SCHORR:
Hello, and welcome to the American Cancer Society's Cancer Survivors Network, the service created by and for cancer survivors. I'm your discussion leader, Andrew Schorr, in Seattle. Today's topic: prostate cancer survivors in their mid-60s and older who've had cancer more than once. On the phone with us are four prostate cancer survivors from across the country. They know the shock of hearing the cancer diagnosis not once, but twice, or even more. Over the next few minutes we'll discuss issues such as: being proactive and attacking the problem, having multiple cancers and the fact that they are not necessarily related, how to reach a decision on what treatment is right for you, and how helping others can help you live better. Well, let's begin. Norton joins us from Willows, California. Norton, I know that you're 78, you're married, you had prostate cancer back in 1991, and at that time you had both your prostate and your testicles removed. Now you're getting medication because you're dealing with some skin cancer. Is that right?

NORTON:
I don't have any medication for skin cancer, but I have had two removed. And I have some others that are probably going to have to be removed very shortly. But your information about my prostate cancer is correct.

SCHORR:
So you have to keep an eye on it. Now, tell us how the cancer and the treatments have affected your life today.

NORTON:
Oh, I think it's made me appreciate every day a little bit more than I did before. I think I appreciate friends more, because you don't know how long this life is going to last. So the minutes that you have, the days you have, they're all valuable days that you think are sort of extra. I think that, in some ways, while having cancer is very bad, it's also a blessing. You begin to appreciate life much more.

SCHORR:
Norton, I find it interesting that you're a retired hospital administrator, so one would think that you would know how to find a good doctor. Yet, despite that, I'm told you feel that your doctor wasn't as aware of the danger of prostate cancer as you would have liked, given your family history of the disease. So tell us about that.

NORTON:
Well, that doesn't apply to my urologist. It actually would apply to my doctor of internal medicine. My grandfather died of prostate cancer in 1947, which was in my medical record. This should have made the doctor even more vigilant about my care. In the late 1980s I started having some unusual things. I had to get up and urinate five or six times a night, which could be an indication that something's going on. I actually had blood in my semen. For both of those things, I was told, "Well, these are the sorts of things that old men have." And I was sort of lulled by thinking it's not unusual. Well, I should have known that it was unusual, and that while old men have these symptoms, old men also have prostate cancer and die of prostate cancer.

SCHORR:
So what have you learned, as a former health care professional and as a patient dealing with cancer, that might help other men dealing with cancer again?

NORTON:
I think that people should be aware of the signs of cancer. They can get those through the American Cancer Society. The American Cancer Society has guidelines for men being screened. The only way you can get a cure from prostate cancer that is a sure and actual cure is by having it treated early. You get it treated early by finding out about it before it has had a chance to metastasize and spread. So, I think that people should always be vigilant, especially when they get older, about cancer. Be aware of what the screening and guidelines are. And be informed.

SCHORR:
When you have had cancer not once but twice, what sort of radar do you have now? About the way you are vigilant with yourself, and your dialog with your doctor, to make sure that you can live for a long time?

NORTON:
Well, my prostate cancer was metastatic and I think with metastatic cancer, you're never sure when it's going to rear its ugly head again. So I'm not through with my prostate cancer. At some point, it will probably reoccur. The PSA test is a good screener to diagnose prostate cancer, but it's also a good monitor. And a person who's had prostate cancer should be monitored at least twice a year. Supposedly, after treatment, you reach a nadir with your cancer, a low point in your PSA score. From then on, it's very evident if it starts rising that there's cancer there and that something is going on. So, you certainly should be watching your PSA very carefully.

SCHORR:
What about your dialog with the doctor, or when to go to the doctor? Sometimes, you know, men are not always the best in speaking up for themselves. If there's something a little bit out of whack, you let it go, or you don't want to know. But do you think that men should be more proactive when you've had cancer intervene in this way in your life?

