When prostate cancer scare hits close to home

When Rabbi John Rosove of Temple Israel of Hollywood was diagnosed with prostate cancer in 2009, he was devastated. Given a dire prognosis by his first doctor (who later turned out to have exaggerated the circumstances), he felt the weight of his own mortality for the first time.

“I never really understood what it meant to be sick like that,” he said. “I felt as though I had been given a death sentence.”

Upon seeing a second physician, Rosove was given better news — his cancer was serious but treatable.

Rosove is now cancer-free, but in that split second he joined the estimated 240,890 men who are diagnosed with prostate cancer in the United States each year. Over the course of their lifetimes, approximately one in six men in the U.S. will be diagnosed with the disease.

More men are being diagnosed with the disease while it’s still in the early stages, said Dr. J. Kellogg Parsons, a urologic oncologist at UC San Diego Moores Cancer Center.

“More people are getting tested, and there is more awareness among the public,” he said. “Men with cancer have always been reluctant to talk about it, and I see a change in that over the last five to 10 years. That, in turn, often affects screening.”

That screening generally involves a blood test called a prostate-specific antigen (PSA) test. The test is performed by drawing blood, and if PSA levels are high, a doctor may recommend a biopsy to see if cancer is present.

While commonly administered, the PSA test has generated a great deal of controversy recently. Because prostate cancer can be so slow-growing that a man’s natural course of life may outpace it, some medical experts believe that the test — and the subsequent treatment — might do more harm than good. Others who are in favor of the test say that it prevents death in men who have a disease that will spread quickly. 

Even major health organizations are divided on the issue: In October of this year, the U.S. Preventive Services Task Force issued a draft recommendation that men who don’t show symptoms of prostate cancer not be given the PSA test. But the American Urological Association recommends that it be offered to men who are 40 and older and who have a life expectancy of at least 10 years. 

“It’s imperfect,” Parsons said of the PSA test, “but the fundamentally important thing is that it is the best test for detecting the more aggressive cancers while they can still be treated and cured.”

The course of treatment for prostate cancer depends greatly on the individual, said Dr. Timothy Wilson, the chief of the Division of Urology & Urologic Oncology at City of Hope. A unique aspect of prostate cancer treatment, though, is that because it can be so markedly slow to progress in some men, doctors generally begin by assessing whether the cancer requires immediate treatment or just needs to be monitored.

“What we are trying to predict is what the cancer will do over time,” he said, “and how it may impact that gentleman’s life in terms of local symptoms, and when we think it might spread.”

Not surprisingly, some patients take more keenly to the notion of monitoring than others. Certain men who are diagnosed with prostate cancer may be happy not to have to undergo treatment, but rather to get regular PSA tests every three to four months, and biopsies every year.

But for others, the notion of having cancer in their body is more than they care to contemplate every day.

“Just the concept bothers the hell out of them,” said Wilson, who also serves as the director of City of Hope’s Prostate Cancer Program. “They want to have treatment because they just want to be done with it.”

Treatment generally involves either surgery or radiation, and, Wilson notes, both can be equally effective.

A rapidly emerging trend is the use of robotic-assisted surgery, in which the surgeon employs remotely controlled mechanical arms that have a broad range of highly precise movement to operate on the patient’s cancer. Parsons estimates that 60 percent of prostate cancer patients who undergo surgery have robotic-assisted treatment.

Not all patients are candidates for robotic-assisted surgery, he said, but for those who are, the results can be excellent. “A person will generally spend less time in hospital, they have less pain after surgery, and they are back to their normal activities more quickly.”

Survival rates for prostate cancer have improved over the past 13 years. According to the Centers for Disease Control and Prevention, 29,093 men died from prostate cancer in 2007, which demonstrates a decrease of about 3.9 percent each year from 1998.

But, Rosove said, we still have a long way to go in accepting those in our community who are dealing with the disease, and helping them through their illness.

