Joe Torre on Prostate Cancer

On Baseball

Torre’s Gift to All Fathers: Frank Talk About Prostate Cancer

By GEORGE VECSEY

Published: May 28, 2011

When Joe Torre was managing, he used to receive suggestions from fans about lineups and rotations and, most helpful of all, how to handle the Boss. As if.

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Elise Amendola/ Associated Press

Joe Torre learned he had prostate cancer in 1999, one year after leading the Yankees to a total of 125 victories.

Now that he is working for Major League Baseball, Torre occasionally receives news from strangers that they have something in common: they have survived prostate cancer.
“All of a sudden, we’re in the same club,” he said.
Torre has been out front in fighting this surreptitious disease since his bout with it early in 1999. One hundred twenty-five victories the year before meant nothing at that moment. The only number that counted was that his P.S.A., the marker for cancer, had nearly doubled in one year.
Instead of choosing between the lefty and the righty in the bullpen, Torre had to choose between conservative and aggressive treatment. He opted for surgery. Now he is 70 years old and working in the commissioner’s office and enjoying his family, and spreading the news about prostate cancer, which strikes one in six men, in the gland between the bladder and the rectum.
Torre is putting himself in public, serving as a judge in a Father’s Day contest, MVP Dad, held by Major League Baseball. Through Wednesday, fans may nominate their fathers on a Web site, MLB.com/mvpdad. Thirty fathers, one per franchise, will be honored around June 19; Torre will visit four ballparks in the preceding days — Coors Field, Yankee Stadium, Nationals Park and Wrigley Field. Current stars will also publicize the cause, and a charity home run challenge will be held in June.
“My father wasn’t the best role model to me,” Torre said, alluding to the abuse his father directed at his family, the motivation for the Safe at Home Foundation, which combats domestic violence.
Father’s Day is the perfect time to remember the love and guidance fathers can give — but it works both ways. Children can also urge their fathers to seek annual checkups for prostate cancer, the way many of them lecture their parents about smoking or bad diets.
“Kids are much more intuitive these days,” Torre said in a telephone interview. “Not that I’m crazy about what’s on TV, but they know so much these days.”
Torre was 58 when a routine checkup revealed he had prostate cancer. His daughter, Andrea Rae, was 3. “I wanted to be around for her,” he said.
His wife, Ali, was part of the process, which Torre says is vital, to have somebody close sharing the details and the fears. He often refers to his wife in conversation, as if her counsel was helping him hold a news conference, say the right thing, and maybe it is.
Then there is the army out there, the men who have faced the chilling diagnosis, the options for treatment. Some men cannot talk about it; others share their experience.
Just like checking the batteries on a smoke detector when moving the clocks two times a year, Father’s Day is a good time to remind men of a certain age. Torre praises Michael Milken, the founder of the Prostate Cancer Foundation, for taking some of the mystery from this common disease.
After a few months off for surgery in 1999, Torre helped the Yankees win two more World Series, then moved to Los Angeles after 2007, when the Yankees let him know it was time. Last September, he turned the job over to Don Mattingly.
“The price for losing wasn’t worth it,” Torre said. He recalled going to spring training this year and saying to Mattingly, “How do you feel about this managing stuff now?” Mattingly, still on the learning curve, is engrossed. Torre said he was sad to watch M.L.B. take over the strapped team.
“It’s a shame,” Torre said. “I go back with that club to growing up in Brooklyn.”
He was a Giants fan, but he understands the history. He also watches his previous club, the Yankees, in their first full season since the death of George Steinbrenner last July.
“Let’s admit it, George cast a very large shadow,” Torre said. He gets a kick when fans say this event or that event would not have happened if the Boss had been running the club, as if things always ran smoothly back in George’s day.
Torre’s main responsibility is overseeing the umpires. He says he feels for them, when modern technology suggests they have made a mistake. He says he can see technology deciding fair from foul one of these seasons, adding to the current use of cameras to determine whether a ball went over a home run line. But he does not see the day when technology decides balls and strikes, or plays at the bases.
“It’s an imperfect sport,” he said, adding quickly that umpires were very, very good.
Ultimately, it is a sport, however combative and expensive — not to be confused with real life, which is children urging their fathers to get a checkup.

