DESCRIPTION
Jack McCallum of Bethlehem, Pennsylvania enjoyed an active lifestyle, but one year his prostate specific antigen (PSA) score shot up from zero to 4.9. That’s when his doctor ordered a digital rectal exam, than a biopsy, which revealed he had prostate cancer. Initially, Jack opted for active surveillance, which doctors would continue to monitor the state of his prostate. Then one day he abruptly changed his mind and decided to have his prostate removed with robotic surgery. Post-surgery, Jack believes his urinary and sexual function are as good as they possibly can be.
For years, Jack McCallum thought if he was going to have health-related issues in his sixties and seventies, they would be orthopedic in nature because he freely admitted before exercising, he rarely took time to stretch. However, he was surprised when blood work that was part of a routine annual physical showed his PSA had gone from zero to 4.9.
He was referred to a prostate cancer doctor, who performed a digital rectal exam, then called for a biopsy. It revealed Jack had prostate cancer. At first, he wanted his doctor to
monitor the health of his prostate through active surveillance. Then he changed his mind, and concluded that with active surveillance, there would be a lengthy procession of digital rectal exams and biopsies. Not wanting that, he then chose, at age 62, to get his prostate removed with a robotic prostatectomy.
The surgery was a success, but Jack woke up from it with a catheter inside him. It was painful, but Jack to wear it for eight more days. He did experience a bit of leakage, which require buying pads, but was very happy to note that within a few days, he no longer them. He was prescribed medication to aid with sexual function, but suspects he might have needed such medication, prostate or no prostate cancer.
By way of advice, Jack says if one is diagnosed, they should be informed of all available options, and if one chooses robotic surgery, to make sure one selects a urologist experienced in robotic surgery because not all urologists are.
Additional Resources:
Jack’s book: The Prostate Monologues
Jack’s email: jacksprostatebook@gmail.com
Support Group: Fans for the Cure https://www.fansforthecure.org
TRANSCRIPT
Bruce Morton: Hello, and welcome to the Cancer Interviews podcast. I’m your host, Bruce Morton, and on this segment, we will hear from a man who not only beat prostate cancer, but he decided to write a book about it. He is Jack McCallum of Bethlehem, Pennsylvania, the author of “The Prostate Monologues,” a book that chronicles the prostate cancer experience of those who survived prostate cancer and the doctors who treated them. It was a very informative read, and you, too, will be informed when you hear what Jack has to say. So, let’s get started, and Jack, welcome to Cancer Interviews.
Jack McCallum: Thanks for having me, Bruce.
BM: Jack, all of our interviews end up veering in a slightly different direction because everybody has a different story to tell, but we like to start from the same place, and that is to personalize you a little bit, and get to know a little bit about you. So if you would, just start off by telling us where you are from, where you went to school, your life’s work and what you like to do in your leisure time, stuff like that.
JM: Well, that’s a lot of territory to cover because I am not young. I am 70 years old, and I had my prostate intervention when I was 62. By that point, I had been retired, or semi-retired from Sports Illustrated, where I was a senior writer for 100 years, as I like to say. I am still associated there, still on the masthead, still do a lot of stuff, so journalism has been my career, specifically sports journalism. I started out at a few smaller newspapers, got to Sports Illustrated in 1981. I was lucky. I wasn’t the reason for it, but I was there for the Golden Age of Sports Illustrated. It was very influential, a great, great magazine, and I covered basically pro basketball from the mid-1980s, on. Once again I was lucky because I happened to hit the Golden Era of pro basketball. It was Magic Johnson and Larry Bird, they were still in the league. Michael Jordan came in, lit another fire, uh, the Detroit Pistons, Atlanta Hawks, all these great teams that almost could win it, but yet it was defined by Jordan, Magic and Larry, and then it culminated kinda my first run with the NBA, with the Dream Team (the 1992 US Olympic team), and I was able to write a book about that, and then I took a couple years off from covering the Dream Team, did some other things, then went back to the NBA, and was fortunate enough to hit another kind of mini-Renaissance, with the coming of Lebron, the coming of the great San Antonio Spurs teams, and I was lucky to have covered that sport. When I wrote the cancer book, I already had a bunch of sports books behind me, so I really looked upon it as a great opportunity to be informative about it, and I hope that I was, but also to do something a little bit different from what my career path had been to that point.
BM: Jack, you referenced Sports Illustrated, and I was but an infant when Sports Illustrated came on the scene, but I know that the Luce family wanted to change the way people looked at sports; and yet here you are saying, you were around for the Golden Age of Sports Illustrated. How did that Golden Age distinguish itself from any other era in the magazine’s existence?
