Introductory Letter for USMA Class of 1962

re Prostate Cancer Support Group

Classmates,                                                                                                                            August 22, 2006

“The time has come, the Walrus said, to speak of many things….” [“Walrus & the Carpenter” by Lewis Carroll]

The time has now come for our Class of 1962 to start to pull together, as we have before on so many other important issues, to support classmates with severe illnesses. One of the more common ailments now is Prostate Cancer (PC). It has a recognized increase of occurrence due to aging (and we all are). In fact, research shows that by age 80, 70% to 90% of men have cancer in their prostate.  And for those of us who had the Vietnam experience, the Veterans Administration has recognized increased likelihood due to possible Agent Orange issues.

At a recent social function I attended, I happened to be talking with a member of the USMA Class of 1958, who described to me a class initiative to establish a Prostate Cancer Support Group for afflicted members of that class. He put me in touch with ‘58’s Class Moderator, Stan Bacon, who has been very helpful in sharing what they’ve attempted and how they’ve gone about it. They use a restricted web-site (thru wp-org), where some of the general info parts are accessible to all and individual-specific info is in a permission-only subset.  As the occurrences of PC within our own class have continued to grow, it sounded like a very useful effort for our class, as well. Stan has been sufficiently successful within his class that several other classes, from ’55 thru ’60, have each established their own Class Prostate Cancer Support Group, and the Class Moderators remain in communication and coordination on relevant developments.

Their intent, as would be for ours, has been to develop an active group to provide information and support to those in the class who become afflicted with PC, and to those wanting to learn more about how to prevent it in the first place.  Naturally, non-cancerous prostate issues such as BPH, or enlarged prostates, are fair game as well.  Although we should start with ‘58’s guidelines so we can get underway with structure, faster, we are free to go in whatever subsequent directions we feel our individual class should follow. As time goes on and other issues arise, the Class could encourage similar support groups for other ailments, building on this program.

The true success of the group is highly dependent upon our ability to communicate freely and openly with each other. But the issues we deal with are often very personal and highly sensitive in nature.  They include, but are by no means limited to external assaults upon our masculinity, even our mortality.  Therefore, confidentiality and sensitivity are the very cornerstones of our program.  Personal issues stay within the group and we are very mindful and respectful of each other’s feelings and needs.

‘58’s group grew rapidly to just over a hundred, or a quarter of their living classmates and former classmates.  Of those, 24 have been diagnosed with PC from as early on as 1993 and as recently as this year.  Surprised?  Don't be!   There are probably a few more still out there who haven’t announced, and regretfully, more to come in the future.  This is an issue that most people just don't like to talk openly about.  But there are 22 list members in ’58 who have been afflicted with PC, who have courageously and selflessly identified themselves to the group and have availed themselves on a one-on-one basis to provide counsel and assistance to those who become afflicted and want help from those who have been there, done that.   And the system really works.  Those from ’58 who have identified themselves within their class as PC-afflicted have certainly been appreciative of the emotional support they have received from close friends and concerned classmates.

In our Class of 1962, I know of three cases of PC in my company alone, two successfully overcome; it has already claimed the life of at least one of our classmates from another company just this year. Extrapolating leads to numbers similar to ‘58’s.  Others are undoubtedly busy fighting for their lives.  Many others have succeeded in getting their afflictions under control before this list can be established, and we hope they will join in the list to share their own specific “lessons learned” in their success so that others may benefit.

We are working to put our Class of ’62 Prostate Cancer Support Group together with the initial support of two survivors (one as Alternate Moderator) and another classmate who will bring his medical experience to help us laymen understand (try, anyway) the medical issues and terminology.

It must be clear to all, however, that this is to be a Support Group, not an alternative to medical support from your own medical practitioners. We cannot replace or substitute for medical diagnoses or treatments – not even our own PC Support Group MD would attempt that without personal and in-person evaluation and assessment; we intend to help you understand better, and to provide support in the form of information and encouragement from those who experienced it already.

1.       This Support Group’s Objectives are, initially at least, to:

a.  Provide support to those classmates who have been newly diagnosed with PC.

b.  Enable those previously afflicted to assist and support each other during and beyond initial treatments.

c.  Enable newly afflicted members to seek and receive advice and assistance from those previously afflicted, keeping in mind that individual circumstances and priorities for treatment vary, so one's choices may not be best for another. 

d.  Educate members on prevention, treatment options and post treatment lifestyle modification options.

e.  Educate members on various issues relating to benign prostatic hyperplasia/hyper-trophy (BPH) and other non-cancerous prostate problems.