Prostate Treatment Matrix

It has become abundantly clear to me that there is no "one size fits all" when it comes to deciding the best procedure for treating prostate cancer.  There are too many variables and too many ifs, ands and buts.  I found that I always placed the procedure that I read about last on the bottom of my preferred list because of all the disadvantages.  In order to place some logic in choosing the right procedure for me I decided to create a matrix.

The first thing I had to do was create a list of all the reasonable options I have available.  I am sure I could come up with a list of about twenty options because of all the choices I have within a specific procedure and even the possibility of combining different procedures.  I ended up listing six procedures.   The next thing I did was create a list of  concerns with each procedure and assign a weight for each of these concerns.  For me the most important concern was "what are the chances that this will eliminate all of the cancer cells".  Because this was the most important factor I assigned this a weight of 10.  At the other end I listed external scars as a concern.  Because this is not that important to me I assigned this a weight of 2.

The last thing I did was to rate each of the concerns against all of the options with an input number.  For instance, since a radical prostatatectomy will leave a fairly significant scar around my midsection I gave it an input number of 2.  Robotic surgery will leave small incisions around my midsection I gave it an input number of 6.  This is the most subjective part of this exercise.  I think ranking the concern for each procedure is pretty straightforward but whether an input number should be a 5 or a 6 can always be debated.

				Input
Weight	Concern
		A	B	C	D	E	F
10	Odds of 100% Cancer Removal	8	8	7	7	7	0
8	Minimum Collateral Damage	7	6	4	5	5	10
2	External Scars	6	2	8	8	10	10
7	Leaves other options open	7	7	3	4	7	10

Procedures

A	Robotic Surgery
B	Radical Prostatectomy
C	External Beam Radiation
D	Seed Implantation
E	Cryotherapy
F	Watchful Waiting

Once all of the input data has been entered I simply multiplied the input data by the weight to calculate a number for each concern for each procedure.  I then simply added these numbers together to arrive at a total score for each procedure.

As you can see from the table below the robotic surgery came out with the highest number which means it appears to be the best option for me.  I am sure that some of my input numbers will change as I learn more about each procedure.  I also suspect that I will add one or two concerns over time but I think this is a good starting point.  My sessions with the specialists in each of the procedures will certainly help me refine my matrix.  I am scheduled to have all of these consultations complete by the first week of July.  After that date the ball will be firmly in my court and I will have a big decision to make.

If anyone has any ideas on how to improve my analysis I would love to hear from you!

				Score
Weight	Concern	A	B	C	D	E	F
10	Odds of 100% Cancer Removal	80	80	70	70	70	0
8	Minimum Collateral Damage	56	48	32	40	40	80
2	External Scars	12	4	16	16	20	20
7	Leaves other options open	49	49	21	28	49	70
	Total	197	181	139	154	179	170

The Test Results

May 25, 2011


Today (5/24/2011) I had the results of all of my screening tests reviewed and to quote Ginny; "we couldn't have asked for better results.  All of the test results indicate that my prostate cancer has not spread to other parts of my body.  This means that my cancer can be treated by focusing only on the prostate.  I should point out as I have painfully learned that there are no "guarantees" in this business of dealing with cancer.  It is possible that some renegade cells are hiding inside of my body and only waiting for the opportunity to wreck havoc at some future date. 

Given these results the task now is to decide on the best option to fight the cancer.  My options are as follows:

1. Radical Prostatectomy:  This is an operation that essentially removes the entire prostate gland, both seminal vesticles (small glands behind the bladder that produce most of the semen) and a portion of both vas deferens (tubes that transport the sperm from the testicles to the urethra).  This is a major surgery and will require 2 to 3 nights in the hospital and full recovery will take anywhere from 4 to 8 weeks.

2. Radiation Therapy:  There are essentially two types of radiation treatment.  The first is external beam radiation where a machine delivers radiation in brief sessions to the cancer cells.  The treatment usually takes 40 sessions.  This means that you have to make a trip to the hospital for 5 days a week for about 8 weeks.  The second type is radioactive seed therapy.  With this procedure radioactive seeds are inserted into the cancerous area of the prostate and over a period of days or weeks the radiation is emitted from the seeds and attacks the cancer cells.

