A: For some guys it's very important to them. Or incontinence, or dribbling afterward. Or even if the surgery goes well, some things could go wrong. The surgeries on the whole carry about a 30% impotency rate, even in the best of hands. A lot of guys think they won't get impotence from radiation, but about 80% of them get impotent years later. And radiation can also irritate the bladder and can also irritate the rectum . . . so there's a lot of gray areas. That's why when I have a patient and I present prostate cancer screening to them, I present all the facts up ahead. I say, "Nobody knows exactly what to do." It's an ongoing area of research, but the older my patients are — let's say they're between 70 and 75 and there's other things wrong with them — I say prostate cancer screening is available, but if we find it you probably won't live long enough to die from it. Maybe we shouldn't even do it.
Q&A: Charles Holzner
Q: Why does the idea of living with cancer, although it may not be a serious threat, bother some patients to the point of insisting on operation?
A: A lot of it depends on culture. A lot of times their family members want them to get treated. Like my brother, he was perfectly OK with maybe not even getting treated because he was 65, but his wife couldn't live with the idea that he had prostate cancer, so she sort of talked him into it.
Q: How's he doing now?
A: He's doing fine. He had surgery. He doesn't know whether he's going to have complications until later. So I guess I had the personal experience of him asking me what I would do.
Q: What did you say?
A: I'm sort of against most treatments for prostate cancer because I'm not convinced that any treatment makes you live longer right now, unless you're kind of young, like under 60. But let's say you get to between 60 and 65, I'm not sure the evidence is good enough that treatment is all that beneficial. In Europe, they're much more conservative with treatment. Also, these treatments for prostate cancer are very expensive. Like radiation treatment costs on the order of $25,000 to $30,000.
Q: You've conducted thousands of screenings: Do negative representations in movies of latex gloves and prostate exams ever cause problems with you and patients?
A: Usually the screening involves a blood test and a quick rectal digital exam, which usually I save to the end of the physical. I go, "Now comes the fun part."
Q: What are your patients' reactions?
A: Most guys take it OK because you just stick a finger up there and see if you feel any nodule. And also at the same time you do a test for colon cancer, which is much more serious, in terms of much more efficacious for treatment, so I do a two for one.
ZAIN SHAUK covers business and politics. He may be reached at (818) 637-3238 or by e-mail at zain.shauk@latimes.com.