JM: Sports Illustrated started very slowly. I was born in 1949, and SI was hatched in ’54 or ’56. Sports Illustrated came from Time-Life, and at that time, Time magazine was a behemoth and Life magazine was a behemoth, and so they had a lot of operating capital. At that time, the only other sports magazine was Sport magazine, which was what I started on. It was a monthly. It was very nuts and bolts. Baseball, football, basketball, it was a very well-done magazine, but Henry Luce had this idea that we could do this more sophisticated, I suppose, and have it be a weekly, because that was the secret to Time magazine. It came out every week, it felt almost like a newspaper, you know, things didn’t move as fast back then. So if you had a weekly magazine, it looked fast, and it was the same kind of idea for Sports Illustrated; but Sports Illustrated started very slowly. I was not there then, I was too young. What helped Sports Illustrated was car advertisements. Ford Motor Company decided to sell, I believe, the Thunderbird, in Sports Illustrated. They decided this was a men’s magazine, they started piling ad money into SI, and from what I understand, the history, that’s when SI started to take off. In the early days, we covered dog shows, yachting, I mean, someone was a yachting reporter, pro basketball, forget it, baseball was big because the Yankees were big and they were in New York, basketball not at all, hockey, not at all, but we covered dog shows and lot of these “rich people” kind of sports, and so right at the time the magazine started coalescing with men’s advertising, the editorial product of the magazine started getting better. You know, boxing matches, pro football, pro baseball, great photography, and so it went on kind of a run from the mid-60s to the mid-2000s, that we basically didn’t have a competitor. There was nobody who could do what Sports Illustrated could do. We had 35 writers on salary, on the masthead, that’s unheard of for a magazine. I mean, the New Yorker and National Geographic, they would have four or five people on staff, I mean, they were great magazines, and they had a bunch of freelancers, but SI had a staff of photographers and reporters that no one could really match, and I was fortunate enough to have been there during that time.
BM: You said your coverage with Sports Illustrated focused mainly on pro basketball, but I know enough about Sports Illustrated to know that eventually it evolved so that it was covering all sorts of things. Did you have any oddball, non-basketball assignments that stood out as you think back to your time at SI?
JM: I had come from newspapers, and that meant that I had a reputation. That meant that I wrote fast, and that you wrote about a lot of different things. If you worked at a small paper like I did, that meant that you covered high school football, high school basketball, high school wrestling, high school swimming meets, you did everything. So, my first three or four years at Sports Illustrated, I was like the long man out of the bullpen, the guy you called in, in the fourth inning. I wasn’t the glamorous starter, I wasn’t the closer, I was the middle guy. There was a period of time around 1983 when I covered nine different sports in nine weeks. Let’s see, pro football, college football, pro basketball, college basketball, indoor track, boxing, hockey and the world championship of squash, which took place at the Yale Club in New York City. And I went to cover it, and I didn’t have a sportcoat. I had to go out and buy a sportcoat to cover the world championship of squash, about which I knew nothing, by the way. One of the secrets of sportswriting was when you cover when you cover say, swimming, you want to make sure ‘nobody gets wet’ in the coverage of the story. In other words, you want to tell the story of the person and not the technical aspects of the sport. So that was my start at Sports Illustrated, very wide-ranging. I did a little bit of everything.
BM: Jack, I want to get on to your cancer journey, but I want to ask one more question about your time at SI. Obviously, you were around for the reign of some great teams in the NBA during when your basketball coverage was heaviest. The Celtics, the Lakers, and the great run of the Bulls, that could have been eight consecutive championships, had Michael Jordan not taken off two years for his foray into baseball. Out of all those great teams that you followed, is there one great experience that stands out above all others?
JM: I was very lucky because the first year that I was on the beat happened to be 85-86. I had done pro basketball before that, but the first year I got put on the beat was probably the year of the Celtics’ greatest team. Early in the season, I went to do a story because they had signed Bill Walton, and Bill Walton had been out of the league for a number of years with foot injuries, and he was almost like a Sasquatch type of figure, you know we knew him from UCLA, and he won a title with the Portland Trail Blazers in 1977, and then he drifted into this anonymity. He had something like 27 foot surgeries, I mean, he could barely walk, and here he was, coming back with the Celtics. So, I went to training camp and I can still see us sitting on the grass, and I am with this college legend, this guy’s not going to make it back. But that team was such a magical team for one year. They really put it together, Bird was at his absolute best in 85-86, was never better, was the MVP. McHale was at his best, Robert Parish, then Walton added this kind of strange ingredient off the bench, and he was such a fun character, that it set the tone for what the NBA was like then. It wasn’t all fun, it was a job, but it was easy to get your job done, the players understood the role of the press, even the superstars that came along had been sort of ingrained under the leadership of Magic Johnson, who came into the league and understood, you gotta be a good guy, you gotta cooperate with the press, you gotta cooperate with the fans, gotta sell this league, the league had not been doing well in the 70s, and everybody was kind of on this trip together. They understood they were on this elevator, and it was rising, you could see it, you could feel it, and it was really great to have been around the league at that time, and I got that feeling from the very first time I went on as a beat writer.
