•  Book Review: Prostate Cancer Guides •  Prostate Health Center

Hit Below the Belt: Facing Up to Prostate Cancer
By F. Ralph Berberich, MD
Celestial Arts
201 pp $14.95

When Ralph Berberich found out he had an aggressive form of prostate cancer in 1998, it propelled him on a long, desperate quest for information on the type of treatment he should get.

In doing so, Berberich had a distinct advantage over the ordinary patient: He is a doctor, a pediatrician with a background in pediatric oncology. But none of his medical training prepared him for being a patient. "There is nothing smaller and more vulnerable than a patient with a life-threatening illness seeking help from the elevated starched white coats," he writes. "The faculty clinic building and the urology suite formed an imposing unit. I didn't feel like the powerful doctor anymore."

This humbling entry into the world of serious illness is a haunting refrain in Hit Below the Belt, the author's odyssey through sterile waiting rooms, laboratories, and radiation chambers, and the fears he confronts along the way. As he chronicles his journey on the rubble-strewn road to remission, Berberich makes some uncomfortable discoveries about a disease that has often been dubbed the "breast cancer for men."

The first indication that there was something wrong with Berberich came when, in a routine physical, the results of his prostate-specific antigen (PSA) test were abnormally high (on various tests, between 4 and 6). It was the first example of what Berberich found to be a maddening lack of certainty in the field of prostate diagnosis and treatment. PSA readings can give false positives and false negatives, doctors told Berberich, and rates can vary with age and the presence of common noncancerous conditions. To make sure there's really something there, doctors said, better have a biopsy. But even then, there's no certainty; the biopsy needles can miss a tumor entirely.

Biopsy completed, tumor identified, Berberich was then thrust into the predicament of choosing the best treatment. His endless search for another opinion revealed three options: radical prostatectomy, radiation, or, the choice of many European doctors, "watchful waiting," the practice of closely monitoring the disease's progress. Berberich kept a chronicle of his consultations with physicians, and he was excruciatingly methodical in his quest for the proper treatment. He spent months on his research, interviewing the most advanced experts in the field, including former colleagues and people he attended medical school with. Friends and relatives feared that he would disappear into the minutia of the search, he recalls.

Despite the lofty claims of some physicians he interviewed, it took Berberich several more months to arrive at the strategy that was right for him. The surgeons he talked to were supremely confident that they could solve his problem. But there were no guarantees that a prostatectomy wouldn't damage the nerves that control urination and erections. "The first cousin of this very quality of confidence [that surgeons all seem to possess]," notes Berberich, "is arrogance." Radiologists, on the other hand, were of many opinions as to how best to attack prostate cancer: radiation focused on the prostate tumor, generalized pelvic radiation, radioactive seeds. Berberich's head was spinning.

His big concern, of course, was to reduce the risk of any long-term damage to himself. Ultimately, Berberich decides on treatments that he felt were the least intrusive options. These included testosterone deprivation to bring down the PSA numbers ("Remember that most prostate cancer cells need testosterone"), five weeks of having his prostate zapped with X-rays (external beam radiation), then, the hoped for coup de grace for the disease, the implantation of radioactive "seeds" in his tumorous prostate. Rejecting the removal of his prostate as an option, he confesses, had as much to do with his deep aversion to general anesthesia and surgery (and the twin curses of impotence and incontinence that can sometimes accompany a prostatectomy) as with his seasoned conviction that a prostatectomy was the wrong medical choice for him. "In the end," he says, "I had to admit to myself that what I saw as my own judgment was that quality others had referred to as gut feeling."

There's a lot of compelling description in the book, like what it feels like to try to urinate just after those radioactive "seeds" have been surgically implanted in your prostate. But for all of the candid -- sometimes courageously honest -- descriptions of his treatments, we never really get to know Berberich as a person. He talks about his determination not to speak in euphemisms when it comes to revealing intimate details, and no one could fault him for that. At times, though, the narrator himself disappears into the colorless text: He can talk about his bowel movements, but he won't tell us about his partner, other than the fact that she's also a doctor who lives with him and is in the midst of her own battle with cancer.

And Berberich doesn't do much soul-searching about the disease. He never asks the question: Why me? Was it an inherited trait that selected him for the disease? A meat-heavy diet? Although the answer is almost never certain, people with prostates want to know.

Nevertheless, "Hit Below the Belt" is an extraordinarily useful book, one likely to become an indispensable read for those grappling with treatment choices. The disease will disrupt a patient's life like a depth charge going off in a pond, the author says. But those who are afflicted with prostate cancer have little choice but to leap into treatment with energy and faith. "With cancer," Berberich says, "the clock is always ticking."

But don't give up hope, he adds. "Keep in mind the difference between 'I have cancer' and 'I am cancer,'" he says. "Work to keep the monster in his box."

-- Edmund Newton is a former reporter for the Los Angeles Times. He has also reported for People, Reuters, and the New York Post.

First published March 27, 2002
Last updated February 19, 2008
Copyright © 2002 Consumer Health Interactive

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