2.       Keep in mind that individuals have differing motives for participating in the PC support group.  Be understanding and supportive of each other’s differences.

3.       The real success of this group will be best achieved by establishing and maintaining an environment in which we all feel comfortable speaking openly and discussing sensitive issues that are personal in nature.  Lend your personal support to that goal by:

a.  Treating all discussions confidentially and not discussing content of a personal nature outside the group without the express permission of the individual concerned.

b.  Being sensitive to the feelings of others when approaching individuals to request personal information and in framing your message responses to the group and to individuals.

c.  Vital to overcoming threats of PC and other prostate afflictions is the timely sharing of relevant information with the group. Whenever and wherever you encounter such, make the effort to get it on out to us.  When in doubt, err on the side of getting it on out there, and we’ll try to help ascertain relevance and import.

If you would like to learn more about prevention or if you have become afflicted with PC and would like to receive support, please review our “PC Support Group Guidelines” as they get published on our web site. Also feel free to email me (jhmalley@adelphia.net ) or Charlie Shaw (charles.l.shaw@us.army.mil), our Alternate Moderator and a PC Survivor, or our Class CIO Jim Heldman (jheldman@heldman.com) for more information.  As indicated in the “Guidelines” we offer different levels and types of assistance depending upon the particular level of confidentiality desired.

Respectfully offered,

                        Jim “Moose” Malley                                                                                              Charlie Shaw

                        PC Support Group Moderator                                                                      Alternate Moderator

Attached:          USMA Class of 1962 Prostate Cancer Support Group Guidelines (First Draft)

                        Other PC-Related Links


 

USMA Class of 1962

Prostate Cancer Support Group Guidelines
(First Draft as of August 2006, with appreciation to Class of 1958’s earlier efforts)


I.  FOR ALL LIST MEMBERS:

1.  This Support Group’s Objectives are, initially at least, to:

a.  Provide support to those classmates who have been newly diagnosed with PC.

b.  Enable those previously afflicted to assist and support each other during and beyond initial treatments.

c.  Enable newly afflicted members to seek and receive advice and assistance from those previously afflicted, keeping in mind that individual circumstances and priorities for treatment vary, so one's choices may not be best for another. 

d.  Educate members on prevention, treatment options and post treatment lifestyle modification options.

e.  Educate members on various issues relating to benign prostatic hyperplasia/hyper-trophy (BPH) and other non-cancerous prostate problems.

2.       Keep in mind that individuals have differing motives for participating in the PC support group.  Be understanding and supportive of each other’s differences.

3.       The real success of this group will be best achieved by establishing and maintaining an environment in which we all feel comfortable speaking openly and discussing sensitive issues that are personal in nature.  Lend your personal support to that goal by:

a.  Treating all discussions confidentially and not discussing content of a personal nature outside the group without the express permission of the individual concerned.

b.  Being sensitive to the feelings of others when approaching individuals to request personal information and in framing your message responses to the group and to individuals.

c.  Vital to overcoming threats of PC and other prostate afflictions is the timely sharing of relevant information with the group. Whenever and wherever you encounter such, make the effort to get it on out to us.  When in doubt, err on the side of getting it on out there, and we’ll try to help ascertain relevance and import.

II.  FOR THOSE WHO HAVE (OR HAD) PROSTATE CANCER:

   1.  Identify yourself to the list moderator with the year you were diagnosed, and let him know whether or not you choose to be identified on the list with a (PC-XX) by your name, referred to as the (PC) Badge w/Wreath, indicating that you are available to consult with other list members on a one-on-one basis to discuss treatment options, post treatment issues and/or receive/provide moral support (see paragraphs 3 & 4, section V).

2.  If you wish, complete the Prostate Cancer History Form (separately available) for your own use in giving information easily and simply to those you wish to have it.

3.  Answer inquiries from others if you wish, or do not.  Your choice.

4.  If you wish, send the list moderator your completed history form for inclusion in a master worksheet, to be held in confidence.  The information provided may be used for statistical analysis to develop trends of interest to all list members, presented in an anonymous format.  For (PC) Badge recipients, portions of the information will be used to develop and maintain the Treatment Selections Table to be provided to all (PC) Badge recipients to facilitate mutual post treatment assistance, and to all newly diagnosed classmates, in confidence, to assist them in receiving advice and assistance in consideration of various treatment options.