BM: All right, let’s move on to your cancer journey. Quite obviously, there was a time, and thankfully, a sizeable chunk of your life when prostate cancer was not a part of your life. Can you describe what life was like, from a health standpoint, at the time just before your diagnosis?
JM: Nothing had been wrong with me, except orthopedically. I mean, I had played pickup basketball and jogging and running, and was always active, but always doing what you shouldn’t do, not stretching, not doing the right things to get my body ready for what I always did. So, I had a lot of orthopedic things going on. Back surgery in 1986, both knees scoped around 1999, I tore my Achilles near my fiftieth birthday playing basketball, all these orthopedic things that were always happening to me, but nothing really serious. And my wife, who I’d been married to since 1975, was sort of the opposite. Nothing had really happened to her orthpedically because she had always done the right things, but she had a couple other things. She had Addison’s Disease that she was diagnosed with, and that led to Type One Diabetes, and she had all these autoimmune type of struggles, which were daily struggles, which were things you really had to monitor. My life was more screwing up something in my knees and then cleaning it up, so I never really thought about something serious happening to me. I knew my father had had cancer. He had had lung cancer, he was a smoker, probably didn’t do the things he needed to do to take care of himself, so I never really put myself in that category. I went to my primary care physician, primarily once a year, and he would always insist I get a physical. He was a very good PCP. We were friends, he understood me, my heart was always normal, my cholesterol was always under control, but one year, my PSA went from zero to 4.8, 4.9, which is referred to as your velocity. So that’s when he became kinda concerned, and when he told me I had to get a biopsy, it was crushing to me because something like that had never occurred to me. I was always the guy who was going to screw up orthopedically, and I was going to get it fixed, and then I was going to go on. So, the first thing I did was schedule a biopsy because of the velocity.
BM: So, what were the results of that biopsy?
JM: The prostate cancer doctor who performed it was a guy I had gone to college with, he was down in Philadlephia. I remember saying to my wife, there is just no way I have prostate cancer. The digital rectal exams had never revealed anything. I did not have any problem with urination. I did not have problems with erections. None of those things necessarily translate to whether you have prostate cancer, nevertheless, I was including them. “There’s nothing wrong down here,” was basically my approach. And my doctor kinda said so, too. And my PSA, when it did elevate, was not out of the ballpark. Whenever I talk about prostate cancer, and whenever I answer questions about it, I always start by saying, “I’m not a doctor.” You know, my PSA did not go up to nine, but I think it was 4.8. Then again, it had been nothing. I remember distinctly, my wife and I were driving back from the Jersey Shore, and my doctor called me, and he said he had some results for me. I told him I was driving, and he suggested I pull off to the side of the road. So, I pulled off to the side of the Garden State Parkway, and he told me I had shown signs of cancer in four of the 12 sectors they had taken in the biopsy. I was flabbergasted. I couldn’t believe it because I couldn’t see myself as a guy who had cancer. I saw myself, as I’d said, as someone who was really healthy. I thought my cross to bear would be the orthopedic stuff with my body breaking down from doing too many energetic things that I should be better prepared for. When I got that news, that’s when I had to make a decision as to what treatment option I would pursue.
BM: Something that sets prostate cancer apart from many other types of cancer is that it just seems to me there are more variables involved in terms of who’s treating you, what type of treatment they prefer, and what type of treatment option that you follow. What was your chain of events once it was laid out in front of you that you had options as to which way to go?