NORTON:
Oh, I certainly think so. We could take a page out of the book of women who've had breast cancer. The women are very proactive about their cancer. They get funding that is far beyond what prostate cancer gets, so in terms of where they are, they're probably ten to fifteen years ahead of us in knowledge about their cancer. Men have been sort of reluctant to come out of the closet. I started a support group in my area, and it's not unusual that the wife will come to the support group when the husband doesn't come. Or... I'm sort of a resource person for the American Cancer Society, and instead of the man calling me to get information about prostate cancer, they'll have the wives call. So, men have sort of not been willing to come out of the closet yet. This is not true of all men, but certainly true of many men. They don't seem to want to talk about their cancer. I guess because it involves sexual things, and so forth, that makes them reluctant to talk about it.

SCHORR:
Okay.

SCHORR:
Well, I want to bring in a second member of our group discussion, Keith. Keith, you're in Vadnais Heights, Minnesota, right outside of Minneapolis-St. Paul, and I know you're married and 64. Keith, it was 30 years ago when a cancer diagnosis reared its head for you, and that was colon cancer. I know it came back in 1994, many years later. And then pow! Three years ago you found out you have a different cancer, prostate cancer. I also know from having spoken to you before that those colon cancers were quite serious, and it was quite something to get through that. And now, you find out you have prostate cancer. I know these were not necessarily connected. Is that right? That you can have all these different cancers, and it's not necessarily recurrence, but it's just kind of a string of bad luck.

KEITH:
Correct.

SCHORR:
So you've had several, or maybe almost an ongoing big cancer battle. And also I know that you lost your daughter to cancer as well. So when you look at these interventions in your life with cancer, what would you say to men who have found themselves, through no fault of their own, dealing with cancer more than once? Something that could give them some inspiration or way to go on?

KEITH:
I think once you've been diagnosed, obviously you should have a much higher awareness of everything that's going on around you from a health standpoint. I can only encourage people to stay on their schedules of return visits to the doctors. I'm a good example, and I say example by luck, not because of my skill. But because of the commitment I have made to continue early detection. I have good medical people dealing with me, and I'm a benefactor of many years of research that's been funded by the American Cancer Society through the years. There's no question in my mind that I happen to be one of the people who, because of research, and the types of cancer I've had, is alive today. And that early detection goes with that.

SCHORR:
So, for someone who's affected by cancer, being proactive is really important.

KEITH:
There's no question. My philosophy on each of the diagnoses has always been: run to the fire, not from it. You can't put out the fire by backing away from it. You should go after it and resolve the issue and get the best available facts and then react.

SCHORR:
Now, one last thing for you before we introduce another member of our discussion, Keith. And that is, here you've had cancer several times in your life. One of your children died of cancer. Is it tough at all to go on? You know, years ago, we thought all people died of cancer. We know now that's not true. But still it's a scary word. Has it ever depressed you or gotten to the point where you've had difficulty going on? You sound so positive now.

KEITH:
I think first of all, the issues that I've been through personally, my cancer, are so secondary to what I've experienced in life in losing a daughter. It can be very depressing. You certainly need faith and love. And to live in the moment, as our daughter taught us how to live, and how to die. I don't think I've been in a depression, but I've also been in a situation where my personal experiences are secondary to what we walked through with our daughter as a caregiver. A caregiver's journey is as tough as the survivor's. That may sound ridiculous, until you walk both sides of the ledger with somebody you love. It's the truth, from my standpoint.

SCHORR:
Keith, you mentioned, and Norton did, too, about really being proactive. Being vigilant, I think is the word Norton used. What are specific things that you've done over the years, and that you do now, to keep cancer under control? To keep it from intervening in your life again? And what would you recommend along those lines to other men? Specific things... I mean, we know about regular checkups. Is there a state of mind, or other things that you strive for in between checkups?

KEITH:
I'm very active as a volunteer in the Cancer Society. The "Relay for Life" has a lot of visibility in our community, and I'm involved in that. But I just feel that to be proactive, and to go after something...

In my particular case, I'd had a PSA exam eight or nine months before that was at 3.5. My hip was bothering me, and my wife insisted that I go in, and we just coincidentally decided to have a PSA exam. My PSA went from 3.5 to 12.5 in nine months, which is very unusual. It was on the move, and I was just very fortunate to have my wife say, "Go in and have that hip looked at." Then, because of the colon history, I was getting my hemoglobin checked. And it came up that we might as well get the PSA exam done again, too. So, just by the grace of all those lucky incidents... Normally, I wouldn't have been back for another four or five months for a PSA exam.