5.  At some point you may wish to share particularly sensitive aspects of your history anonymously in narrative form with the group.  This would allow you to preserve confidentiality while helping others by enhancing their awareness of the resource base available to them and providing them with a means of contacting you directly if you are so willing.  The list moderator will assign an ID number to the document and post it to the list.  Anyone wishing to consult with you on your history would first need to contact the list moderator or alternate for approval.  Do not include information that you would not want to discuss with someone directly.  You may also post an anonymous history and elect not to be contacted.  Your choice

6.  If you consult with others, avoid recommending any specific course of treatment.  Remember that goals and treatment options vary for each individual and that treatments will be changing and improving over time.

7.  The best advice you can give a newly afflicted classmate is to recommend that he follow the suggestions below.

III.  FOR THOSE WHO HAVE JUST BEEN DIAGNOSED POSITIVE FOR PROSTATE CANCER:

1.  Get a second opinion. And a third.

2.  If you did not already get a biopsy, get one, from a doc/hospital with lots of experience.  Reason: a diagnosis can’t be medically confirmed without one, nor various characteristics of the particular tumor determined. Experience counts.  Learn about the Gleason Score.  Learn your Gleason Score for each positive sample, and the location of each.  Get a drawing of it.

3.  If your urologist doesn’t explain all the current treatments available and all the pros and cons, get a new urologist.

4.  Get knowledgeable on all aspects of PC in order to understand the issues, ask the right questions and take a proactive involvement in the treatment process.  By far, your most accessible source is the Internet. 

5.  Determine your goals and priorities, and be honest with yourself.  Here are some things to consider:

   a. What is really most important to you – your quality of life in the short term, or your best chance for long-term remission?

   b.  What are your priorities?  Best chance for getting rid of the cancer? (There is no sure cure, but the odds are greater or lesser depending on the stage of your cancer and whether it has escaped the prostate.)  Best chance for bladder control?  Best chance for an active sex life?  Rank these 1, 2, 3.

   c.  Discuss your priorities and goals with your significant other.  Hers may be different, and may change yours!

6.  Discuss your diagnosis with as many physicians (not urologists, radiologists or surgeons) as you can, asking them these questions (do not prompt them):  If you had my diagnosis, (1) what treatment would you select? (2) Who would do it?  (3) Where would you go to have it done?  And (4) Why to those questions?

7.  Contact the list moderator or the designated alternate.  He will provide you with a copy of The Treatment Selections Table showing the previously afflicted  (PC) Badge recipients and the treatments they selected so that you can consult with them on a one-on-one basis as you choose.  Their experiences may help you in your treatment selections, keeping in mind that their priorities and the treatments they selected may differ from yours.  Also let the moderator know how much information about your situation you want released to other list members (see paragraph 7, section V).

8.  Decide on a course of treatment(s).

9.  Get it done as soon as possible.

10.  Follow instructions for recovery/rehab, etc.

11.  Do all these things, and live life to the fullest.

IV.  FOR THOSE WHO HAVE NOT BEEN DIAGNOSED POSITIVE FOR PROSTATE CANCER:

1.  Get your PSA (prostate specific antigen level) checked at least once per year, or more often if you have problems such as trouble urinating or frequent urination.  The PSA is a simple blood test that requires no fasting.  Just have it added it to the list of stuff already on the Rx for the lab work associated with the annual physical we should all be getting anyway.  And you should have your physician perform a digital rectal exam (DRE) , also known as the “finger wave”, as part of the physical.  This is the companion diagnostic tool to the PSAT for early detection of PC. Avoid having sex 48-72 hours prior to being tested as that may produce a false high reading.  If your PSA is elevated, your physician may recommend further testing.  Or he/she may prescribe antibiotics to insure that infection is not the cause of an elevated PSA score.  Request a test that will include your free/unbound and bound PSA percentages. 

2.  Obtain a copy of your previous PSA test (PSAT) scores from your doctor and watch for changes.  A rise of 0.5 or more should be cause for concern.  But keep in mind that factors other than PC may produce a temporary rise.  Get it checked out.

3.  Maintain good general health and an effective immune system by following the advice in our Prostate Cancer Prevention Guide.

4.  Stay informed, and have a general idea of what to do if you develop PC.  Help other list members stay informed by passing on pertinent information that you come across.