JM: Yes, and another option is whether to get treated at all, which can be very confusing to people. I think that’s the biggie. You fall down, you break your arm, you’re going to the doctor. The closest thing to a woman, I guess, is breast cancer. There are so many deaths from breast cancer, and we know so much about it, that you get diagnosed and you get treated. That doesn’t mean you get a mastectomy right away, but you know you better get some treatment. Prostate cancer brings a whole different type of thing. We started doing research on it, and one of the things that started happening to me was, I ended up writing a column for my local newspaper about getting the prostate cancer diagnosis. The reason I did that is (a) I am a writer and I deal with things by writing about them, and (b) one of the things we found out was, so many people get this diagnosis, and (c) there is so much confusion. So, I wrote this column for the Sunday paper of the Allentown (Pa.) Morning Call. This was in 2011. There was so much response to it that I couldn’t believe it. They put my e-mail at the end of it. I remember going to my e-mail on Monday, and there were dozens and dozens and dozens of responses to it. I mean, just how many people have this thing, and I think it was in the back of my mind then, that I would have to write a book about this because I just saw right away, being a writer, that this was necessary. Then I saw right away and decided after talking to my wife that I would do active surveillance, that I would watch my cancer numbers, and if there were such percentages, I would seek treatment. Probably this wasn’t going to kill me in ten years, I was 62. I was going to be alive at 72. I had two grandkids with another one on the way. That’s what you start thinking about when you get to be that age. You don’t start thinking about yourself, you start thinking about what you are going to see, so that becomes part of your equation. Now, am I going to be alive at 82? Well, less of a chance, and part of the other reason to get treated is that there was nothing else wrong with me, in other words, when you go to a prostate cancer doctor, they will tell you if you have underlying heart problems, cholesterol problems, you have already had a stroke, you have another type of cancer, lung cancer, pancreatic cancer. That is more of a reason to watch it, than to get treated, because the odds are, you are going to die from something else. My odds told me I was going to die from prostate cancer because everything else looked pretty good. Nevertheless, I decided I was going to go on active surveillance, but I made an appointment at Johns Hopkins, because by then I had discovered that, out of many places in the medical field, Johns Hopkins is where you should go, praise the temple, as this is one of the ‘it’ places. By then I had done some research and I concluded I wanted to write a book about this, and I went down and saw one of their top guys. I still remember I was the last appointment of the day, and he agreed to see me at the end. I had told him I was going to do this book. He looked at my numbers and gave me a digital rectal exam, then said I wasn’t a good candidate for active surveillance. You’re too young. I wouldn’t do it, he said. So, I said, what’s the age? He said, “I don’t have a set age, but at 62, you’re too young. You could die at 80, it could kill you when you are 77. It’s not going to kill you next year. It’s not going to kill you in five years.” And my opinion changed, just like that. I remember my wife and I drove home from Baltimore, and I turned to her said, “I’m going to get surgery.” I think I was inclined that way also because I looked at active surveillance in a different way. With active surveillance, you gotta keep getting biopsies, you gotta keep getting digital rectal exams, you gotta keep going to your doctor, and I had started to learn all along about infections. I learned that robotic surgery for a prostatectomy is safer regarding infection than doing a biopsy, that the rate of biopsy infection is higher than it is for surgery. So, I took all those things into account. Namely, how I felt about it. I had had previous surgeries, and I was an orthopedic surgery guy, so I bounced back many times. I wasn’t scared of surgery. My wife strongly felt I should get surgery. When I told my two sons I was thinking about doing nothing, meaning active surveillance, they said, “What are you? Crazy?” Did all that figure into decision, of course. I also asked myself if I thought I would bounce back, and the answer was ‘yes’. And, finally, I asked myself if I could find a surgeon who had hundreds if not thousands of these robotic procedures that I thought would give me an honest answer as to whether I should do it. I also asked myself if doing the book would be more interesting if I’d had the surgery? One day this title flew into my mind, “The Prostate Monologues.” And somebody said, isn’t somebody going to confuse it with “The Vagina Monologues”? I said, “Sure! That would be great! More sales!” I am being a little facetious, but only a little bit, and when I did all the calculation, I decided that the best thing for me was to get my cancer treated surgically with a robotic prostatectomy with a guy named Dr. David Lee, who was at Penn Prebyterian Hospital in Philadelphia, who was in the group of my prostate surgeons that I had talked about. I just thought for me, weighing all of those things, that I was a bit leery of radiation, and as I continued to research the book, I just found there were going to be radiologists out there who will say, “You’re full of it, it (radiation) is just as safe.” My reading of it was, I would rather be treated surgically than with radiation. Some of that has to do with the commitment you have to make with radiology, and I understood that if the cancer escaped the prostate, that I would have to be treated radiologically. They can’t take out the prostate is the cancer is already in your body. The best guess for mine was that the cancer had not escaped. So, I went in for cancer surgery on February 20, 2012, and I was glad I did it.
BM: So you went with the robotic surgery, which is more in vogue today if that is the right way to put it. That was an option that wasn’t around I underwent my prostate cancer procedure in 2001, but once it was done, how did you feel?