SCHORR:
Well, let's bring another member of our discussion in, and that's Al, from Dresher, Pennsylvania. Albert, I know you're a widower and you're 81. You've had both prostate cancer and, I believe, skin cancer, although it's not too serious.

AL:
Just very, very minor. A few little spots here and there from when I had sunburn. But I go to a dermatologist every six months and he's not found anything, I would say, in the last three years. So I'm not really worried about the skin cancer. Though I have a brother down in Florida who has basal cell carcinoma and he has had a very bad experience. He has lost part of his face, the right side of his face, and one eye, and he's had many skin grafts and so forth. Basal cell carcinoma can be very, very bad.

It just so happens I was down visiting him about eight years ago, and he was having trouble urinating. He decided to get one of these roto-rooters... you know, the DURC... and when they examined the chips they found that he had prostate cancer. With his physical condition, they said he was a good candidate for radiation. He had the usual 37 or 38 treatments, and it worked wonders for him. He came out with PSAs virtually zero. About a year later I was having a checkup and my doctor told me that the PSA was a little too high, and when I had it biopsied by a urologist, they found that it was cancerous. But again, because of my physical condition and the way my brother went through it okay, we decided to go through with radiation. And it worked perfectly. Absolutely no side effects of any kind, and my PSA dropped down to virtually zero. Between zero and one. It went along fine for years, with no side effects or anything.

I was getting my PSAs checked every three months, and a little over a year ago, they started to go up a little bit. Every three months they doubled, until it reached up to 34.1, at which point my urologist suggested a number of checkups. They found I had a metastasis in my spine. It was very localized. You could just see it on the MRI. Again, I decided to treat that with radiation, and it knocked the PSA right down in two steps. It went down to 1.9. Now it seems to have leveled off at around 3.5, and if it just stays there, I'll be happy. It's a number I can live with. But I have had, since 1991, not one single side effect of any kind due to the cancer.

SCHORR:
And what do you attribute that to? Anything in particular? I know that you work hard at physical conditioning. Is that right?

AL:
Yes, I was a runner as a matter of fact, up until six months ago. I started to get a little bit of arthritis in my hip. At one time, when I was in my sixties, I was running eight miles a day, every morning. But I've leveled off until recently I've been doing just a mile and a half.

SCHORR:
So, you've had this cancer word again in your life. Really it's been, in your life personally, beyond your brother, it's been three times. The initial prostate cancer, the radiation, the metastasis. The skin cancer was not a big deal, but there was that. What's your attitude about cancer in your life, and moving on with your life despite it having intervened?

AL:
Well, the other cancer that I lived with was with my wife. She was a sun lover, and about ten years ago they found that she had a melanoma. A rather small surface melanoma. But, after a long consultation with the doctors, we realized that that surface melanoma is nothing compared to what happens when it goes internal. It metastasized in her lungs, in her colon, and ultimately in her brain. During the roughly ten years that she had this sentence of death hanging over her... because that's what we were told... she lived life to the fullest. We loved to travel. My wife was full of joy, a happy woman, always with a good outlook on life. Right up to her very last day, she was a happy woman. So I can see the bad side of cancer.

SCHORR:
Al, I'm sorry you lost her. How long ago was that?

AL:
She died four years and four months ago.

SCHORR:
Al, given that cancer was in your life like that... But you kind of talk wistfully, and in a beautiful way, about the full life you and your wife had together. Is that something you would say to men who are dealing with prostate cancer, and then either recurrence or metastases or some other cancer in your life beyond that... To live fully?

AL:
There are so many other unknowns in life. The cancer is just one of them. You don't know. You get in your car and you think you're just going down the street to the grocery store and suddenly somebody slams into you, and that finishes you. You can't tell. You can't try to close your life in and say I'm going to stay in one room and protect myself from all outside influences. Life isn't that way. You're always expose to some dangers, some outside influences over which you have no control. Cancer is one of them.

