With the development of the prostate-specific antigen (PSA) test in the early 1990s, the urology community advocated for population screening of all men of a certain age, igniting a heated argument about the test’s clinical value vs potential harms that has not abated to this day. Moreover, from screening to diagnosis and on to a multiplicity of anxiety-ridden treatment decisions, the prostate cancer waters remain as muddy and turbulent as ever. 

Rare Breed of Oncology Specialist

To bring clarity to this crucial public health issue, Mark Scholz, MD, has written and edited a clear-headed and accessible book called The Key to Prostate Cancer: 30 Experts Explain 15 Stages of Prostate Cancer. Dr. Scholz, who is Medical Director of Prostate Oncology Specialists of Marina Del Rey, California, and The Prostate Cancer Research Institute of Culver City, California, is also the author of the acclaimed book The Invasion of the Prostate Snatchers: An Essential Guide to Managing Prostate Cancer for Patients and Their Families. 

Separated into seven sections, each section neatly arranged into highly readable, subheaded units, The Key to Prostate Cancer is a well-designed roadmap for men facing the dilemma of selecting the right treatment among so many options—many that confer significant risks and side effects. Dr. Scholz has spent his entire career in medical oncology specializing on one disease—prostate cancer—which in itself makes him a rare breed of oncology specialist. Along with his clinical practice, in which he sees patients 4 days a week, he writes, does public speaking engagements, conducts research, attends and arranges conferences, and makes educational videos. His passion for men’s prostate health comes across on every of the book’s 50 chapters, which includes contributions from 30 nationally recognized prostate cancer experts. 

Why Read This Book?

Besides books on breast cancer, prostate cancer books rack up the most shelf space in the cancer-related sections of book stores and libraries, so the single most important question becomes what makes this book relevant? The resounding answer is that The Key to Prostate Cancer is designed to educate men, slow down the decision-making process, and guide them to strategies that will help them avoid losing their prostate. 

Early on, it becomes clear that Dr. Scholz is a skeptic of the urologic communities model of detection and treatment. And although PSA testing remains in the crosshairs of hot debate, Dr. Scholz stresses that if used properly, the PSA test is a valuable tool; it’s the overuse and misuse of the fickle core biopsy that lead to unnecessary procedures and attendant harms.

In Chapter 2, Stanley Brosman, MD, explains in lay-friendly language everything a man needs to know about PSA testing. It is a small gem of knowledge that every man should have. It would make a great handout for primary care doctors to give to their middle-aged male patients. Likewise, the chapter on pathology, in which the dauntingly difficult to grasp Gleason scoring is handled with equal facility, is educational. 

Perhaps the most salient messaging for the medical community arrives in Chapter 15, where Dr. Scholz continues his discussions of staging, contending that understanding staging is empowering for patients, providing them the confidence to confront industry biases and respectfully stand up to doctors who may be less than fully informed. Here he deals with one of the most controversial and problematic issues in the prostate cancer decision tree: when to recommend active surveillance.

He points to a 2012 survey from the Mayo Clinic and Harvard about physicians’ attitudes regarding active surveillance for men with very low–risk prostate cancer About two-thirds of doctors were comfortable recommending active surveillance. However, for men who had merely low-risk disease, just 21% of doctors endorsed active surveillance, which drives home his concern about industry bias and uninformed doctors. 

The book rolls out systematically, making it easy for readers to mark sections for future reference. Also included among the clinical content are excellent sections on lifestyle, general health issues, interpreting lab results, and a glossary. This is a comprehensive yet small book, a breath of fresh air from overwritten tomes that bog down readers with too much information. Dr. Scholz knew when less was more. Studies show that treatment choices based on partial or wrong information often leave patients in a state of regret. The Key to Prostate Cancer can serve as an antidote to that. It is highly recommended for The ASCO Post readers and their patients. ■