Prostate Cancer History

Helen Valier, A History of Prostate Cancer, 2016, Palgrave MacMillan.

    This is the best book I’ve found that covers the scope of prostate cancer—history, treatments, research. There are quite a few articles that deal with specific topics in a limited way, but Helen Valier has brought everything together, and her book answers most of my questions. I say most because her book came out in 2016, and medical advances have continued to occur over the last seven years. One example is the development of the PSMA-PET test that can detect trace amounts of cancer cells that traditional scans miss.

    The book covers the entire history of prostate cancer, what physicians in ancient times thought of it, how it was treated through the centuries, the struggles of doctors to find solutions and a cure, the debate over whether to PSA or not, and the big question that we continue to struggle with, is it better to catch the cancer early through prescreening and the PSA, or wait until symptoms show up, when the cancer might have spread into the lymph nodes and bones. Doctors have differences of opinion about this. So do patients.

    The chapters cover the problematic prehistory of prostate cancer, surgery and specialization, sex and hormones, clinical trials, screening and the politics of prevention, and radiotherapy.

    Part of the dilemma with the PSA is that it can give a false positive result, which can cause you anxiety to no end. But then you have a digital exam, and if THAT indicates something, then they do a biopsy and find out what you’re dealing with. The Gleason score that comes out of this determines what kind of treatment you need to get. If it’s a low score, you probably have the wait and watch variety, and you don’t need to do anything. If it’s a high score, then your cancer is more aggressive and something has to be done.

    Part of the risk with a higher than normal PSA is that men overreact at the cancer declaration and demand treatment right away, when their cancer is actually of the wait and watch kind. Most of the risks are in the treatments because they can have serious side effects. Doctors can also over diagnose and do more than is necessary as they try to be proactive. Patients need to be aware of this.

    If cancer has remained within the prostate, the standard course of action is removal of the prostate. If cancer cells have moved outside it, then you take on a combination of hormone therapy and brachytherapy, followed by external radiation.

    If your cancer is slow growing, and most men has this type, then you wait and watch, and monitor developments via the PSA.

    While the book focuses on the diagnosis and treatment of prostate cancer over the years, the patient side of the equation is not dealt with much. Valier says that other historians can explore this aspect. She does provide one example, which is enough to give me hope. Her father’s cancer wasn’t found until it was Stage 4 and in his bones. He is being treated and doing well ten years along.