Prostate Cancer: A Family Consultation

Prostate Cancer: A Family Consultation

Reviewer: Kenneth Blank, MD Affiliations: Abramson Cancer Center of the University of Pennsylvania Posted Date: August 4, 1997

Authors: Philip Kantoff, MD and Malcolm McConnell Published by: Houghton Mifflin Co. Boston, MA 1996 ISBN: 0-395-71823-6 Price: $15.00 US

Prostate Cancer: A Family Consultation is authored by Dr. Philip Kantoff, Director of the genitourinary oncology program at the Dana-Farber Cancer Institute in Boston, and Malcolm McConnell. Dr. Kantoff's training as a medical oncologist places him in a unique position among physicians who commonly treat prostate cancer, as he neither performs surgery nor prescribes radiation, the two primary treatment modalities for early stage prostate cancer. Therefore, he writes, "you can consider me a neutral referee, a physician who represents the patients' interests," without bias towards radiation or surgery. Prostate Cancer: A Family Consultation is a well written, easy to read book that aims to provide answers to the commonly asked questions of patients with prostate cancer. This goal is partially accomplished.

The book begins by explaining in layman's terms the complex anatomy of the prostate glad: where it sits in the body, what function it performs, how it develops with age , and syndromes other than cancer that are common to the gland. Occasional black and white pictures and schematic diagrams complement the text. A small section of the book is devoted to explaining the molecular and cellular characteristics of cancer in general, with a focus on prostate cancer specifically. The heart of the book centers on treatment of prostate cancer. In this regard Prostate Cancer: A Family Consultation has many strengths but also a glaring weakness.

Among the books' strengths are its completeness. There are no treatment options left unexplored, and even discussions on fairly new concepts such as PSA velocity, PSA density and bound versus free PSA are included. Another strength is the books 'readability': many chapters are written in question and answer format, which may appeal to many readers who have similar questions to those posed by the authors. Another feature of the book which is particularly helpful to patients is recommended questions patients ought to ask their physicians regarding the work-up and treatment of prostate cancer.

The books' weakness lies in its strength; in attempting to simplify a confusing topic, Prostate Cancer: A Family Consultation shortchanges specific data and information. For example, in deciding between surgery and radiation as the primary treatment of early stage prostate cancer, the major side effects of each therapy are often the major determinants that influence this decision. As both surgery and radiation offer similar chances of cure, the side effects of these therapies must be carefully weighed. Prostate Cancer: A Family Consultation cites just one study on the risk of urinary incontinence and sexual function after radical prostatectomy versus external beam irradiation. The data from the study cited does not agree with other studies. Additionally, the data which is found in table form in appendix 1 is confusing to interpret. For example, it would appear that radical prostatectomy, a procedure whose main side effect is impotence, cured men of impotence, as the percent of men who had erections adequate for intercourse increased from 32% pre-therapy to 93% at 12 months after surgery?

The final three chapters of Prostate Cancer: A Family Consultation discuss metastatic prostate cancer and the role of hormonal therapy, chemotherapy and experimental approaches. The discussions are complete and invaluable for the patient whose cancer has spread outside the prostate gland area.

In summary, Prostate Cancer: A Family Consultation is a well written, easy to read book that will answer many questions faced by patients with early stage or advanced prostate cancer. However, a major shortcoming lies in the brief discussion of the side effects of radiation and surgery- an issue that is critical to early stage prostate patients when deciding which treatment modality to undergo.