SCHORR:
Let me bring in our fourth guest, and that's Hans, who's here in Seattle. Hans, I know that you're 67 now and when you were about 62, 61, you were diagnosed with prostate cancer. You had the radiation seeds as your treatment. That treatment was pioneered here in Seattle, I believe. Then last year, several years after prostate cancer, you found out you have a leukemia, chronic lymphocytic leukemia. Did you feel a little cursed that this word cancer had come up in your life again, and totally in an unexpected way?

HANS:
Yes, and just a month ago the oncologist said there's something wrong with my red blood cells, so I'm beginning to be a little bit paranoid about it.

SCHORR:
Have you been on any chemotherapy?

HANS:
No. I am waiting for a trial of gene therapy in San Diego.

SCHORR:
Oh, I understand. So, that's actually the same leukemia that I'm dealing with myself, although I haven't had treatment. Hans, what would you say to men who have cancer come up more than once in their life? You've heard Norton and Keith talk about being proactive and being vigilant and staying on top of things medically. Al, you were also echoing that, and talking about really leading life to its fullest despite having had a diagnosis of cancer. What would be your point of view on all that, Hans?

HANS:
My point of view is... What I have done is try to find out as much as possible. I have gone on the Internet almost daily, and read about it and found out what it is and how it gets treated. What is to be expected? Is there something that is just in the beginning stages of being found out by the medical profession?

SCHORR:
Well, it sounds like there are two examples of that for you. With your initial prostate cancer, you sought out what then was very new, the radiation seeds. And now in CLL you're talking about gene therapy, which is certainly on the leading edge of treatment for leukemia. So it sounds like this is your modus operandi, if you will. To look at the latest and see if it applies to you.

HANS:
Well, in a manner of speaking, I think one has to manage one's own health care.

SCHORR:
That's difficult for some men, because often if you have a spouse, it's the woman who's kind of more plugged in to that. That's more difficult, often, for us men.

HANS:
Well, I know. I've been a carpenter and cabinetmaker and, for the last ten years, I was an apprenticeship teacher. So I've been, in general, in a male type of work situation. Most males shrug it off. You know, they don't want to talk about it.

SCHORR:
Yeah, but as Keith said, if he'd been shrugging it off when his hip was bothering him he probably wouldn't have been treated early on for prostate cancer. Right, Keith?

KEITH:
That's correct.

SCHORR:
So you needed to jump in.

HANS:
Indeed, and in Seattle it is very easy to find out about it. Swedish Hospital has a screening program that is free, and the Northwest Hospital has a screening program that is free. All that one has to do is go in there and find out.

SCHORR:
But, not everybody lives in a city where there is advanced medical care. Norton, you were saying that your internist wasn't really thinking prostate cancer, or serious disease, as it became clear. Let's say somebody is treated by a general practitioner, or maybe they occasionally check in with the oncologist because they've had cancer previously. But they live out God knows where, not near a major medical center, and there aren't necessarily these screening programs. It sounds like they still need to be looking out for themselves very aggressively, wouldn't you say, Norton?

NORTON:
Oh, I think so. I think that you have to get all the facts that you can about your particular type of cancer. There are lots of symposiums, there's a lot of information on the Internet, certainly about prostate cancer. Then you should be able to partner with your doctor in making a decision about treatment. And then when you decide upon a treatment, you ought to really find the master of the art. I've heard you talk about Seattle. Seattle is sort of the mecca for brachytherapy. That's the interstitial implantation of radioactive seeds. Johns Hopkins in Baltimore is the mecca for radical prostatectomy. I know that not everybody can go to those places, but still they should look for a doctor who's regarded as a real artist, a real master of that particular procedure.

SCHORR:
Al, you mentioned about the metastases on your spine related to cancer, and you're being treated for skin cancer. Do you worry on a day-to-day basis about the other shoe dropping for you? That there could be something that would seriously affect your quality of life and your longevity?

