- prostate cancer-- it's a widespread killer, yet there's no consensus on how to treat it. - every doctor i talked to, there was a different story. - the screening methods are questioned. - it's very confusing for patients, and it's very confusing for the physicians. - and wild charges are made. - over 50,000 surgeries are done every year. 40,000 of those are unnecessary. - i don't believe that that statement is based in scientific fact. - sorting out the prostate puzzle. also "inside e street," the puzzles that draw fanatics from all over the country. - jeez, i can't believe how close this is gonna be-- a nanosecond. wow! - "inside e street" is made possible by... auto and home insurance from the hartford, helping to make a difficult time a little less difficult for drivers 50 and over. information about our program, including how to find an agent,

is available at hartfordautoinsurance.com. - from the heart of the nation's capital and around the country, you're "inside e street" with lark mccarthy. - one in 6 american men will get prostate cancer, a disease that kills more than 30,000 men a year. it's the second leading cancer killer after lung cancer. the good news is the emergence of the psa blood test in the late 1980's that has led to great progress in diagnosing and treating the disease. nonetheless, many american men and their doctors are now confused about the disease, confused about who should be tested and when, confused about appropriate treatments if diagnosed. conflicting studies have called into question whether the psa test actually saves lives. and the vast number of new cases every year has led to charges of overdiagnosis and overtreatment.

we'll try to cut through some of the confusion by speaking with two leading prostate cancer specialists. but first, more on the complicated picture of diagnosing and treating the disease. - since we last talked, you've retired, right? - mark kleckner's father died of prostate cancer at the age of 60. when mark was diagnosed at 46, he ran into a wall of confusion. - i immediately came to realize there isn't one specific protocol to treat the disease, and i became somewhatfrustr. - kleckner's frustration regarding treatment is widespread, and there's also confusion related to the screening process, disagreement over whether the psa blood test for prostate cancer actually saves lives. - two studies were published in the same issue of the new england journal last year, and the two studies had conflicting results. so this...this was a confusing topic

that became more confusing. - yet another study questioning the psa test made headlines earlier this year. to further muddy the waters, a popular book with a horror-invoking title claims that prostate cancer is grossly overtreated, often causing side effects that are worse than the disease. - it's very confusing for patients and is very confusing for the physicians that take care of them, both primary-care doctors and urologists. - the psa blood test for prostate cancer was approved by the fda in the late 1980's. - so before we had a blood test for prostate cancer, prostate cancer was only agnosed at much later stages. - so in the 1990's, there was a surge in the diagnosis of prostate cancer, and it was picked up at much earlier stages. that surge has led to today's charges of overdiagnosis and overtreatment. - we may overdiagnose cancers in people who it may never affect them in their lifetime,

versus if you didn't have the blood test, you may be missing cancers that will eventually kill someone. - to find the right balance, doctors at baltimore's john hopkins hospital concur inecommending annual psa screening for men over 50 who are presumed to be otherwise healthy and for men over 40 who have a family history of prostate cancer or who are african american. they suggest that most men over 75 probably do not need to be screened. - if you pick up a very early, very small tumor in someone who's 75 years old, it will likely not affect them in their lifetime, even if that is another 15 years. - the confusion regarding treatment is therefore focused on younger men. - the problem is we've now discovered that many of these cancers aren't life-threatening, and the treatment is almost always toxic to a man's sexuality.

- author and doctor mark scholz is one of those who claims that prostate cancer is overtreated. - doing surgery on everyone that has prostate cancer results in a tremendously high incidence of impotence, inability to function sexually, and incontinence. - and i have a veggie sandwich... - the side effects that i've experienced since the surgery are i don't have control over my bladder, and i don't have control over my bowel movements. so i have to wear protection all the time. i'm also impotent. - every patient who undergoes a prostatectomy is at risk for these side effects, but their incidence can be greatly reduced by choosing one's surgeon carefully. at johns hopkins and some other major research hospitals, 90% of post-surgical prostate patients retain continence, and more than 50% do not become impotent. regardless of side effects,

dr. mark scholz makes the highly charged claim in his book that most prostatectomies in the u.s. are avoidable. - over 50,000 surgeries are done every year. 40,000 of those are unnecessary. those men could either be watched or treated with a much milder treatment. - it's a claim strongly challenged by those at the forefront of prostate cancer research and treatment. by t- i do not agreefront of pwith that statent,earch and i d't belie that that statement is based in scientific fact. - take a deep breath, please. - dr. scholz nonetheless advocates far less aggressive treatment for most patients. - hundreds and now even thousands of men are living with known prostate cancer and undergoing no treatment whatsoever. this is an approach called active surveillance that has become standardized. - johns hopkins has the largest active surveillance group in the country but strictly defines who is eligible. - patients who are candidates for active surveillance

