Editor’s Note Visiting professors

Prior to my own experience, I didn’t really understand what happens internally when you are diagnosed with prostate cancer. I have always tried to distance myself from my patients so that I could deal with their problems. When you have the disease, things are different.

— Jeoffrey Deeths, MD

I would echo the visceral nature of being diagnosed with prostate cancer. For me, I felt a great sense of sadness and a feeling that things had changed. Even if you have 15 percent of one core, Gleason 3 + 3, things have changed. It is now part of your life, and you can’t put the genie back in the bottle.

— Richard -, MD

Nobody knows what it’s like to go through what their patients go through unless they’ve gone through it themselves. You can try to imagine it, but you can’t.

— Alan Roberts, MD

Having been on the other side, one of the most powerful medicines is a sense of optimism from the person who’s taking care of you, and not just sort of brainlessly patting you on the shoulder, but a true, reasoned and genuinely felt sense of optimism.

— Gustav Magrinat, MD

My first major educational foray outside the endless field of breast cancer began more than three years ago when I was unexpectedly contacted about the possibility of launching a new audio series on prostate cancer. Our previous audiences for many years had been medical oncologists, surgeons, and oncology nurses, but the prostate series would be for urologists and radiation oncologists... Sure, why not!

The prostate experience was deceiving at first — it looked easy, but wasn’t. It took a couple of years to learn the subtleties of the research-to-practice issues involved in the urologic oncology culture. Along this very interesting path, three unusual experiences helped us discover that this disease was, in fact, unique.

As part of our CME needs assessment program, we regularly invite outstanding research leaders to participate in a visiting professor series. Physicians spend a day with our education team in Miami, where they present research data, answer questions and allow us to pick their well-developed brains. Toward the end of the day, we conduct many of the interviews you hear for our various audio series.

The visiting professorships in prostate cancer yielded some of the most personal and compelling interviews of my career, starting with the second one we hosted with urologist Paul Schellhammer.

Within the first few moments of chatting over a cup of coffee, Paul — in his gentle and humble manner — made it known that after a career of prostate cancer clinical research, he himself had been diagnosed with the disease. Much to my surprise, he was totally willing to share this experience with our national audience of physicians. After a lifetime of considering radical prostatectomy a relatively routine procedure, Paul developed a psoas abscess after his surgery. He also noted that just prior to our meeting, his PSA assay was persistently elevated, and he shared his thoughts with me about what steps he might take.

A storm of supportive emails from listeners followed this unplanned experience, and one year later, I again asked Paul to record an interview. At that time he was recovering from radiation therapy and complete androgen blockade. This interview again resulted in very positive feedback from our listeners.

The month after Paul’s first visit to Miami, another unexpected discussion occurred. Judd Moul was visiting our shop for a long and very educational day. Judd — in his thoughtful, candid and very well-informed manner — shed a great deal of light on key controversial issues such as management of PSA relapse and watchful waiting for low-risk tumors. Toward the end of our conversation, he mentioned that his father-in-law died of prostate cancer about 10 years ago.

This was a painful experience for the entire family, and one that was particularly disturbing to Judd, who from the beginning, was constantly reassuring his loved ones that prostate cancer is usually an indolent and non-life-threatening disease. When his father-in-law died 36 months after first diagnosis, Judd believed he had “let his family down.”

A third extraordinary visiting professorship occurred not too long after that. Radiation oncologist Colleen Lawton spent the day with our team reviewing prior, current and future RTOG trials. During the end-of-day interview, after discussing her many research activities in the management of locally advanced disease, Colleen casually commented, “and my Dad was actually treated for locally advanced prostate cancer.”

I silently digested this for a few minutes and then asked her to tell the story, which included her father being treated with a regimen of androgen deprivation and radiation therapy that she had developed and tested in a randomized RTOG trial. One positive outcome of this experience for Colleen was that her prostate cancer patients could no longer think that, as a woman, she would have no idea what they were going through.

Being a scientific person who also believes in fate, I figured that these three extraordinary people had crossed our group’s path for a reason and that perhaps it would be interesting and informative to gather them together with a group of other oncology peers who also had personal experiences with prostate cancer, and audio record the event.

Amazingly enough, this actually happened in Atlanta on October 7, 2004. In addition to the three visiting professors, we recruited 11 other physicians — mostly urologists, medical oncologists and radiation oncologists — to participate in this event. All except one had been diagnosed with prostate cancer, ranging from low-risk localized disease to PSA relapse to metastases. The “nonpatient” was a radiation oncologist, who very much wanted to talk about his father, who has experienced essentially no morbidity from metastatic disease, but is virtually housebound due to the adverse effects of androgen deprivation.

The clinical backgrounds of these physicians varied widely and included major research figures who run urology departments and multidisciplinary prostate cancer research programs, and a couple of retired docs who now do consults in post offices and at condo meetings.

One urologist and radical prostatectomy survivor is a self-described “country doctor” who treats mostly indigent people in a small town, while another panelist was a medical oncologist who was very pleased that he — unlike a couple of colleagues — chose to have laparoscopic rather than open prostatectomy. Another urologist learned by phone during rounds on two post-op prostatectomy patients that he had a very low-grade tumor. In spite of his knowledge of the disease and the favorable prognosis in this situation, he wouldn’t buy clothes for six months after the diagnosis because he assumed he would soon die from the disease.

The group bonded relatively quickly and spent the day talking about the diagnosis, treatment — and in some cases, non-treatment — of prostate cancer, and how their perspectives changed after what was for all, a life-altering experience. The relatively unplanned and free-flowing discussion over about six hours was then edited into this special end-of-year issue.

I don’t know what else to say except, stick the tape or CD in your car and see what you think.

— Neil Love, MD
NLove@ResearchToPractice.net