JM: One funny story, Bruce. I was wrapping up my book on the Dream Team. I was at the end of the project. It was all finished and printed. You can still make changes, but the publisher didn’t love such an idea if you made changes. It was going to cost a little bit of money. For the book, I had not yet interviewed Larry Bird. Even though I had always gotten along with Larry, for some reason, he had escaped me a few times, and then I had to cancel one appointment. So, the book was all done, except I didn’t have an interview with Larry Bird, and I had interviewed everybody else. Now, there was a lot of Larry in the book and could probably used quotes from that, but it was bugging the heck out of me that I hadn’t gotten him. So, ten days before my prostate surgery, I call his secretary for like the seventeenth time, and I said, “Tell Larry that I am going in for prostate cancer surgery next week, and if something happens to me on the operating table, my last thought is going to be that Larry blew me off for this book. I pulled out the Prostate Cancer Surgery Card!” So, Bird gets on the phone, and says, “Whadaya want?” I told him I had to see him in person. He says okay. So, I flew to Indiana the following Monday, and he was great. I interviewed him, and I remember calling up my editor, told him I got all this stuff from Larry Bird. I’ll just make this the last chapter of the book. We don’t need to change everything in the middle of it. I can just kind of add this on. It really fits with what I am writing about. So, the prostate cancer operation did help me get the final interview for the Dream Team book, and that reminds me now that I was not yet done with the Dream Team book when I decided to do the prostate book. The Dream Team book came out, and it was very successful, and once you have success with a book, they kinda want you to do another book and keep the momentum going, but I wanted to do my next book about prostate cancer. I am not a doctor, I am not famous enough for people to care about my cancer experience, so from a business standpoint, the prostate cancer book was not the best business decision I ever made, as my agent would tell you, but in a way, it was the most satisfying book I ever did because of this kind of community of people that I met. That didn’t answer your question, but I thought I would give you the Larry Bird story because it is somewhat interesting.
BM: From a distance it certainly appears your procedure was a success. How did life change for you after that?
JM: I got the procedure on a Monday. I think the following is pretty much standard operating procedure now. You have the operation, you wake up with a catheter, you are pretty much released the next day, which I was. You go home with a catheter, which I had in me until the following Tuesday, so I had it in for eight days. My wife was an enormous help during this whole thing. It’s not easy having a catheter. I was walking constantly around the house. I didn’t like laying there with this medieval thing inside of me and I remember one night, I think I put this in the prostate book, circling the arc of the living room like 137 times, just to stay active. And when I went back to get it out, it was no problem. I had had a catheter for other previous surgical procedures. It was not pleasant, but like every technology, that has changed, they put it in with a balloon, then they take it out. The big thing, you wait in the hospital to see if you can urinate. You are allowed to go to the gift shop and so my wife bought me a big bottle of water, and I just chugged this thing because with something like two or three percent of the cases, you get re-cathetered because you can’t pee, and if you can’t pee, they won’t let you leave. But that had never been my problem. So, as it turns out, I urinated, we left the hospital, and I was the happiest person in the world. What happened, though, and I don’t know if this is still the treatment, but in order to restore some of your function, they put you on contraceptive dosages of ED medication. I took a dosage of it and had a horrible reaction. That night, the night I had my catheter out for the first time, was one of the worst nights of my life. I couldn’t breath, had a headache, had a terrible constriction of the blood vessels in my eyes, and I called my doc and I said, ”We have to try something else,” and they put me on Cialis, because evidently your reaction to these medications can really vary from person to person. So, they put me on Cialis, kinda small doses, and they said if I really don’t want to take the medication, then don’t do it. That worked pretty good for me, but my reaction to the first drug was violent, and to this day, I’ve had people tell me that they take Viagra or Cialis and they don’t have kind of reaction. I do. I get a headache, but they are effective for what they are supposed to do. Anyway, the big thing is urination or your sexual function after you have a prostatectomy. Of course, the most important question is, do you still have cancer? That’s pretty much determined right away. They can look and say it did not leave the area of the prostate, so we do not need radiation. You have a prostatectomy, it’s not like you have going to have chemo or radiation afterward. They can say that they took out your cancerous prostate. That doesn’t mean you can’t get lung cancer, that doesn’t mean you can’t get some other kind of cancer, but they can say they treated your prostate cancer and you don’t have cancer right now. So the two questions are urination and sexual function. Urination is determined right away, and you have to determine yourself when you want to attempt, you know, sex again. I was writing this book, then I got a contract, but it was a small one. As I said, people would rather have me do something on pro basketball, but I had gotten a contract from Rodale Press to write the prostate cancer book, and I told my wife that I am going to have to write about this. My wife would be voted least likely person in the world to want details of our private life exposed, but if I was going to write this book, I was going to have to write about that stuff. The other thing about it, though, is that urination is probably a bigger concern, because we do it every day. As you get older, I was now 62, your sexual life is a factor in your life, but it was not what it was when you were 22, 32 or 42. With urination, one of the things you have to be worried about is leakage. The doctors talk about that a lot. There are times when your urination is spontaneous, you don’t know when it’s happened, you don’t know how you are going to control it, so you’d better be prepared. You better buy pads. The trip to the grocery store, which I write about in “The Prostate Monologues,” deals with going to that area of the store, where the adult diaper products are, I didn’t even know where that was, but now I am over there, searching. That’s a very, humiliating is too strong a word, but that’s a very sensitive part of the prostate journey. And I think for a lot of men, that appears to be a psychological regression. We came into the world in diapers, then we got out of diapers, and the regression back is demoralizing. I only wore them for a few days, and then it became apparent it wasn’t going to be a problem. Subsequently, have I had moments of spontaneous urination? Yes. Due to the operation? Probably, but has that been significant in my life? No. Once again, I am not a doctor, but the surgeon’s ability to spare the nerves that affect sexual function and affect urination obviously affect everything in the process.