AL:
Let's put it this way. It impinges on my consciousness occasionally. But I used to know a fella I was with in the army, and he seemed to get along just fine. We used to say, "He goes along fat, dumb and happy," and everything worked out for him. To a certain extent, I follow his philosophy. Now, in our local hospital... I don't know whether the rest of you have them. We have groups that meet once a month. We call them "Man to Man."

SCHORR:
Right, they're around the country in many places.

AL:
Yeah. And we have top specialists of all kinds come in and talk to us once a month. We also have one gentleman who, strangely enough, does not have cancer, but comes from a family which is loaded with prostate cancer. He has made a specialty of researching and doing investigation on all of the techniques that are in the forefront now. So I hear what's going on, as far as whether it requires action on my part. I have my checkups, my PSA, every three months, and I have no side effects at all.

SCHORR:
I think that's interesting. I've know men who were recently diagnosed with prostate cancer get into these "Man to Man" groups. But Al, it sounds like for you, you just have an ongoing interest that makes you want to keep participating.

AL:
Yes.

SCHORR:
Norton, I had a question for you. I know you're married. How has having cancer affected your relationships? Your relationship with your wife? Has it changed things at all?

NORTON:
Of course, in my case, having had an orchiectomy, it affects my physical relationship with my wife. But I think on another level, a spiritual level, I think it brings you even closer. That you worry more about each other and try to help each other more than you ever did before. I think it brings you closer together. My wife is behind me. I just came back from a symposium in Los Angeles last night. My wife goes to all those things with me. I think your spouse becomes even more supportive, once you've had cancer.

SCHORR:
And Hans, you may be looking at some treatment coming up. Are you concerned at all about how that will affect your energy, or going on day to day? Or are you just ready for a leading-edge treatment, if that's what you need.

HANS:
That is what I'm holding out for. It has been suggested I should take some herb therapy. I'm Stage Two to Three in the CLL. But with the consequences of the therapy for the prostate cancer, there may be problems. I have some radiation burns on my intestine and that may be a problem with chemo.

SCHORR:
You know, I don't hear a lot of anger from any of you at having cancer be part of your life more than once. Keith, you talked about the loss of your daughter, and Al, certainly, the loss of your wife. But you don't sound angry about it. Is being angry even productive? It's a natural feeling, but is it productive or do you just have to move on?

AL:
I think you just move on. I used to love to travel with my wife. She was a born traveler, and this is what we did during the last ten years of her life. We traveled four, sometimes five times a year, all over. Now, fortunately, I have two daughters whose husbands allow them to travel with me. We go on cruises, we go on tours, and I do that always thinking of my wife... if she could have been with me. You live your life as full as you can.

SCHORR:
Keith, what about you? Anger along the way, or now?

KEITH:
There's never an answer to the why question. I was taught that many years ago, and I truly believe that if you ask that question you're not going to get an answer to it. Whether somebody gets killed at an intersection, or goes down in a plane crash, or gets cancer, there's not an answer to the why question. And the sooner a person can learn to deal with that then the faster they can get on with their life. As far as worrying about getting cancer again, I try and live in the moment. I try and help others as much as I can. I'm proactive in my own situation, and my wife and I have just tried to move on with those particular issues all the time. I can't say that I've had anger at any time. Especially when I was diagnosed, the only thought I had was, "Get it taken care of." Try to use the best resources that you know of, get the facts, and then react.

SCHORR:
Keith, you mentioned helping others. I know you and your wife Patty, in the Minnesota area, are very active in helping others. How does that help, not just them, but you?

KEITH:
It just goes back to... In giving you receive. You don't give to receive, but what you get back is tenfold, a hundredfold, of what you put into it because you really help people. Just three weeks ago I had tremendous rewards with a guy. I knew his wife through a "Relay for Life," and he was diagnosed with prostate cancer. She asked if I'd be comfortable talking with him, and we talked about everything. From sexuality to whatever... I told him he should exercise his best options, and he ended up choosing to have a complete surgery and prostatectomy. I saw him Friday night at our "Relay for Life" and there were tears, because he was so thankful for the exchange of communications. What you get back out of something like that is not measured in dollars and cents.

SCHORR:
And Norton, you found that in California, as well.

