On the cutting edge
Blaise Schweitzer, Freeman staff

July 14, 2002

A leading prostate cancer surgeon will talk about his nerve-sparing radical prostatectomies and other treatment options at a Kingston Man-to-Man meeting.

Buying a coffee maker based on a sports celebrity's recommendation is fine, but when it comes to choosing a doctor to treat prostate cancer, it is smarter to investigate the physician's success rates and track record.

Dr. William Catalona, a prostate cancer surgeon with both celebrity endorsements and some of the best post-surgical success rates in the world, is coming to Hurley, 4:30 p.m. Tuesday, to talk about his specialty at the Hurley Reformed Church Hall.

Catalona, who is both a surgeon and a cancer researcher at Washington University School of Medicine in St. Louis, Mo., plans to focus on nerve-sparing radical prostatectomies and other treatments in a public talk hosted by the Kingston chapter of Man-to-Man, a national organization dedicated to educating its members about prostate cancer treatments and survival skills.

Other than death, prostate cancer patients face the possibility of impotence and incontinence, something that Catalona said men have never been good at talking about. The good news is advances in blood tests are reducing the importance of the digital rectal exam that uses a doctor's finger as the primary screening tool.

"Most men don't want anything to do with a digital exam," Catalona said.

Catalona has received a lot of credit for helping prove the blood screening, known as a prostate-specific antigen test, as an effective screening tool. He lead trial studies of the test for the Federal Drug Administration, helping bring it to the general public in the late 1980s. Additional work by Catalolna has helped refine PSA testing even further, making it possible to reduce the numbers of unnecessary biopsies patients must endure.

More men would survive prostate cancer if they had a PSA test regularly after turning 50, or even earlier if the patient is considered a high risk for prostate cancer, such as African Americans or men with family histories of the disease, Catalona said.

Catalona has had help getting out his message, lately, from the likes of Bob Dole, and baseball greats Joe Torre, Bob Watson and Stan Musial.

Torre, Watson and Musial have all been treated by Catalona. And although Catalona didn't treat Dole, the former senator and presidential candidate has embraced Catalona for his work getting the PSA exam established.

"He said 'it saved my life,' " said Catalona, recalling a surprise telephone call from Dole in 1992.

Dole later gave Catalona a tour of the Capitol in Washington, introducing him to many legislators who have had the disease or are recovering from treatment. Catalona said Dole told him that 10 percent of congressmen have personal dealings with the disease.

After Dole went public with his own prostate cancer story - showing an uncharacteristic sense of humor in commercials for Viagra - the former Kansas senator received some 750,000 letters, many from people who decided to be tested for the cancer after having heard Dole's story.

Although celebrities often have handlers who make for tense exchanges, Catalona said the famous people have, themselves, been "a delight" get along with.

He has also enjoyed meeting with groups like Man-to-Man, and he features a transcript of one similar talk before a Syracuse chapter of the group on his website. Enlightenment can travel in more than one direction, Catalona said.

"I find them to be very knowledgeable," he said of men in such groups.

Man-to-Man members also excel at cutting through the confusing facts and dense lingo surrounding complicated cancer treatments, Catalona said.

When he meets with the public, Catalona said he is frequently asked about the difficulty patients have in choosing not only treatment options, but the doctors who would best perform procedures. It isn't possible for every prostate cancer patient to get appointments with surgeons of Catalona's caliber, so how can they sort through the doctors they do have access to?

"It's a hard issue," Catalona said.

In a Wall Street Journal article, last month, Catalona was celebrated as one of the six surgeons with the best success rates in performing a technique called nerve-sparing radical prostatectomy. Catalona has performed the procedure 3,200 times, more than any other doctor in the United States.

"The more you do something, the more you learn and the better you get at it," he said.

While incontinence and impotence are common side effects of prostate cancer treatments, only 8 percent of Catalona's radical prostatectomy patients have incontinence and only 22 percent have difficulty performing sexually. Some of them had erectile dysfunction even before the surgery, however.

By comparison, national surveys found that more than half the prostate cancer surgery patients were incontinent, impotent or both a year after their operations.

Catalona said statistics should be judged carefully, as doctors use varying standards to consider what even "incontinent" means. When calculating his own success rates, he equates any urine leakage with incontinence, for example, while other doctors allow for a looser definition.

And when it comes to rates of impotency, some doctors prefer to operate on only young, sexually active patients, skewing their outcome numbers to the good, Catalona said.

For those who can't afford to fly across the country to see the nation's top doctors when they are diagnosed with prostate cancer or any other serious disease, Catalona suggested a little research.

Favoring doctors who have treated the most patients with similar symptoms and then doing a little telephoning and e-mailing can weed out the weakest contenders.

"Ask the doctor to provide the names and phone numbers of 10 patients he has operated on," Catalona said.

©Daily Freeman 2002