BM: As you look at your physical life today, is there anything you can’t do? Do you feel shortchanged because there is something you could do, but can’t do now?
JM: I do take medication for sexual function. At the age of 70, would I be doing that anyway? Quite possibly. I think that part of your life is a little bit different than it was even when you were 60, but that could be that way, anyway. Urination for me has been fine. I just had a knee replacement, keeping with my orthopedic journey. I can’t blame any of this on my having prostate cancer, on having an operation. I credit the operation and I can’t blame it. However, I just want to make the point that I didn’t do anything correct. It wasn’t like, “Oh, I did this great preparation and I’m this great physical specimen. I got lucky. I had a skillful surgeon. I benefited from having good urination and good sexual function going in, because they are not going to be any better going out. Surgery is not going to improve them.” They were both good, and I had a partner, my wife was great during this whole thing. While I was doing the book, and I hope people do read it, there were doctors that looked at my PSA and they looked at my Gleason score, which is the amount of cancer there is, in many ways more important than the PSA, and if you have a Gleason score in the sevens or eights, your cancer is a lot more serious than if your score is a five or six. Mine was at the point in which one could make a serious argument for active surveillance. You could have made that argument, and a lot of prostate doctors would have made that argument. Others could have made the opposite argument, that I was at the point when I should have gotten treated. So I was right on that borderline, and when I was doing my book prostate book, the federal agency in charge of regulating medical procedures, such as how often should you get a mastectomy, how often should you get your PSA taken, a lot of those sorts of things that do up the cost of the medical profession, but you would argue on the other side are preventative. You know, the whole idea of preventative medicine. Prostate cancer preventiveness was skewing toward not getting treated or even not getting your PSA taken because their idea was, you’re going to get your PSA taken, it’s going to rise and you’re going to need to get surgery, and that surgery is going to cost you your sexual life or your continent life, and you didn’t have to get it done. All I know is that before PSAs became a regular thing, a regular part of treatment, I think it was the early 90s, the deaths from prostate cancer were overwhelmingly high. After PSAs started to be taken, the death rate went down precipitously. Now, did the rate of surgeries go up? Probably, and probably, there were some men treated who didn’t have to be treated, and probably some surgeons were saying you were more aggressively treated than you should have been treated, and it probably wasn’t going to kill you for another 35 years. I didn’t want to take that chance, number one, and, what’s happened in the last few years since I underwent my surgery, was that the idea of identifying cancer that is going to grow, that it is going to become lethal, that is the direction of cancer research, to be able to take that PSA reading, and that Gleason score and discern whether how aggressive it is. Had that been better when I was being scored, would that have made a difference whether I was getting treated, I don’t know the answer to that because all I know is, I was on a walk with my wife one night when we were trying to decide about active surveillance or intervention, and I remember stopping and saying to her, “Every time I go to the bathroom or every time we are trying to be intimate, all I am thinking about is that I have cancer.” Is that a viable reason to get treated? I don’t know that it isn’t a viable reason to get treated. This is an odds game, and sometimes it isn’t. Sometimes it’s very obvious that you have to get treated. Other times it’s obvious that you don’t. This vast volume of men in the middle, of which I was one, you have to decide yourself, according to what the doctor says, according to what your loved ones say, according to how you feel about surgery, according to how feel about your lifespan, according to how about how active you are right now, all those weigh into your decisions, and sometimes they are not easy.