at johns hopkins are individuals over 65 years of age who have a diagnosis of the lowest grade of prostate cancer. - mark kleckner chose to have his prostate gland surgically removed at hopkins in 2009. - a few weeks later, i got the wonderful call from pathology that i had clear margins and the surgery was a success from a cancer perspective. and another week later, i got the catheter out, and you know, everything worked just like it was supposed to. i hope that the science behind prostate cancer can be advanced to the point where maybe my sons won't have to go through what i did. - and joining us now is dr. peter pinto, a urologic oncologist and senior surgeon at the national cancer institute, and dr. jonathan hwang, a urologic oncologist at the washington hospital center. thank you both for coming in. - thank you. - thank you. - no wonder a lot of men are confused, dismayed. let's get your reaction to this story by asking it this way--

is there a lot of dangerous information out there? dr. pinto? - there is a lot of confusion that exists a topic that needs more research. but as we heard just now in the segment, there is ongoing active research to answer these questions. unfortunately, among physicians, we don't know exactly which way to go. so i think the best opportunity to find those correct answers is to speak to your physician at detail about what's best for you, not for everybody. - dr. hwang, what are your concerns, your fear that some people might hear this message about unnecessary surgeries? are you worried that will keep some men from getting the proper screening or getting a biopsy? - i do, because when we look at what's available in the literature, all the studies that are ongoing, really the answer has not come about. i think within the next 5 years, through these randomized trials, we'll have a much more definitive stance whether screening truly does benefit patients or not. but until we have that information, i think it's a little bit premature to say that screening is unnecessary or may harm patients.

- we're going to get to your screening recommendations in just a moment, but one of the things that the author says in the book that we reference had to do with this question, i think, that scares a lot of people, that most of these prostate cancer surgeries are unnecessary, and what they say is that the people would have lived just as long without any operation at all. dr. pinto? - this is the issue, i think-- first of all, i'm a urologic surgeon, so there's some bias there on my part. - which is also what the critics say, right? that surgeons are making these decisions. - very true, and i trained at johns hopkins at the end of my career and came to nih to do these operations, and yet i think if you look at the deaths from prostate cancer compared to many years ago, they are down. i mean, we have seen a reduction in the men dying from cancer compared to many, many years ago. and i think psa, arguably, may have a role in that, including surgery. - dr. hwang? - i do believe that surgery has a role. we do need better markers, maybe better imaging modalities that can really distinguish who will benefit

from active intervention, but it is still too early to tell whether, you know, screening or even treatment at this stage is of harm, so that's something to be...to be waiting for it. - let's talk about the screening guidelines here. so the american urological association, you know, has these guidelines. interestingly, they talk about having to have an individual consultation with your doctor, and then it says language to the effect that men who choose to be screened-- isn't that in itself confusing? - oh, it's very confusing, and as was mentioned in the segment prior to this, we don't know exactly who to screen, when to screen, but we do know that it makes sense-- if you caught things early and treat them early, it should reduce the pain and suffering from that cancer. i think it makes sense to me also. - and i think "men who wish to be screened" is how they... but even with that in mind-- right, that is confusing-- are they the guidelines that you use in your own practice with your patients, those basic guidelines? - yes. - correct. yes.

- so it's the best thing that's out there. right? - yes. so far. - but, i mean, you really have to carry a frank conversation with a patient about the risk and benefit of screening as well as the treatments that may come follow. - all right. let's talk about the side effects, where we are now in terms of, you know, generally speaking, and how your surgeon matters, where you have the surgery matters. all right. incontinence, impotence, and this whole question of whether or not the penis will shrink. so let's just take them one at a time. incontinence--is that likely, not likely if you have prostate cancer surgery? - in the current platform, most surgeons use their technique that works for them. at academic centers, they do this for a living. so if your surgeon does prostate cancer surgery and does it often, those concerns are not really valid today. - ok. in terms of incontinence, generally speaking, most patients have a good outcome on that issue? - if they go to the right center in the right surgeon's hands. i think, unfortunately, when it comes down to this particular surgical modality, i think the surgeon's experience plays a tremendous role

in determining outcomes. - a minimum number of procedures a year that you would recommend for someone who's at, as you said, an academic hospital, a reputable hospital? how do you want to phrase it? i don't want to put words in your mouth, because we're telling people how to choose a hospital and how to choose a surgeon. what do they look for? - you know, that's a very difficult question to answer. there's no absolute. each surgeon has a different learning curve. but i would say that for this type of surgery, clearly i think you do need to perform at least 250-plus cases to become very comfortable really treating all patients with different body habitus and variations in their clinical presentation. - impotence? - so i think what you start with is important. so men that come in who are potent who has a surgeon that does the operation quite often, then maintaining the potency rates as discussed before, over 50% is expected. i think that as you get on in years and you get older, it becomes more challeing. but for the healthy young men, it's safe.

