Johns Hopkins Gazette: June 12, 1995

"I provided the words ... 
she provided the music"

Prostate Book Emerges From Tragedy

Steve Libowitz

     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

     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

     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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