“For men, there is an embarrassment about prostate cancer because of where it’s located,” he said. And for those who work in the entertainment industry, the pressure to be brimming with youth and vigor can cause some with the disease to suffer in silence.

When he was sick, he said, a number of men working in Hollywood confided that they, too, had prostate cancer but were terrified their colleagues would find out.

“They were afraid that they would be seen as sick and damaged, and they would be rejected,” he said. “To have to go through this in secret is a tragedy.”

During his own illness, Rosove said, his faith was never shaken, but rather, made stronger by the ordeal.

“I don’t have this childlike view that if something bad happens to you, God did it, or, ‘Why didn’t God stop it?’ We are human beings, and we get sick,” he said. “Did you expect to live forever?”

Soul Care

I recently visited a hospital patient, an elderly gentleman with a name, a gaze and a life story from the old country. His deterioration had advanced to the stage of inhibiting verbal communication, so he spoke to me instead through gestures, nods and stares. But slowly, we drew closer. We shared sorrow, distress and worry. Eventually, exhausted, he told me he wanted to get some rest. I recited the “Shema” for him, and he closed his eyes in fatigue.

When a person is sick, the medical profession cares for the body with medicines, surgeries, therapy and machines. But who cares for the soul? And how? Each one of us has witnessed illness. We’ve been tortured as we’ve watched illness or injury diminish the vitality of loved ones. We’ve sat by helplessly, wanting to help, bereft of miracles.

What tools of the spirit do we have to apply toward healing?

To this question, our tradition offers two types of answers.

First, we learn to take action — to aid the healing by attendance. We go to the sick person and sit at the bedside, offering the best get-well gift we have: presence. Jewish tradition calls this healing art bikkur cholim, visiting the sick. The rabbis of the Talmud discussed the life-giving power of human contact: “He who visits the sick causes him to live. But he who does not visit the sick causes him to die.” We intuitively understand this wisdom: physical life and death are not in our hands. But our decision to be present — or to be absent — might mean the difference between spiritual life and death, between hope and despair, between glimmers of light and shrouds of darkness for the one in the sickbed.

Bikkur cholim is so significant that scholars throughout the ages have written of it as a legal obligation, complete with dos and don’ts. Moses Maimonides, the great medieval codifier of Jewish law, outlined the details: for example, everyone, regardless of status, must visit the ill; visits should only begin after the third day of an illness and only in the middle part of the day; and the visitor should not sit in a place that forces the patient to adjust his or her head to view the visitor.

Why such careful, almost rigid details? Because we know the spiritual power of physical presence. And we want to make it positive, effective, healthy.

But there is another spiritual tool available to us: we learn to ask God for help. We seek healing through prayer. Instead of turning toward the patient, we turn to the Divine. The Psalms are filled with passionate, emotional models of prayer, words we might ourselves have spoken in our own moments of desperation: “My eyes deteriorate from this illness. I call to You, God, every day. I stretch out my hands to You (Psalms 88).” Prayer expresses pain; it voices our pleas for help. Prayer beseeches God for divine intervention, particularly when human intervention appears to be failing. We have all reached that point. We have turned not only outward, but also upward.

There is an afflicted and distressed sick woman in this week’s Torah portion. It is Miriam, the sister of Moses and Aaron. Her illness is terrible; it is debilitating, dangerous and terrifying. And Moses, in his shock and pain, offers us a third Jewish response when witnessing a sickness: he looks toward heaven and simply screams. Moses expresses himself in five simple words: “Please God, please heal her.” No long-term planning, no eloquent speeches, no philosophizing. He gives voice to his own distress. At that moment, Moses is us — the caregiver — in sickroom desperation, searching body and soul for a lifeline.

The Talmud tells of Rabbi Yochanan, who had magical, healing hands. He too was a caregiver. But when the rabbi himself became ill, his hands were of no help. “The prisoner,” the Talmud explains, “cannot free himself from prison.” As I learned in that hospital room and as we learn from Miriam and Moses, healing comes from extending our hands — and spirits — to each other and to God, and from asking for the healing hands of others in our own hours of need.