V.  FOR THE LIST MODERATOR:

1.  Promote open, free discussions among list members while ensuring the maintenance of appropriate levels of confidentiality and sensitivity to others.

2.  Maintain list currency through timely submissions of changes to WP-ORG, and provide list members with monthly updates.

3.  On the monthly updated lists to the membership, indicate those members who have been previously diagnosed with PC and who have made themselves available to other members for consultation on initial treatments and post-treatment issues, by placing a  (PC-XX) by their name on the list, where XX indicates the year of initial diagnosis.  This is commonly referred to as the (PC) Badge w/Wreath and the recipients as (PC) Badgers. (Or, if you’d prefer, we could have “Wolverines” or “Bears” or “Walruses” or whatevers … just trying to inject a little levity in this otherwise urgently serious subject!)

4.  Acknowledge to the list each newly designated (PC) Badge recipient with an appropriate award ,e.g. “Attention to orders!  By whatever authority my imagination allows as list moderator, (name) is hereby awarded the (PC) Badge w/Wreath to be worn proudly by his name on the PC list, telling other list members that he has been afflicted with PC and is making himself available to them on a one-on-one basis to provide whatever counsel and assistance he can offer on the subject, while keeping in mind that everyone's situation is unique with regard to individual circumstances and personal priorities, and that what worked for him may or may not be best for them. His willingness to participate in this manner is a reflection of his personal courage and selfless dedication to his fellow classmates. He has thus joined an elite group of whom we are all very proud and grateful, and who merit our support as they deal with their individual afflictions.”

5.  Maintain a confidential database of individual historical PC information received from list members.

6.  Maintain the Treatment Selection Table of (PC) Badge recipients showing information on their initial PC diagnosis, the various treatments selected by them, and their results.  Provide an updated copy of the table to them to facilitate mutual post treatment assistance, and also to newly diagnosed classmates, informing them they should handle the information in a confidential manner and use it only for contacting individual (PC) Badge recipients for support and treatment advice.

7.  Make early contact with any classmate newly diagnosed with PC, invite him to join the list if he has not already done so, and explain how he might be supported by the list membership.  Provide him with a copy of the Treatment Selections Table so that he may contact whomever he wishes on the table to seek guidance on selecting treatment options.  Should he choose to join or is already on the list, sort out with him the level of  exposure/confidentiality with which he is most comfortable regarding the diagnosis -- (1) moderator does not tell anyone on the list about the diagnosis, but encourages him to contact (PC) Badge recipients individually for help, (2) moderator notifies only the (PC) Badge recipients so they can contact him to offer help, or (3) moderator informs the entire list so the classmate can receive fairly broad support.  Where he wants to be contacted by (PC) Badge recipients or the list members at large, moderator will make that clear to the appropriate group and provide his phone number and email address.  Moderator will encourage list members to initiate contact with him by phone or email depending upon their level of compassion and/or desire to help.  Moderator will check back with him within a week to see if he is comfortable with how we have been handling it and find out what else we can do.  Should he choose to not join the list, moderator will, with his permission, notify the (PC) Badge recipients of the situation and ask them to contact him.  Similarly, moderator will follow up in a week.

8. Maintain the class PC Diagnosis Distribution Table showing the distribution of PC diagnoses in the class over time and comparing it with the national average as provided by the most recent SEER data which is normally revised in April of each year.

9.  Insure that the class at large maintains awareness of the services provided by and to the list membership by periodically providing information to the class on list objectives and class status with regard to PC, and encouraging classmates interested in PC prevention and those newly diagnosed with PC to join the list.

10.  Maintain a confidential database of submitted anonymous histories published to the list, assigning each an ID number.  Direct individuals wishing to consult with the authors to them based on the latter’s personal preferences. 

11.  Coordinate with the list member designated to maintain the PC web site on use and content of the site.

12. Ensure an alternate moderator is designated, known to the list as such, and kept informed of all appropriate ongoing list activities. 

13.  Interface with outside entities such as other class PC list moderators and representatives of PC study organizations to coordinate activities of mutual interest to the list members.


 


Other PC-Related Links [as provided by Class of ‘58]

 



Helpful Info on Specific Subjects:

·         Moderate Exercise: No Pain, Big Gain:

<http://www.west-point.org/class/usma1958-pc/ModExercise.htm>

·         Returning to Intimacy after PC Therapy
<http://www.west-point.org/class/usma1958-pc/PCReturn2Intimacy.htm>


Helpful Institutional Web Sites:


Alternative Approaches: