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CONFRONTING OUR CANCERS // Putting a spotlight on prostate cancer


By Michael Korda

Random House, $20

Reviewed by Sue Landry

Mention a book about the prostate to a man and he invariably grimaces a bit and shifts his feet uncomfortably. But that's exactly why Michael Korda, the editor-in-chief of Simon and Schuster, wrote Man to Man, an intensely personal and utterly candid account of his battle with prostate cancer. His fight was not only with prostate cancer, but with the code of silence surrounding this disease.

Korda is on a mission to drag prostate cancer into the spotlight. Men are reluctant to talk to each other about it and even Korda's doctors sometimes danced around the unpleasant details of the incontinence and impotency that can follow a radical prostatectomy. In talking frankly about his experience, Korda hopes to encourage men to recognize the danger and know what they can do to give themselves the best chance to defeat the disease.

Most women, he says, know far more about breast cancer than most men do about prostate cancer. And they are reminded at every turn, through the media and educational literature, to have regular mammograms and do monthly self-examinations.

Men, on the other hand, tend to be more like Korda, who remained unalarmed when he learned his PSA (prostate-specific antigen) was 15. The doctor ordered a biopsy, which was negative for cancer.

But later, after he had put off a repeat test for 18 months, his PSA had jumped to 22 and a biopsy revealed cancer. Korda says he delayed the follow-up visit because, "I didn't want to do anything that might result in my having to visit the urologist again."

Korda warms others not to make the same mistake. His advice in a nutshell: Know your PSA.

"I am still astonished _ and appalled _ by the number of men who don't know, or can't remember, or who haven't been told by their doctors," Korda writes. "There is no reason why 50,000 Americans a year should die from sheer ignorance, or from turning a blind eye to a disease which is so easily diagnosed at an early stage."

Korda's recommendations in Man to Man are not without controversy. Some doctors argue the PSA should not be used as a screening test mainly because it is so good at detecting the earliest stages of prostate cancer.

The cancer in many men can be so slow-growing that they will die of something else before the cancer kills them. In those cases, the argument goes, early detection will lead to unnecessary and expensive treatment.

It's an argument that Korda rejects out of hand. In his case, knowing more sooner could have helped him avoid serious surgery.

Besides, he says, imagine the outcry "if doctors pooh-poohed the dangers of breast cancer . . . or sought reasons why it was too expensive to screen large numbers of women for it."

Man to Man succeeds because it is so very personal and detailed. Korda brings the reader along on his scary, unpleasant journey as he discusses with doctors the options of "watchful waiting," hormone therapy, external radiation and radiation implants before deciding that surgery was the best choice in his case.

Not every one will have the same experience, of course, and Korda's position allows him treatment not everyone will be able to afford. He seeks the most prominent expert in prostate surgery, he is flown home by a medevac service from Baltimore to Dutchess County, N.Y., and he has a home health nurse to help with the unpleasant contraptions of incontinence in the first weeks following surgery.

Still, a personal tale tells the story with so much more power than a book that more academically lays out the same information. The clinical details are all there. But Korda adds an additional level of emotional intensity, speaking with ease and candor about his frustrations and fears, the effect on his marriage and his self-image, the difficulties of dealing with the details of his recovery that no one had wanted to talk about before the surgery.

Thanks to Korda, who was willing to talk about the answers to the questions he was afraid to ask and the questions his doctors were afraid to answer, readers will come away knowing exactly what to expect

Sue Landry is a Times staff writer.