Life and Death with Morrie

Mitch Albom,highly decorated sportswriter for the Detroit Free Press, has probedevery subject from Dennis Rodman to Latrell Sprewell. Yet hisbest-selling book, “Tuesdays with Morrie: An Old Man, A Young Man,and Life’s Great Lessons,” finds him tackling an even more demandingsubject: death.

Watching “Nightline” one evening, Albom wasstunned to discover that his former Brandeis University professor,Morrie Schwartz — with whom Albom shared a close relationship as astudent in the 1970s — is the topic of conversation. Schwartz wasdying of Lou Gehrig’s disease (amyotrophic lateral sclerosis).

Keeping a vow he had made 18 years prior to thethen-60-year-old sociology professor, Albom decided to visit the oldman in his suburban Boston home one Tuesday afternoon. Every Tuesdaythereafter — a total of 14 — became set aside for Morrie and Albomto meet together — talking, laughing, living.

Those meetings became their “last class together,”with the book being Albom’s final thesis — and tribute — to hisfallen professor.

“I didn’t want it to be a death book. I wanted itto be a life book,” said Albom, who was in Los Angeles last month fora speaking engagement at Sinai Temple. “So, every time I felt myselfgetting sad, I would steer away from that.”

With Morrie dispensing his wisdom on life — anddeath — and Albom providing the warm comfort of an open ear, the twodeveloped a kindred spirit of sorts.

Albom, who, at the impressionable age of 20, hadto watch his uncle die, said that he was “stupid about death” at thetime, refusing to ask his dying uncle the types of questions thatweighed on his mind lest he become too close to a man who would soonbe leaving him.

With Morrie, things would be different.

“It was hard to go every week and watch somebodydie, but I looked forward to it,” said Albom, who admits that he feltjaded and confused about his career — and his life — beforereuniting with Morrie. “It was hard, but it was great that we wereable to talk up until the end, and I could ask all the questions Iever had about death.”

What did he feel about dying? Was he scared? Wouldhe do anything differently, given the chance? (“No, nothing. I lovedmy life — and my death,” answered Morrie, who was, by then,bedridden.) What’s it like waking up, knowing in a week or two, youwon’t?

In time, all his questions would be answered.Albom decided to make the last 14 weeks of Morrie’s life (“Coach,” hecalled him) their last class together. The book, an account of theirmeetings together, was initially written (a joint decision by Morrieand Albom) to defray some of the mounting medical costs that Morriefeared would leave his family encumbered after his death.

After Morrie’s death, however, the book, whichAlbom finished in nine months, bore new meaning for its author. Thementor’s final wish was that the young sports journalist visit him atthe cemetery “to talk.” Incredulous, Albom asked how he could hold aconversation with somebody who was, well, dead.

“You talk, I’ll listen,” said Morrie.

“And that is the essence of the book,” said Albom,who, since rediscovering Morrie, has rebuilt relationships withbrothers and sisters with whom he had lost touch. (His youngerbrother, stricken with brain cancer seven years ago, lives in Spain,and Albom recently visited him after not seeing each other for overfive years.) “If you lead your life as he did — with people, makingmemories with people — then when you’re gone, you’re not completelygone, because you spent your time while you were here putting yourvoice into their lives.”

Never particularly religious, Albom finds himselfgoing to synagogue nowadays, helping with charity benefits and doingthe sorts of things that, before meeting Morrie, he would have deemeda waste of time: “Work. Work. Work. It’s all I did.” Now, Judaism hasa renewed influence on Albom, who, along with wife Janine, lives inMichigan. He said that he now savors his newfound connection to hiscultural background.

“I don’t worry about things so much anymore,” hesaid. “Work isn’t nearly as important as it used to be, because I’mspending more time with my family. Morrie taught me, taught us all,the beauty of life and the dignity of death. I’ll always rememberthat. In fact, for the very first time, me and my wife are trying tohave children.”

Avi Lidgi is a free-lance writer in LosAngeles