NORTON:
Oh, yeah. I think the biggest thing that I get out of this, the positive thing, is helping others. I've started a support group. I started it about four and a half years ago, and it serves three counties in my area. I have well over a hundred people on my mailing list. We have an attendance of about forty men at each monthly meeting. And then I field a lot of calls for the American Cancer Society for men who've been newly diagnosed. And could I read you my little business card, the message on that?

SCHORR:
We'd love to hear that.

NORTON:
"To those diagnosed with prostate cancer: Welcome, my friend, and a friend you must be, for letting me help you, also helps me. Yes, I've had a problem, so you're not alone. If you care to discuss it, just pick up the phone." And then I have my phone number.

SCHORR:
So, for men listening to this who were not particularly attentive to their health, and find out they have cancer... The doctor says, "We're going to do this, this, and this." It's done, then sometime later it comes up again... Would you say that this reaching out to others, and if you've been dealing with cancer for awhile, actually speaking to others... Having it on you business card, even, as you do... That that would be something you'd recommend? And that there's growth that happens by doing that?

NORTON:
Oh, I think so. My recommendation to men with prostate cancer is that they join one of two groups: "Us Too," which is mostly in the eastern United States, or "Man to Man," which is an American Cancer Society program. I'd suggest that men seek out membership in those organizations. There's so much that you can do in those organizations, with counseling of people who've just been diagnosed. And there's so many ways to help. I would encourage everybody to take a very positive attitude towards cancer, and do all the things they can do to help other people.

SCHORR:
Now, we've talked a little about talking about cancer proactively with your doctors and with other men. Al, you said that you go on cruises with your daughters and their husbands.

AL:
No, no, just with my daughters.

SCHORR:
Oh, with the daughters. Okay.

AL:
Like I say, their husbands are very accommodating.

SCHORR:
Okay. So, your daughters know the history of cancer in your family, and they must worry themselves sick about it. How do you put them at ease? You have such a good attitude, but what is the dialog around cancer with you and your daughters? Can it be a positive thing? And is there open communication, or are things left unsaid?

AL:
No, there's open communication. But they don't dig into things, they don't delve into them. They'll occasionally ask me, if I have an ache or a pain or something like that, they'll ask me about it. And make sure that I follow it up. But, from the experience that we've had with my wife, they know that there's really nothing I can do myself. It's all going to have to be done by medical people and a medical establishment. The best that I can do is to live a good, healthy, active life and try to keep a good attitude.

One of the things that I find helps me... My hobby for many years has been model shipbuilding. I build wooden sailing ships. As a volunteer, I go to various schools, and I meet little kids in the fourth grade or so. I provide them with little kits, and each one of them can make a model ship and take it home. I get a big kick out of that. It makes me feel like I'm young again.

SCHORR:
If cancer comes up again in your life, after having prostate cancer... It might not be particularly serious if you have the right kind of skin cancer, I suppose. But, Al, you mentioned the cancer on your spine. When you have discussions with your daughters, do you also talk about, "What if...?". You're a widower, and I don't want to talk about end-of-life decisions. But, do you have open discussions about what should happen, should you become very sick?

AL:
Oh, very certainly. As a matter of fact, just last week, I finished working with a lawyer who happens to be the same lawyer that worked out the trust situation and wills for my daughter. He has now made a will and set up a trust for me. And that was done openly and across the table. We talked about it. They know where they stand, and they have power of attorney for my estate. So we don't brush anything under the table.

SCHORR:
Hans, I know you're divorced. I don't know what your social life is like or your relationships. Do you talk about your medical situation with your friends, or family, or any ladies you like? You're open about it?

HANS:
Yes.

SCHORR:
And so, when they express some worry, what do you say?

HANS:
Well, when they express worries I say, "I appreciate your caring, your worrying, for me. But basically, I'm okay. Let's just go on from there." And if they want to ask more about it, especially the prostate cancer... What has happened is I tell them what it entails, and where the treatment is at currently. I often remembered the remark of the nurse, when I had those seed implants done. You get a spinal tap anesthetic for it. The nurse came by and everything was supposed to be normal. She came by with a Geiger counter, and the thing started rattling from about eight feet away, and she said, "Yep, you're hot! You go home."

