•  Book Review: Hit Below the Belt •  Prostate Health Center

Prostate &Cancer: A Family Guide to Diagnosis, Treatment &Survival
By Sheldon Marks, M.D.
Fisher Books
343 pp $17.95

Men, Women, and Prostate Cancer: A Medical and Psychological Guide for Women and the Men They Love
By Barbara Rubin Wainrib, EdD, and Sandra Haber, PhD, with Jack Maguire
New Harbinger Publications
315 pp $15.95

One day you're striding manfully along, clinching deals and buying drinks. The next, it seems, you're near-naked in an examining room, silently enumerating the terrors emanating from your walnut-sized prostate gland.

Pain. Impotence. Incontinence. Death. Oh God, you think: Welcome to middle age.

For many middle-aged men, the mere mention of prostate cancer is far more uncomfortable than the poking around doctors do during the annual physicals the patients so grudgingly endure.

"Just lie on your side and raise your knees toward your chest," your doctor says, pulling on his latex glove for a digital how-de-do with your prostate. "There might be some mild discomfort here." Yes, indeed.

Some men can chatter on without shame about things as profoundly personal as the well-being of their prostate. But most don't. Many women earn headlines and raise millions of dollars in annual three-day treks for breast cancer. But there is no equivalent parade for the prostate. The bashfulness may fade as we Baby Boomers trudge through our fifties, but it will be quite a while before you see hordes of men marching through town in I-Survived-Prostate-Cancer T-shirts.

Such reticence makes good books about the disease all the more valuable. Prostate cancer is the second top cancer killer among men. Nearly 200,000 men are diagnosed yearly and a more than one in 10 will die of it. Almost all the rest will be dramatically affected in some way and will urgently need information and support.

Taken together, two recent books on prostate cancer speak clearly to both the head and the heart of prostate patients and their families. Prostate & Cancer is a thorough, easily understandable look at the disease as a medical problem, a physical condition requiring physical intervention. Men, Women, and Prostate Cancer grapples with the emotional problems that prostate cancer can trigger.

Dr. Sheldon Marks, a practicing urologist in Arizona, is struck by how little men know about their prostate, despite bursts of publicity about prostate cancer afflicting luminaries as diverse as Rudy Guiliani, Bob Dole, Michael Milken, and the late Frank Zappa.

"Most men have absolutely no idea what their prostate is or where it is located," he writes. "One of my patients was proud that he knew so much -- until he asked me what the prostate did for women and why women didn't have prostate problems." After 343 pages, no reader will wonder that again.

In an easy-to-follow question-and-answer format, Marks addresses hundreds of concerns that have been raised by his patients. Like too few physicians in face-to-face encounters, he gives readers the impression that every question is a good one: Does it matter if my urologist is younger or older? How soon can I ride my bike after radical prostatectomy? What can be done to treat hot flashes, a side effect of hormone therapy? (Yes, men can get them, too.)

Some of the questions are basic, but no less important to frightened patients. Q: "Can my wife catch cancer by having sex with me?" No, Marks states. "It is an internal problem of the cells in your prostate gland. It is not contagious." Other questions seem highly technical to the lay reader--"What should I do if I have PIN 3 identified on biopsies?" -- but, to a man who has been told he has a significant marker of prostate cancer, they're as urgent as a bedside phone ringing at 3 am.

Well-organized in 40 short chapters, Marks's step-by-step approach is particularly helpful as men consider options for treating their prostate cancer. If you have an inflamed appendix, medical science and common sense dictate just one treatment. By contrast, the menu of treatments for prostate cancer is long and confusing, with at least five main choices, including removal of the prostate, killing the cancer with radiation beams, or attacking it from within with implanted radioactive "seeds."

Unfortunately, each can pose life-altering risks, depending on factors like a patient's age and the severity of his tumor. One will increase the chances of at least temporary incontinence; another will raise the likelihood of impotence. Doing nothing can be the best treatment for men of a certain age -- but not all men, and not all the time. With Marks as a guide, those trade-offs will be just as wrenching but men might be more apt to feel that they've made the best of some tough choices.

However, you don't see urologists for help above the belt. Marks deals only superficially with the emotional consequences of cancer. A chapter called When All Treatments Fail offers helpful insights on the mechanics of kidney failure, but just two paragraphs answering the question, "How do I prepare for my death?" In another chapter, he gives just two-and-half scant pages to the role wives can play in helping their husbands through the crisis.

It's fortunate then, that Men, Women and Prostate Cancer takes a different tack. Its psychologist authors -- Barbara Rubin Wainrib and Sandra Haber -- speak primarily to those who care for the men suffering from prostate cancer. While the book delivers a useful medical overview, it explores more fully the plaintive question asked by wives, often in vain: How can I help?

The answers from Wainrib and Haber are far more specific than misty-eyed advice-column tidbits urging women to "just be there for him." Find your husband a support group. Build a caring team of friends and relatives. Keep a notebook of questions to ask the doctor. Know when hospital visits should end. Do the research. Do the reassurance. Do a hundred things to help healing along without slinging a single pill.

Many of their ideas are as grounded as a pair of sensible shoes. He needs a test? Maybe having it done at a clinic would be less expensive than at a private lab. He has an appointment with the urologist. Both of you should go, the authors advise. And don't feel embarrassed about bringing a tape recorder; even the best doctors can spout jargon so confusing that couples argue later about just what it was the high-priced specialist said. The two are candid in their discussions of post-prostate sex -- to many men, the most anxiety-provoking aspect of their disease. If their explicit descriptions of the mechanical aids available to men might not be the most erotic reading, try their "Beyond the Erection" list of 25 activities for adventurous couples. (Who wouldn't enjoy No. 22 --"frolicking naked or near-naked in a secluded outdoor spot?")

Their point, of course, isn't to titillate; it's to remind readers that -- despite the tests, the procedures, the agonizing uncertainties -- life will resume and it won't be half-bad. Some of the book's suggestions aren't for everyone. Not all men will want to chronicle their feelings in a journal, rating them on a one-to-five scale for intensity. Not all caregivers will appreciate take-care tips like "hug yourself" and "watch clouds sail across the sky." And it will take a particular kind of man -- an engineer, perhaps -- to make crucial decisions on treatment by listing his values on a grid and assigning a numerical weight to each.

But those are small points. The book's real strength is in helping couples accept the harsh realities that prostate cancer has so capriciously imposed on their relationship. Yes, the book reminds couples, we are vulnerable. But no, we don't have to deny ourselves a rich sensual life, to say no to intimacy, or to deaden ourselves to love.

-- Steve Chawkins is a columnist for the Los Angeles Times. He has been a reporter and editor at the Rocky Mountain News and has written for numerous other publications.

First published January 24, 2001
Last updated July 30, 2008
Copyright © 2001 Consumer Health Interactive

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