Background: The men's (cancer) club

Olmert is one of the six Israelis who are informed on an average day that they have prostate cancer.

By
October 30, 2007 04:30
Background: The men's (cancer) club

olmert prostate 224 88. (photo credit: GPO)

 
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Prime Minister Ehud Olmert, 62, is one of the six Israelis who are informed on an average day that they have prostate cancer - the most common malignant tumor in men in this country. The Israel Cancer Association (ICA), which has for some time has been planning a symposium for prostate cancer patients at Kfar Hamaccabiah on November 15, says 2,250 new cases are diagnosed and 380 men die of it in Israel every year. US presidential candidate and former New York mayor Rudy Giuliani is a survivor, and former French president Francois Mitterrand, in whom it was diagnosed at a late stage, died of the disease. The main function of the walnut-sized prostate gland, which is part of the male reproductive system, is to store and secrete a clear, slightly alkaline fluid that comprises 10 percent to 30% of the volume of the seminal fluid that, along with sperm, constitutes semen. The rest of the seminal fluid is produced by the two seminal vesicles. The prostate also contains some smooth muscles that help expel semen during ejaculation. To function properly, the gland requires male hormones, and the main one is testosterone, which is produced mainly by the testicles. Ironically, while testosterone is needed by the prostate, it can also be its downfall - as many years of exposure to testosterone is one of the causes of prostate cancer. The longer the exposure, the higher the risk, so older age is a risk factor. But having a first-degree relative (father, son or brother) who had prostate cancer is also a danger, as family history increases the risk of contracting it. So does smoking (Olmert smokes cigars) and obesity. Eating overly fatty food and drinking excessive amounts of alcohol are also believed to raise the risk. The main symptoms are difficulty or pain in urinating (although frequent urination ironically can also be a sign), blood in the urine or semen and a drastic decline in sexual function. Dr. Avivit Neumann, an oncologist who specializes in cancer "from the waist down" at Meir Medical Center in Kfar Saba, said after Olmert's press conference she was "sure he will be healthy. It was diagnosed at a very early stage." She told The Jerusalem Post she welcomed his openness in "telling the whole country and the world." Israel has excellent urological surgeons who perform radical prostatectomies, the surgical removal of prostate glands, Neumann said. It is performed here as retropubic open surgery, in which the surgeon removes the whole gland through a single incision in the lower abdomen about 12 centimeters long. In some countries, especially France, urologists have begun performing it by laparoscopy (keyhole) surgery in which some five cuts are made. In this more challenging technique, in which there is much less experience, the surgeon makes small incisions and uses a tiny camera and specialized instruments to remove the prostate. In an even newer laparoscopic technique, the surgeon removes the prostate with the help of several robotic arms that mimic his hand movements and allow for more precision. Only in Holland is there a surgeon who is performing "enucleation" of the prostate, in which the tumor itself is removed from the gland, while the organ remains intact. But he has performed only a handful of cases. Neumann said possible complications from radical prostatectomy included temporary or permanent incontinence and impotence. In addition, the patient becomes sterile, so patients may deposit semen in a sperm bank if they want children. "A very good urological surgeon who performs nerve-sparing surgery avoids this complication in 90 percent of cases if the patient doesn't suffer from high blood pressure, diabetes or other conditions," she said. "Sometimes, if the tumor is near the nerve, preserving it could be very difficult. About 2.5% of patients develop mild incontinence and about 0.5% significant incontinence," Neumann said. No drugs need to be taken long-term after prostate surgery. Urologist Prof. Ya'acov Ramon of Sheba Hospital in Tel Hashomer, who attended the press conference along with the Olmert's personal physician, Prof. Shlomo Segev of Sheba, is expected to operate on the prime minister. The procedure is expected to take place within a few months. After hearing his options, Ramon said, Olmert decided to have the tiny tumor surgically removed rather than wait to see how it developed or to undergo chemotherapy or radiotherapy. Although biennial mammography screening of women for breast cancer is universally accepted, testing all men over 50 for their prostate-specific antigen (PSA) count - the level of a component in the blood naturally found in semen and produced by the prostate - is not accepted, as it has not been proven to save lives. The test costs a health fund only some NIS 16, but there are men with high PSAs who don't have prostate cancer and others with low PSAs who do have it. Some men have high PSAs because of benign inflammation of the prostate, which causes annoying symptoms but is not cancerous. ICA director-general Miri Ziv said her association, just like the American Cancer Association, recommends that all men over 50 and those with a family history or risk factors for prostate cancer consult with their physician about whether to undergo testing. "It can save a life, but it can also make a person miserable," she said. "Researchers are trying to refine parameters to learn who is at risk. Over-diagnosis and performing biopsies unnecessarily can cause harm. Only 16% of men with prostate cancer will have symptoms, and only 6% will die of it. As it is a slow-growing cancer, many men with the tumor will die from another cause without knowing they have it. We are not for automatic screening. We have held workshops for doctors to keep them informed." More than 500 men had registered for next month's Kfar Hamaccabiah symposium prior to Olmert's announcement, but now the ICA expects many more will want to attend. "It's very good that the prime minister spoke openly," said Ziv. "I know of many well-known people who kept their prostate cancer a secret. Men should consult with their doctors and get advice. What they do is up to them." The Israel Medical Association wished Olmert a "quick recovery" and congratulated him on his "courage" for announcing his diagnosis to the public. Suitable measures were needed to determine the medical condition of a prime minister and inform the public, it said in a statement. "The leader must forgo in advance some of his privacy, including the part relevant to his health," the IMA said, adding that a leader's decisions could affect the fate of many. According to Dr. Eric Klein, head of urologic oncology at the Cleveland Clinic's Glickman Urological and Kidney Institute, "When opting for prostatectomy, it's important that you not only know your surgeon's experience, but also understand the risks and side effects of surgery and your long-term outlook." A recent study Klein conducted found that patients of those surgeons who have performed more than 1,000 prostatectomies were about 10% more likely to be cured of their cancer than those whose surgeons had done 250 to 999 of the procedures, and 30% more likely than those whose surgeons had done fewer than 50. "Most patients can expect a return to regular physical activity within a few weeks, regardless of how the surgery's done, and good results with continence and potency," Klein said. More information on prostate cancer can be obtained (in Hebrew) at www.cancer.org.il.

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