SCHORR:
Well, gentlemen, let's begin to wrap up with final thoughts. For men who will listen to this discussion, who've maybe recently had a second diagnosis of cancer, after a first diagnosis of prostate cancer... Norton, what do you want them to know? What do you want to say to them?

NORTON:
I think if they're being diagnosed with prostate cancer as a second cancer, they shouldn't rush into treatment. Generally, prostate cancer is one of the slower-moving cancers. I think men ought to get the basic facts about prostate cancer. Their emotions may be telling them they should act quickly, and time is important. But since it's not a fast-growing cancer, they should get accurate facts so they can partner with their doctors in making decisions. And if there's any doubt in their minds that they've made the right decision, they ought to get a second and maybe even a third opinion. They don't need to worry about their doctor's feelings because he's giving second and third opinions, too. So, I think the best thing a man that's being diagnosed with prostate cancer can do is to get all the facts that he can. There are so many treatments for prostate cancer and he has to pick out the one that's best for him. He shouldn't just let the doctor make that decision. He should partner with a doctor.

SCHORR:
Hans, in Seattle, you're a man who believes in getting information, and you've had two different types of cancer. Is that what you would say to a man who faces cancer again: "Get information?"

HANS:
Yes. Don't be afraid. You can be scared out of your wits, you know, but don't be afraid of finding out. Don't be afraid of going forward with it. Don't pull back. Just go on. Find out, or a doctor will. It's much easier to talk to a doctor, and easier to talk to you as a patient, when you know what you're talking about.

SCHORR:
And when you say, "Don't pull back," you mean, I guess, "Don't give up?"

HANS:
Well, don't give up. Many people I have seen they, sort of like I heard before, they had their wives be the spokesman for them. Do it yourself. Don't hide from it, don't negate it, don't be in a mood of negation. That is dangerous and that is just piling up the problems.

SCHORR:
Al, in Pennsylvania, what would you say to men who are facing cancer yet again?

AL:
I would say... It's serious. Look into it. Follow it up. But don't let it rule your life. You're going to live a long time even if you do have the cancer. It's not something that is fast-acting and there are enough good treatments around that I think all of us are going to live into our nineties, at least. I know I have to wait and see my grandchildren get out of med school.

SCHORR:
Amen, Al. I wish that for you. Keith, in Minnesota, what's your view for men who are finding themselves with cancer more than once?

KEITH:
In my particular case, because prostate cancer was the third one, my reaction was somewhat different. I chose not to get a second opinion. I certainly have good contacts, and I knew the doctor I went to was very qualified. When my PSA had moved from 3.5 to 12.5 in less than nine months, I knew it was on the market and moving. I didn't feel comfortable in trying to make decisions, such as seed implants versus... If you do the seed implants and it doesn't take, what are the alternatives? They're not real positive, from what I understand.

I moved rapidly and I moved specifically with the support of my wife. She said, "He's been through cancer twice." She looked the urologist right in the eye with me and she said, "I am not concerned. Sex is important in our life. Loving, touching, and everything else. But I'm more worried about having him here five years from now than I am about whether or not he has the capability of having an erection. I want him alive, first of all." And those kinds of decisions really help you cut to the chase in a hurry. I can relate it to the many times, in support groups, I've heard from men who have stepped forward when their wife was faced with losing a breast. They said, "I'm with you, whatever you look like, honey. I love you and I'm there." That's just what my wife did.

SCHORR:
So, Keith, it sounds like, for a man dealing with this, he should know that he doesn't have to deal with this alone. Open conversation with his wife, or other loved ones... Al talks with his daughters... That sounds like it's really important.

KEITH:
No question.

SCHORR:
Well, gentlemen, this has been a very rewarding discussion. Unfortunately we will have to close. But I want to thank all of you for your insight, your personal stories, and your dedication to helping others. Really, thank you very much. And I hope that we'll get to talk again with even better advice many years from now. I wish you all the best.

For the American Cancer Society's Cancer Survivors Network, and from our Healthtalk Interactive studio in Seattle, I'm Andrew Schorr.