"I provided the words ... she provided the music" Prostate Book Emerges From Tragedy Steve Libowitz ------------------ Editor Books get written for all kinds of reasons. Some bloom from a scholar's academic interest, others from an artist's drive to create and express. Others, still, are born from personal experience. They serve as a sort of long and winding telegraph urging readers not to do as they themselves have done, or they provide help for those who might benefit from the author's experience. That's how award-winning science writer and former editor of the Hopkins Medical News Janet Farrar Worthington came to co-write "The Prostate: A Guide for Men and the Women Who Love Them" (Johns Hopkins University Press). Worthington's father-in-law, Tom, was a relatively healthy man at age 52, except for the cigarettes, which he assumed would be the death of him some day well in the future. Then he was diagnosed with prostate cancer. Worthington describes her father-in-law's following year as one of optimism, when he went into remission, and then--as the tumor returned "with a vengeance"--a slow and constant agony. He died at 53. During his illness, Worthington and her physician husband-- Tom's son--tried to supply the family with as much information about the disease and its treatment as possible. But they found only a smattering of articles in medical journals and "a couple of books that proved unhelpful and, worse, inaccurate," she wrote in the book's preface. After Tom's death, Worthington met with Patrick Walsh, director of the Hopkins Brady Urological Institute, and arguably one of the country's leading urologists. "Janet was absolutely broken up about her father-in-law's death, and she wanted to write a long article about prostate cancer for the News," Walsh says. After it was published, her office was swamped with requests for reprints and more detailed information. She knew she was onto something. Not long after that, Walsh was asked to review a new book on the prostate and perhaps write an introduction to it. "The book was just full of errors," he says. "I got through about five pages and said, What am I doing here?" After returning the book with a polite letter of regret, "it struck me that I should be the one to write this book," he says. Few would disagree. Since coming to Hopkins as a full professor and director of the Department of Urology--at age 36--Walsh has distinguished himself as a teacher and a researcher. Among his many achievements is the development of a nerve-sparing surgical procedure for treating prostate cancer, which is referred to as the Walsh procedure by almost everyone in the field, except Walsh. The surgery removes a malignancy without damaging the nerves, allowing a man to have an erection and remain continent. "Pat Walsh represents the best in innovation and leadership at Hopkins," says Michael E. Johns, dean of the School of Medicine and vice president for medicine at the university. "He is a man of great moral stature with a reputation for being a stickler for detail when it comes to patient care." "He is the most caring physician I have ever met," Worthington says. "He takes time to educate his patients about their health. He sends out updates, which he writes for them. At the bottom he puts his home phone number and encourages them to call him anytime. He signs off saying 'Always consider me your doctor and your friend.'" "I tell my patients that we are partners in the process of discovery," Walsh says. "I want them informed because knowledge is power, and it could save their lives." That became the impetus for--and the mantra of--the prostate book. Walsh wanted men, and the women in their lives, to realize that if caught early enough, all prostate problems can be cured, even cancer. He sent a letter to Worthington proposing that they write a book together, and the two set about on what would be a two-and-a-half-year project. "Dr. Walsh directed all the content," Worthington says," giving me stacks of papers with notes about what he thought was important. He'd dictate notes and send me the tapes. And then he left me alone to write. Some portions came from me, like the chapter on what to look for in a surgeon. He was always encouraging about adding ways to make the book more reader-friendly. It was a true collaboration, and he was just a peach to work with." "Janet is an excellent writer, and she really gave the book soul," Walsh says. "You could honestly say that while I provided the words, she wrote the music." The medical "libretto" turns on the authors' desire to make a potentially dry subject accessible to men who, in general, are not as self-conscious about their health as they should be and who have access to information about the prostate and prostate cancer, which is the leading killer of men over age 50. The book is designed to be not merely a technical medical guide for men, Walsh says. It was crafted as a guide for "the women who love them." "To be realistic, men don't take good care of themselves," Walsh says. "Because the women in their lives are often the primary caregivers, they should be equally informed if a disorder should develop. "We wanted the book to dispel certain misconceptions about the disease: that only old men get it, that it is slow-growing, that it is nourished by hormones, and that it can't be missed on a physical exam," Walsh says. This year, over 200,000 men in the United States will be diagnosed with prostate cancer, and an even greater number will seek help for problems caused by prostate enlargement and inflammation. The cancer is the most common among men and, because more men are living to older ages, it is the only cancer with a steadily increasing mortality rate. But still, Walsh says, there is much not understood about the prostate by patients and their doctors. "Prostate cancer is a topic that there is a lot of misinformation about," Walsh says. "It's not a field that is black and white. There has been a tremendous explosion of discovery, and not everyone can keep up with it. "It took us a long time to write the book, but it is as up-to-date as any information out there. Doctors also will learn from this book." Worthington relates that the section on benign prostatic hyperplasia, for example, was rewritten in page proofs after Walsh attended a BPH conference in Paris at which significant new information was reported. "I would go to the meetings and then come back to my room and dictate into my tape recorder all of this information," he says. A book on the prostate may not seem like best-seller material. But that's just what it has been since it was released- -and sold out almost immediately--in April. Since then, it has become Barnes and Noble's third best selling health book. "I'm not surprised that it's selling well," Walsh says. "Prostate problems are so prevalent and so misunderstood." One person who recognized the importance of the book is Walsh's longtime friend Tim Johnson, medical editor for ABC News. Walsh had asked Johnson to read and then write an introduction for the book. Johnson, as a matter of policy, declined, but he loved the book and thought more people should know about it. So, he asked Walsh if he would mind appearing on Good Morning America to talk about it. On air, Johnson not only recommended the book, but also told his audience that it would have a prominent place on his own bookshelf. Walsh has been happy to oblige the local and national media. Like most tasks in his life, he takes to the media with an easy, unassuming charm. He has appeared on Donahue and given numerous interviews to the national print media, including the New York Times and the Washington Post. But he is quick to clarify that he is not hungry for media attention. He is, however, savvy enough to know that the media afford him a wonderful way to educate the public about something on which he may be the world's leading expert, a fact he refuses to let get in the way of his patients' care. "What many people might be surprised to know about Pat Walsh," Worthington says, "is that as a leading urological surgeon, he doesn't push for surgery as a primary therapy. He's the first to tell a patient he's not a candidate for surgery and that they should explore other options." Walsh wanted the book to be self-instructive, so there are lots of chapters and charts about what various test results mean and when and how to act on them. "With medical care being uneven, and people in HMOs being denied care by specialists, they need something like this to help them through their difficulties," he says. "By being self-instructive, the book allows patients to come to their own second opinion and become their own advocates." "He always encouraged me to talk to experts in other fields of prostate therapy, like radiation, as a way of giving readers as much information as possible to work with," Worthington says. She believes the book already has saved a life. A friend of her father's was diagnosed with prostate cancer. He had almost no information about it, she says, and he didn't even know the right questions to ask. His surgeon suggested that because of his patient's advanced age, castration--an all-too common intervention--was the best course of treatment. The procedure effectively stops the production of male hormones thought to exacerbate the spread of prostate cancer, but has never been proved to stop the spread of the disease. Worthington gave her family friend the book. He read it and confronted his physician and then sought a second opinion. He finally opted for surgery to remove only the malignant prostate. And now he's recovering well, Worthington says. "I had only one purpose in writing this book," Walsh says. "I wanted to get the message out and I wanted to get the message straight. I'm pleased with the results. It's very clear and honest. And I believe it can help the American public."
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