By Jon Gillis
“I’m sorry, Mr. Gillis, but I don’t have good news for you.” So began my conversation with a Seattle urologist on a warm August day this past year. After sensing the adrenaline surge within my body in reaction to his words, I began to assess their impact.
“Me?” I asked myself. “I have prostate cancer? Now what?”
The answer to the last question, in the context of the past seven months, has been pretty basic: Get rid of the cancer, give myself the best possible odds for long-term survival, and educate as many people as possible on the facts surrounding the subject of prostate cancer. I’ve addressed the first two goals, and now I’m dealing with the education.
The 2006 estimate for prostate cancer among American males is 234,460 newly diagnosed cases, with approximately 30,000 deaths. The new cases exceed those of breast cancer among women. In fact, a man is 35 percent more likely to be diagnosed with prostate cancer than a woman is to be diagnosed with breast cancer. It is the second leading cause of cancer deaths among men in the United States (lung cancer is first). Approximately one in six men in this country will be diagnosed with prostate cancer in their lifetime. For firefighters, the estimate is even more ominous. The results of a three-year University of Cincinnati study published in November 2006 underscore this point. Referring to the report, lead researcher Dr. Grace LeMasters indicated that we face a 28 percent higher risk of prostate cancer than other male workers.
According to the Prostate Cancer Foundation, a nonsmoking man is more likely to develop prostate cancer than he is to develop lung/bronchus, colon, rectal, bladder, melanoma, lymphoma, and kidney cancers combined. Also, as men age, their risk of developing prostate cancer increases exponentially. Although only one in 10,000 under age 40 will be diagnosed, the rate becomes one in 38 for ages 40 to 59 and one in 14 for ages 60 to 69. More than 65 percent of all prostate cancers are diagnosed in men over the age of 65. African American men are 61 percent more likely to develop prostate cancer compared with Caucasian men and nearly 2 1/2 times as likely to die from the disease.
What does this mean for you, one of America’s firefighters? Well, my brother, I would start educating myself on the subject. For example, since many cancer experts believe our American diet contributes significantly to this deadly phenomenon, I urge each of you to read up on the pros and cons relating to nutrition and prostate cancer (see the resources listed at the end of this article). I hope you will work your way through this information.
Since prevention is such an operative word for the fire service, we would be wise to focus on this, as an imperative, as it relates to prostate cancer. As I’ve indicated, we can mitigate the risks, in part, through positive changes in diet. Limiting our exposures to various toxins on the fireground (and other emergency locations) should be another goal, albeit a very challenging one.
LeMasters, in her University of Cincinnati study, concluded that, “ … firefighters are exposed to numerous cancer-causing substances. I think obviously they have not got enough protection from that exposure. We feel that the protective gear that protects them from acute exposure, such as heat and carbon monoxide, doesn’t protect them from the chemical residues that cause cancer. When firefighters are sweaty on the job, the pores in their skin are open and are more likely to absorb chemical residue. We do have protective gear for soldiers and NASA astronauts, and if we make it a priority, we can protect these firefighters. It just has not been a priority, even though firefighters are public servants and risk their lives.”
One action we can take to mitigate exposure during the course of our emergency work is to limit the actual time of exposure. Incident commanders should rotate crews more often. Company officers and members have a stake in ensuring this effort. Dealing with our emergencies in a thoughtfully aggressive manner is the best prescription.
Additionally, each of us must strive to motivate our department leaders; our local, county, and state jurisdictions; and our union leadership (where applicable) to lobby for better protective ensembles. Clearly, industry has the creative means to ensure such improvements. However, we all have to be more deliberate and innovative in how we secure the appropriate funding to accomplish this.
There is also the controversial subject of appropriate medical coverage for prostate cancer treatment. For example, many fire service jurisdictions fall under a workers’ compensation umbrella for job-related injuries and illnesses. These laws generally put the onus on the employees to prove that their illness or injury arises from their employment. As most of you are aware, various firefighter unions, state associations, and the International Association of Fire Fighters have been working tirelessly to secure “presumptive” legislation for various cancers. This legislation puts the onus on the employer to prove that the particular cancer is not job-related.
One such legislative change has taken place in Washington State. The Washington State Council of Fire Fighters was successful in securing presumptive language for prostate cancer. A trade-off resulted in coverage only for those under age 50 who are affected.