3.  Cryotherapy:  With this procedure a probe is inserted into the prostate and something like liquid nitrogen is used to freeze, thaw, refreeze and thaw the cancerous cells to kill them. This is one of the newer treatments for prostate cancer and the results have been promising with some patients but the long term effects of this procedure are still being developed.

4. Watchful Waiting:  This is exactly what the name implies.  I would essentially do nothing but watch my PSA scores and have periodic biopsies taken of the prostate to see if anything changes.   This may be an option if  I were 80 years old but at 65 it isn't an option that I am considering.

5. There are other options such as hormonal therapy, chemotherapy and investigational therapy (clinical trials)  that probably are not appropriate for me.

During the month of June I will have consultations with doctors who are experts in the first three options.  My intent at this time is to make a decision either in late June or early July and have the procedure as soon as possible after I have made my decision.

I should point out that none of these options are to be taken lightly.  They all have potentially serious side effects and as I stated earlier there are no guarantees that any of the procedures will kill all of the cancer cells.  Also, some of the options preclude the use of other options should the cancer flare up again.  For instance if I elect external beam radiation I probably will not be able to have surgery to remove my prostate at some future date.  No simple solutions and no guarantees.  This is serious business.

At this point I feel it is appropriate to mention a few people who have been very important in helping me deal with my prostate cancer and  giving me guidance and comfort through this challenging journey.  The first is my urologist Dr Michael Del Terzo.  He has been very open, informative and supportive since the beginning.  I couldn't have asked for more.  I am very lucky to have him on my team.
 
Second is our neighbor and good friend Liz (Korman) Bond.  Liz is a dietitian with Lancaster General Hospital who works with cancer patients.  Liz knows a lot about my cancer and she is well connected with the key specialists who work with prostate cancer.  Liz was able to get me signed up with a couple of doctors who are among the best in treating prostate cancer in their specialities.

Finally of course there is my wife Ginny.  Always by my side and always looking out for my best interests.  Sometimes I ask myself; "how was I so lucky to find a mate like this?"  As you can imagine, I am not always the best of patients but Ginny is always there.  I hope I can give her the same kind of care should she ever need me.

Now its off to China and a wonderful trip with my wife!

China Trip

We leave on May 31, 2011

Currently it is 7:50 AM in Lancaster PA and the current time in Shanghai is 7:50 PM.  That means in order to determine the current time in Shanghai, add 12 hours to east coast time.  Or conversely if  we are giving the time in Shanghai, deduct 12 hours to determine the time on the east coast.

May 31, 2011   Depart Baltimore to Toronto, Toronto non Stop to Shanghai.
June 1 - Shanghai
June 2 - Shanghai
June 3 - Fly from Shanghai to Wuhan, board ship for river cruise
June 4 - Yangtze River
June 5 - Yangtze River
June 6 - Yangtze River
June 7 - Yangtze River
June 8 - Disembark ship in Chongqing fly to Xian
June 9 - Spend day in Xian and fly to Beijing
June 10 - Beijing
June 11 - Beijing
June 12 - Beijing and fly to Toronto and then to Baltimore
June 13 - arrive home

Gerry's Prostate Cancer Journey

I guess I always knew there was a high probability that some day I would hear the dreaded words; "you have prostate cancer".  After all my father had prostate cancer and there was a history of prostate cancer on my mothers side as well.  I do try to eat reasonably healthy foods, I have stayed physically fit and I thought maybe I could beat the odds.  But no such luck.  This week I received the results of the prostate biopsy I had last week and there it was:  "Cancer"!!

It wasn't as bad as it could have been, the cancer only showed up on two the the twelve samples taken from my prostate and based on the  Gleason Grading System ( see below) of measuring the cancer I had a score of 7 which placed me in the middle in terms of aggressiveness.  My scores were 4 - 3 from one sample and 3 - 4 from the other sample.

Gleason Grading System

Gleason grade Lower grades are associated with small, closely packed glands. Cells spread out and lose glandular architecture as grade increases. Gleason score is calculated from grade as described in the text.

