With PROSTATE CANCER Grim tally: This disease may kill 34,000 men in '92

GOING PUBLIC

April 28, 1992|By Jonathan Bor | Jonathan Bor,Staff Writer

Sen. Bob Dole, the Kansas Republican, can tell you exactly how much of a telltale protein his prostate was producing last August. And he can tell you how his blood-test readings suddenly rose over a five-month period -- leading to a biopsy that revealed cancer and to his decision last December to have the tumor removed.

These days, he's talking comfortably -- as are several other men in the public eye -- about a disease that until recently few men wanted to discuss.

"I'm a legislator. I'm always looking for a compromise," he quipped during a relaxed interview last week. "I'm always asking, what can we do that doesn't hurt? But I was finally convinced that surgery was the way to go."

The issue of prostate has taken an increasingly high profile for a few reasons. Recently, the blood test that flagged Senator Dole's cancer has both gained in popularity and drawn the fire of scientists who say it could cause doctors to over-diagnose cancer and prescribe unneccessary treatments.

And the willingness of men in public life to discuss this very common disease -- or at least to disclose the fact they had it -- seems to have arrived with the swiftness of a Kansas tornado.

In the last year, the public has learned about prostate cancer from an assortment of men, many of whom would never have been mentioned in the same breath. Besides Senator Dole, they include tennis star Bobby Riggs and Maryland Attorney General J. Joseph Curran Jr.

News accounts have told of several other public figures who have been treated for the disease:

Rock star Frank Zappa, Time-Warner chairman Steven Ross, the late producer Joseph Papp, Senators Jesse Helms and Alan Cranston, Supreme Court Justice John Paul Stevens and ABC (( news president Roone Arledge, who is recovering from prostate surgery at Johns Hopkins Hospital.

About a week ago, Mr. Curran composed a letter to state lawmakers, revealing how early diagnosis and surgery arrested his cancer before it could spread to surrounding tissues and threaten his life.

In a letter utterly devoid of legal or political content, Mr. Curran advised men to have a physical prostate examination every year. He also made them aware of a simple blood test, called PSA, that has recently gained popularity as an aid to catching prostate problems early, as it did for him.

On Friday, a reflective Mr. Curran said many men may have been reluctant to discuss prostate cancer because surgery can leave them unable to control their bladders. Indeed, he said, he temporarily had that trouble following his operation last September.

"People are afraid to talk about it, but what the heck, it happens," Mr. Curran said Friday. "I might as well tell them what I know -- even the women, so they could tell their husbands."

In the past, perhaps it was the reluctance of men to discuss the intimate details of body parts and functions that drove the

disease underground. Maybe, as some have argued, it was the relatively low level of federal funding into prostate cancer research and education.

Victims, doctors and researchers agree the time for a public airing is overdue. The disease will strike one in 11 men during their lifetime. That makes it almost as common as breast cancer, which will afflict one woman out of nine.

The American Cancer Society estimates that 34,000 men will die from the illness in 1992 -- the second-highest cancer death toll for men, next to lung.

High-profile figures like Mr. Dole are telling the plain truth when they say that prostate cancer is highly curable when caught early and hardly ever cured when caught late.

"We've had a lot of people who have written to say, 'You've saved my life,' " said Mr. Dole, who has urged older men to get regular screening for prostate abnormalities. "They were alerted and went to see their doctor."

Men whose cancers are caught before spreading to surrounding tissues can expect a normal life span. Once the disease has spread to other organs or bones, victims survive an average of only 2 1/2 years, according to the National Cancer Institute.

Disagreement over detection

But not everyone agrees on the best way to detect prostate cancer.

While the senator recounts how PSA tests helped alert doctors to his cancer, some authorities say the test has yet to prove its worth as a screening tool as reliable as the mammogram is for breast cancer.

The prostate test measures the amount of a protein called prostate specific antigen that circulates in the bloodstream. Elevated levels or rapid increases in PSA can signal trouble: either a benign growth or cancer.

The prostate is a chestnut-sized gland, located just below the bladder, that provides part of the seminal fluid necessary for ejaculation. Cancers are thought to result from a series of genetic changes that may begin early in life but don't usually trigger cancer until men have at least reached their 40s.

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