Concurrent with these essential efforts, we all need to be proactive and plan for a healthy future. I urge every man age 40 and older to seek annual blood testing and track your PSA results [“prostate-specific antigen,” or PSA, is a protein produced by the prostate that may be found in an increased amount in the blood of men who have prostate cancer, benign prostatic hyperplasia (BPH), or infection/inflammation of the prostate]. It is essential to establish a baseline. An increase in your PSA from one year to the next may indicate the presence of prostate cancer.
Another important step is to get an annual digital rectal exam. As unpleasant as this may sound, it is an important component of prostate monitoring. The exam is an approximately 10- to 15-second procedure in which the doctor palpates the surface of the prostate through the rectal wall. There have been numerous instances where this exam picked up prostate abnormalities, yet the PSA results were within normal limits.
Prostate cancer is the most curable of known cancers afflicting men. Early detection is key. It is generally slow growing and can take years before it is noticed. My specialists have indicated that it is likely I had prostate cancer for five years before it was detected. My PSA results over a three-year period “told the tale.”
MY TREATMENT AND OUTLOOK
So, what have been my personal challenges with this devious adversary? For starters, I had a biopsy two days after being promoted to battalion chief. Three days later, I received confirmation of prostate cancer. Two of the 12 testing samples showed cancer. It was determined that the cancer was of an “intermediate” aggressive nature. I figured I would have one of the shortest battalion chief tenures on record in the Seattle Fire Department.
I was determined to meet the challenge head-on and began educating myself on the options. I used the Internet, read books, consulted with physicians, and discussed personal histories with a number of other affected men (most were referred to me by friends and relatives). The most common approaches for dealing with prostate cancer are surgical removal of the cancerous prostate (prostatectomy) and the implantation of radioactive seeds into the prostate (“brachytherapy”). Unfortunately, there are a number of potential side effects associated with both procedures. A man’s urinary continence and erectile functioning can hang in the balance. Clearly, all of the factors involved present a complex set of circumstances.
In my case, I chose to have the known cancer removed from my body. Along with the prostate, the doctors took my two seminal vesicles and 12 lymph nodes and performed a bone marrow draw (to ensure that my hip bones were void of the cancer). I was fortunate that the doctors were able to use a state-of-the-art robotic procedure, which is less intrusive than the so-called “open” method of a radical prostatectomy.
My surgery was considered successfulthis means the cancer was confined to the prostate, the important nerves affecting continence and erectile function were spared, and there is an approximately 85 percent chance these cancer cells won’t reappear. My surgeon noted that I had five times the amount of malignancy than what was anticipated. I will have my PSA level checked every three months for a year and twice a year for the ensuing five-year period. (Note: Even with the prostate removed, prostate cancer cells can produce PSA results.)
Currently, I’m seven months post-surgery, and I have 100 percent urinary continence. The doctors say the return of normal erectile functioning can take from 12 to 18 months, which underscores why prostate cancer is seen as a “couples disease.” Believe me when I say your spouse or partner has a huge stake in the consequences of prostate cancer!
Prostate cancer can dim your perspective of your chosen profession. Or, it can foster a personal determination to avoid becoming a “victim” and can present an opportunity to accentuate the positive by forging a new plan for wellness and fitness. I hope you choose the latter and give yourself the best odds of having a long and productive fire service career, as well as a happy and satisfying life.
LeMasters, Grace K. PhD; Ash M. Genaidy, PhD; Paul Succop, PhD; James Deddens, PhD; Tarek Sobeih, MD, PhD; Heriberto Barriera-Viruet, PhD; Kari Dunning, PhD; James Lockey, MD, MS, “Cancer Risk Among Firefighters: A Review and Meta-analysis of 32 Studies,” Journal of Occupational & Environmental Medicine, November 2006; 48(11):1189-1202.
JON GILLIS is a battalion chief and a 31-year veteran of the Seattle (WA) Fire Department. He has degrees from the University of Washington and is a past Fire Fighter of the Year and Officer of the Year. He is a past co-chair of the department’s Wellness-Fitness Committee as well as a past vice-president and president of the Seattle Fire Fighter’s Union, Local 27. He also spent time representing his firefighters on the Washington State Council of Fire Fighters.