The Gleason Grading system is used to help evaluate the prognosis of men with prostate cancer. Together with other parameters, it is incorporated into a strategy of prostate cancer staging which predicts prognosis and helps guide therapy. A Gleason score is given to prostate cancer based upon its microscopic appearance.^[1] Cancers with a higher Gleason score are more aggressive and have a worse prognosis.

The pathologist assigns a grade to the most common tumor pattern, and a second grade to the next most common tumor pattern. The two grades are added together to get a Gleason Score. For example, if the most common tumor pattern was grade 3, and the next most common tumor pattern was grade 4, the Gleason Score would be 3+4 = 7. The Gleason Grade is also known as the Gleason Pattern, and the Gleason Score is also known as the Gleason Sum. The Gleason Grade or Gleason Pattern ranges from 1 to 5, with 5 having the worst prognosis. The Gleason Score ranges from 2 to 10, with 10 having the worst prognosis. For Gleason Score 7, a Gleason 4+3 is a more aggressive cancer than a Gleason 3+4. Also, there is not really any difference between the aggressiveness of a Gleason Score 9 or 10 tumor.

How do you know that you may have prostate cancer?

The realty is that if you are a man and you still have your prostate the odds are pretty high that if you live long enough you will get prostate cancer.   For most men the likely-hood of having prostate cancer before you are 40 is pretty low.  After you reach the age of 40 the odds of having prostate cancer increase with each passing year.  As for myself, I never had any problems with my prostate.  My MOJO is still working pretty well.  While I wouldn't rate myself as a Don Juan, I haven't had any complaints from my wife.  Like most men, for the past 5 to 10 years I do tend to get up once or twice during the night to urinate.  I think trying to find a 65 year old man who doesn't get up at least once during the night is like looking for the proverbial needle in a haystack.  My doctor would also perform a digital examination of my prostate (that's where the doctor sticks his finger up your ass and feels for an enlarged prostate or lumps).  Theses examinations have always been very good.  The bottom line is that I didn't have any physical issues that would cause me to believe that I may have prostate cancer.

About 15 years ago I began having blood tests done that would check my cholesterol, as well a a number of other factors.  One of the tests done was the PSA.  A PSA number between 1 and 4 is considered good and there is no need for concern.  My original PSA scores were between 1 and 2 so there was never any indication that I had a problem with my prostate.  In 2007 my PSA started to climb and by 2009 it was at 3.8.  In December of 2010 my PSA was at 7.0 and my doctor decided it was time to "take a closer look at the prostate".

  Ginny and I were spending February and March in Florida so there wasn't much that we were going to get accomplished before we got back.  I did have a meeting with a urologist in Lancaster in January and he suggested that I schedule another blood test when we returned from Florida to check the PSA.  On April 5, 2011 I had a blood test and the PSA number was 6.8.  My urologist determined that there was enough concern on his part that it was time to do a biopsy on the prostate .  So we scheduled to have the biopsy done on May 3.

My word of recommendation is that if you are a male over 40 years of age have your PSA checked at least once a year.  Many times the PSA will give a false positive but at the present time there really isn't a better test to monitor the health of the prostate.

Prostate-specific antigen (PSA) is a protein produced by the cells of the prostate gland. PSA is present in small quantities in the serum of men with healthy prostates, but is often elevated in the presence of prostate cancer and in other prostate disorders. A blood test to measure PSApositive predictive value of only about 35%.^[1][2][3]

Rising levels of PSA over time are associated with both localized and metastatic prostate cancer (CaP).

The Prostate Biopsy

The procedure for taking a prostate biopsy is very similar to a colonoscopy.  You can't eat after midnight the day before the procedure and you can't take any blood thinners or similar medication one week before the procedure.  You are also required to begin taking antibiotics the day before the procedure to fight any infection.  The procedure itself is pretty uneventful and only takes about 15 minutes.  I elected to be totally out during the actual procedure.  I did this for a number of reasons.  The obvious reason is that you don't feel any pain.  I also felt that if I were awake I may make some sudden movement which could cause some problems.  Lastly I didn't want to distract the surgeon by asking a lot of annoying questions.  The reality is that there wasn't much I could contribute to the whole thing so why not take a nice nap?  If you insist, you can be awake during the biopsy and I understand that there are some people that elect this option.

I must have been out for about a half hour and when I awoke in the recovery room I felt a little groggy at first but quickly recovered.  I felt no pain at all and was up and walking within 15 minutes.  I did feel a little discomfort the afternoon of the biopsy but never experienced any real pain.  My urine was a bit darker for about a week after the procedure and I assumed that it was from blood.  The only other side effect I had was some discomfort around my anus.  If the doctors intent was to give me a good case of  hemorrhoids he didn't succeed but he came awfully close.  Within two weeks everything was pretty much back to normal.

Prostate biopsy is a procedure in which small samples are removed from a man's prostate gland to be tested for the presence of cancer. It is typically performed when the scores from a PSA blood test rise to a level that is associated with the possible presence of prostate cancer.

The procedure, usually an outpatient procedure, requires a local anesthetic, with fifty-five percent of men reporting discomfort during the biopsy.^[1] The most frequent complication of the procedure is bleeding in the urine for several days, some bleeding in the stool for several days, and blood in the ejaculate for several weeks afterwards.

The procedure may be performed transrectally, through the urethra or through the perineum. The most common procedure is transrectal, and may be done with tactile finger guidance,^[2] or, more commonly and precisely, with ultrasound guidance.^[3]

About a dozen samples are taken from the prostate gland through a thin needle - about six from each side. If the procedure is performed transrectally, antibiotics are prescribed to prevent infection. An enema may also be prescribed for the morning of the procedure. In both the transrectal and the transperineal procedure, the doctor inserts an ultrasound probe into the rectum to help guide the biopsy needles. A local anesthetic is then administered into the tissue around the prostate, similar to the local anesthetic administered for a dental procedure. A spring-loaded prostate tissue collection needle is then inserted into the prostate, through the rectum (or more rarely through the perineum), about a dozen times. It makes a clicking sound, and there may be considerable discomfort.^[3]

Okay, you have prostrate cancer now what?

Well, the first thing that needs to be determined is; "has the cancer spread to other parts of the body?"  In order to determine this I have been scheduled to undergo the following procedures:

Ultra sound of the kidneys and bladder
Additional blood work
Chest  x-ray
bone scan

I had the ultra sound on the kidneys and bladder yesterday (5/17/2011) and "no irregularities were observed".  I also had a blood sample taken yesterday and they will be looking for cancer markers.  I will have the results next week.  Both of these procedures were very easy and uneventful except for a little incident during the drawing of my blood.  I went to a blood clinic at the health center on Harrisburg Pike and it is a real blood sucking factory.  There must have been at least 20 people in chairs having their blood samples taken.  My phlebotomist whose name was Grey was getting ready to take my blood when I heard an announcement; "Grey we have an emergency at station 6".  With that Grey took off to station 6 leaving me in the lurch.  I happened to have a clear view of station 6 and I observed a teenage girl who was having her blood taken and she threw up all over the station.  They had a real mess to clean up. About 10 minutes later Grey came back to my station and I asked her; "did you wash your hands?"  She assured me that she had and she asked me if I was a puker.  I told her that depended totally on how well she did her job.  Fortunately Grey is a very proficient phlebotomist and the blood sucking proceeded without further incident.

Today, 5/18/2011, I am scheduled for a chest x-ray and bone scan.  The chest x-ray was pretty straight forward, one from the front and one from the side.  The bone scan is a bit more extensive.  The first thing they do is inject a very small amount of radioactive tracer into my blood stream.  This tracer has to circulate completely throughout my blood stream which takes about three hours.

I just got back from the bone scan.  Pretty uneventful.  I had to lay on a bed that went back and forth underneath a camera that  scans my entire body.  The entire procedure lasted about 30 minutes.  Some people say that they find it uncomfortable laying completely still for 30 minutes under this large camera but it did not bother me at all.  I just closed my eyes and took a short nap.  After I was done the technician told me to wait in the lounge while they reviewed my pictures to determine if more were needed.  After waiting for about 15 minutes he came out and told us that we were done and no more pictures were needed.  I asked him if anything showed up on the pictures.  He told me that he was not qualified to review the results with me but then he said with a wink in his eye; "when they don't ask for more pictures that is a good sign".  Now the wait begins until next Tuesday when we review the results with the experts and consider our options.