BM: All those options, they can be part blessing and part curse. Our guest is Jack McCallum of Bethlehem, Pennsylvania, he’s the author of “The Prostate Monologues.” Jack, I want to talk to you about this book. I suspect this sort of thing evolved as you went on, but at the very outset, what was the objective of the book?
JM: Well, my joking objective was that I wanted to tell the lighter side of cancer. I was being somewhat facetious. I thought the only way I could write, the only way my style would allow me to write this would be if it were a little bit lighter, and even if my cancer had had a worse effect, even had I been, let’s say they didn’t get everything and they had to go back in, it still would have had that tone to it. That was sort of number one, it had a facetious tone to it, just because that is the way I had to write it. Number two, since I am not famous enough to say that the journey of Jack McCallum is going to be enough to sell a book, and because my outcome wasn’t tragic, I wanted to make it as ‘real person’ as I could. So my idea was to tell my experience, but in the back of the book, I knew I was going to interview a bunch of people, get their outcome, interview a bunch of doctors, get their opinion and I was going to sort of lay out, I had a chapter on my own personal care physician, I had a chapter on my surgeon, I had a chapter on who told me I shouldn’t have gotten surgery, you know you were fine. I had another chapter on who said I have got to get surgery as soon as you see that velocity go up. So in a way, what I did in the book was sort of illustrate the confusion because if you look at some of the opinions and some of the outcomes, there’s not one particular answer. There’s not one surgeon who says, “This is it.” All I could do was gather this, I told my own story in the beginning, and then at the end I had a lot of anecdotal evidence from friends, people that I had found, and I had created an e-mail, which I put in at the end of the book. If anyone wants to write me, it’s jacksprostatebook@gmail.com. This was in 2012, and I still get e-mails, not every day, not every week, but I have gotten hundreds and hundreds of e-mails, just saying here was my cancer experience, or I like your book. It’s committed a whole community of people, and as I said, financially and fame-wise, it hasn’t been as successful as some of my sports books, but it has been a much more satisfying feeling doing that prostate book than any other book that I ever did.
BM: Jack, you have referenced the survivor piece in this equation, and the urologist piece, but there is still one other part of this equation and all its variables that I would like you to talk about, and that is the ‘P’ word, politics. Politics manages to bubble to the surface just about everywhere, and as anyone will learn when reading “The Prostate Monologues,” politics asserts itself in the overall prostate cancer equation. Knowing what you know, what are those politics and how do they manifest themselves?
JM: Take my personal physician. He knows me, I’ve been going to him for 30 years. He knows what he needs to do to treat me. He has seen me all these years, he knows what I want out of life. He knows my blood pressure, my cholesterol, those sorts of things. So when it came to prostate cancer, he wants to be able to give me a PSA test. In other ways, though, he is kind of hamstrung, partly allegiant to federal guidelines on what standardized testing has to be, all that has to do with budgets. All of that figures into what does the budget for tests that are preventive medicine. There’s a preventive medicine wing of things and a treatment wing of things. The prostate part of this seems to go up and down. If you have a senator or a representative who was saved by having prostate intervention, you’re going to get somebody who’s voting to have a very aggressive preventive medicine philosophy. Then you’ll run into someone who says we treat too many people, we’ve overtreated this disease, that becomes the watchword for a while. When I was writing the book, I said that was kind of what was going on. I am trying to remember the name of the federal organization, it’s got seven letters, a preventive medicine task force that determines how you should treat these things, and this was right before I wrote the prostate book. That agency had recommended the number of breast examinations, something like a woman should get it if she 40, and now if she’s 50, and the outcry was unbelievable and was literally like three days later when they changed it. That’s pure politics. So, it’s almost like who has the greatest lobby in Washington, because it’s all about how much money to spend on preventive medicine versus how much money to spend on treatment. You’re right, Bruce, politics does play a big part in this and it’s all, federal budgets and it goes, up and down, you know, almost with every new administration that comes in.
BM: Jack, just one other question I want to ask you, and it pertains to something that is sort of in lockstep with what we do at Cancer Interviews. We never provide medical advice, and if you need that sort of advice, we suggest you contact a licensed health care professional. In some ways, you say the same thing in your book in that you refrain from giving unsolicited advice pre-treatment and you refrain from being judgmental about somebody else’s treatment after their procedure. That said, I am going to ask you to make a very athletic move and walk a tightrope.
JM: I just had a knee replacement, so don’t ask me to walk too carefully.
BM: Okay, well, just do your best and stay on top of the tightrope. That said, can you give somebody a primer in terms of how to go about seeking the best treatment options, and do that without dispensing medical advice.
JM: I would say if you have cancer in your family, and I am about to have this argument with my 43-year-old and my 40-year-old sons, because I had cancer and my father had cancer. They are candidates. So my oldest son is 43. Am I going to start haranguing him about going to his primary care physician to get a PSA test? Maybe his physician says to start getting tested when he is 50. Go to your primary care guy, get a physical, you don’t have to get one every year, but get your PSA testing. If you show a velocity in your PSA, get a biopsy. A biopsy is no longer the medieval procedure it used to be. When I got it, I wimped out and was put to sleep for the biopsy, and somebody else I know recently got it, and said it wasn’t that bad. All that considered, I would say if your primary care physician or urologist recommends getting a biopsy, I would get it. I would take my age into consideration, I would read all the existing literature, remember that every year things get better. You know the old saw, if you open up every 85-year-old man, you are going to find some form of prostate cancer. If you are much younger than that, and your level of cancer is negligible, and your doctor says to check it again in five years, I would say that is legitimate advice because the ability every year to tell aggressive from non-aggressive cells get better and better. This is just me. If you ask my opinion, what they do with robotic surgery, if you get someone who is skilled at it, and who has done thousands and thousands of those surgeries, I got out of there on a Monday, came home with the catheter on Tuesday, got the catheter out the following week, by the following Friday, there was nothing I couldn’t do. I felt nothing. With that surgery, I am not going to say nobody has ever screwed it up. Everything is a chance. I am just going to say for me, and for dozens and dozens of people that I interviewed, that has worked amazingly so. That technology keeps getting better and better, and make sure you get someone who has done thousands and thousands of these operations. Now, Dr. David Lee, who did mine, there was somebody at one time, who was Dr. Lee’s first, and there was somebody who was his nineteenth. I happened to be something like his 1,900th, but you can always find somebody who has done it many times, and chances are, you are going to be fine. Probably don’t expect your sex life to be the same as it was before the procedure, but this is a disease that is preventable, this is a disease that is treatable, it is a disease about which there is much information, unlike other forms of cancer, there is a lot you can do about this disease, so good luck with it and pay attention to the experts, and…I’m not a doctor.
BM: Jack, thanks so much. We’ve been talking with Jack McCallum of Bethlehem, Pennsylvania, author of “The Prostate Monologues,” and Jack, before we go, I am hoping there is somebody watching right now who will be intrigued enough that they want to get the full monty, they want to get the book. Because this book might not be available in bookstores, what’s your best advice for someone who would like to pick up “The Prostate Monologues”?
JM: Well, it was written in 2013, so you would only stumble upon it in used bookstores. The normal course of things is Amazon, or Google it, or if anybody wants to talk to me, I would be able to get you the book, I would be able to find out where to get it. I know it is on Amazon. Again, my e-mail address is jacksprostatebook@gmail.com, and I will see your e-mail and I will get back to you.
BM: Okay, Jack, thanks so much for spending time with us, and I think anybody who heard you on this segment, they certainly know more about this subject than when we began, so once again, thanks so much.
JM: Thank you, Bruce.
BM: And remember at Cancer Interviews, we want to with you on your cancer journey, and until next time, we will see you on down the road.
SHOW NOTES
TITLE: Jack McCallum, Prostate Cancer Survivor – Bethlehem, Pennsylvania, USA
Jack McCallum is a prostate cancer survivor. A legendary pro basketball writer for Sports Illustrated, he combined his storytelling skills and the details of his cancer journey to write The Prostate Monologues. The book examines prostate cancer from every imaginable viewpoint, all with an eye toward helping others who are dealing with prostate cancer.
Additional Resources:
Ed Randall’s Fans for the Cure: fansforthecure.org
Reading Material: The Prostate Monologues by Jack McCallum (Rodale Press)
Time Stamps:
13:56 Life before diagnosis.
19:08 Jack learns his biopsy results.
22:45 Why he decided to write “The Prostate Monologues.”
24:50 Treatment options.
29:09 Why Jack opted for robotic surgery.
34:54 How he felt after robotic prostatectomy.
39:02 Urinary/sexual function.
41:45 Urinary leakage issues.
51:50 Objective of “The Prostate Monologues”
68:20 Depend on a doctor with a prostate cancer surgery track record.
KEYWORDS (tags):
prostate cancer
cancer
active surveillance
cancer interviews
digital rectal exam
bruce morton
robotic surgery
jack mccallum
the prostate monologues
robotic prostatectomy
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