue, the systematic areas of the prostate that may cause cancer. I am familiar with a radiologist and all he does is sonar in this sector and he can make a determination of, for example, the accumulation of white deposits on the surface of the gland and he can guess or conjecture as to whether its calcium or whether its cancer. But if he sees that, he then looks at the other testing, the other diagnostics, but im i was given to believe that a biopsy requires a threshold beyond that which you have described, that a biopsy doesnt always go hand in hand with any usage of sonar. Well, i think thats a fallacy that needs to be straightened out because i would take exception to the radiologist you mentioned being aircraft diagnose cancer on the basis of a ultrasound. I didnt go that far. I used the word conjecture. Sonar is a limited instrument. Theyre all limited are they not thats why you need all three together. Thats correct. We crave for better diagnostic tools in the world of Prostate Cancer. Are we getting them . Yes, i think we are. We have new blood tests becoming available, were learning much more about Prostate Cancer and the steps for development of cancer and then the spread of cancer. We have new imaging techniques that are used, such as the body scans used for soft tissues, lymph nodes, there are a variety of things that are on the horizon. Another way of treating Prostate Cancer is radiation and we have on the screen there a an image of radiation treatments. What do we see there, dr. Manyak . Well, you see a schematic representation of what would be termed external beam Radiation Therapy which is an outside a source outside of the body directing the beam towards the prostate area. Yeah, what are the risks and what are the unfortunate negative side effects . Well, radiation has similar risks to surgical approach in this area, you can have both incontinence and erectile dysfunction. Was radiation considered to you rather than the radical surgery . Is there i considered all of it. Did he give you that option . Yes, i had that option. Did you rule that out . I did personally. You wanted to make sure you had gotten rid of the cancer . Thats right. What was available in the i used the john hopkins medical library as my source, and from my reading, it was very clear to me that in 1993 the survival rate, longterm survival rate for men was highest with surgery if they could handle the surgery so i opted for surgery. Yeah, but then you went to the zone of real risk, you got the incontinence and impotence risks, what other risks what are the negative whats the negative downside of radical surgery . I think you covered the two that are of most concern. Theres always a chance you might lose some blood during surgery although weve been able to decrease that significantly over the years. In connection with radiation, besides radiation, you can also treat it by internal insertions into the gland itself. What do you put in the gland to help control the spread of cancer . Well, there are radioactive seeds that are placed. Seeds, right . Yes, tiny pellets. What else besides seeds, what are those radioactive . Theyre radioactive. So its a similar how is a cure effected through Nuclear Energy . It kills the cell. What happens after the cells are killed, the seeds are removed . They stay there. Whats coming down the road is something more interesting, also very small inserted pellets that are actually create heat, thermal energy and you can place a patient into a Magnetic Field afterwards and treat them and then retreat them again at another time. Colonel anderson, did you contemplate that or was that offered to you . You put these are they pellets or rods . Tiny pellets. Pellets, like a bb. Yeah. A little bigger. Cylindrical. Cylindrical pellets inserted. 20 to 40. You get those. And they function on a heat principle and you get additional heat if you sit. And if you sit x number of minutes it can drive up the body temperature. You need to drive it well beyond body temperature to cause the death of the sell. You dont have to get to a boiling level, do you . Well, you can do that. That may not be necessary. Well, that sounds like a dream therapy cause you can go in and do it on monday and two weeks later you go back and theres no side effects and the heat will do it . Thats right. There are Clinical Trials ongoing right now in chile and the data looks very interesting. So this is brand new. Brand new. Is there anything else thats brand new by way of treatment . Well, there are a variety of people that are looking at vaccines and different types of intervention from the medical tan point. Whats the relationship between Sexual Activity and a healthy prostate . I think if you have an unhealthy prostate such that you have an infection or something that will affect your desire. How about the other way . Namely that if you give your prostate a real workout, a lot, which means considerable Sexual Activity, a lot, are you better off physically . From a prostate point of view . No relationship between development of cancer with either underor overactivity in the sexual arena. Did your support group get into any questions we discussed here and what do you focus on . Weve only got a few seconds and im sorry for that. I think the bad effects from Prostate Cancer, the one that causes the most grief is incontinence. The men, they dont impotence is not that big a problem, incontinence is. Because of the level of frequency or because it can be handled psychologically and emotionally better. Handled emotionally better. Thank you, dr. Michael manyak and