- that your penis will shrink? - you know, i have had many patients actually make that comment that, you know, for a short duration, that there appears to be a reduction in penile length. fortunately, there's now a very aggressive way of trying to rehabilitate the penile function, and with that usage, i've noticed that most patients do regain their length back. but you do have to be up-front with the patients that this is a possibility, that usually it should not interfere with their ability to have a very normal sexual life and be very satisfied with it. but you do need to warn the patients ahead. - let's talk about it. are there terms that every man ought to know, especially since the emphasis is on "have this individual discussion"? so when you're going to have that discussion or they're saying you do need this screening, what are some-- like for example, should every man know what psa is and psa velocity, which we haven't even talked about? so maybe we should talk about that just a little bit-- psa velocity and why is that important. - so, data supports and now does not support the use of a change in psa value over time.

and so if your psa was to rise quickly, some would argue that that means cancer could be hiding somewhere in your prostate. but more recent publications have questioned that. again, it speaks to just the difficulty in coming up with a concrete solution to these issues. - but again, a term that a man should know to ask about, and whether or not you believe this-- because some people say, hey, riding your bike, whether or not you've had sex can change your psa level. is that true or not true? - that is true, that we do recommend abstaining from any sexual activity as least two days prior if you know that you will have your psa test. in addition, we do have other biomarkers now available beyond psa alone, such as the urine pca3 test. there's also percent free psa analysis. so it's not just the psa alone that we rely on or nor velocity to be able to look at the whole picture, combine that with a digital rectal examination, and make a determination whether this patient will truly benefit from the next stage of workup, which is a biopsy. - how many opinions should a man get

if he is told, "you have prostate cancer"? - i usually advise my patients that you should get as many opinions until you feel comfortable. now, sometimes that can lead to more confusion, but at the same time, because there is no definite answer in regard to what is the best way to manage patients with early-stage prostate cancer, i think each patient has a different level of comfort level. i do believe you should at least get one other opinion of a different specialty, because we all do have biases towards what we do, and i think in order to get more balanced opinions about what may be available or may be most effective, that you should at least get one other consultation outside a particular specialty. - you were nodding yes. - 100% correct. john's right. and not just urologic opinions, but radiation oncology, medical oncology, your internist, your family practitioner, your general practitioner all should weigh in on this. - your message, you know, just in wrping it up here, to men--what would you say about it? because there's on the blogs, it's, you know, articles, all sorts of information is out there.

where do you get reliable information to make an informed decision about your health? - i believe you should definitely have a very frank conversation with your urologist or with your internist and also, because there's so much information about this topic that's available in the internet, rather than using a biased website, i think it's very imptant to use much more national-based websites, such as the national cancer institute, american cancer society. and at the end of the day, i think you need to speak with your family and decide what's the best way to move. - i think your internist really, your family practitioner will help in many ways guide you through the specialists. - well, we thank you for helping guide us through some of this prostate puzzle confusion. we appreciate your time today and for sharing your expertise. good luck on your work, both of you. - thank you. - thank you for having us. - in a moment, we're going to meet a man whose brush with prostate cancer surgery brought him face to face with the confusion that often surrounds this disease. - we want your ideas and feedback. so follow us on twitter at insideestreet.

retweets are welcome. - our next guest knows the value of getting more than one opinion. calvin lawrence is an abcnews.com editor who was days away from a prostate surgery he didn't need. calvin, thanks so much for coming in. - thanks for having me. - so you go to the doctor, and you get a diagnosis of prostate cancer, right? - that's correct, yes. - so you get a second opinion. what was that second opinion? - the second opinion was that i also have cancer, although it was not as severe as the first opinion, but i still had cancer. - ok. and so with this information-- when you say "not as severe," they were saying it was not the most aggressive type of cancer, was what they were telling you? - well, just by way of background, there are 12 core samples taken from the prostate. the first biopsy, or first analysis, that i had 5 of those 12 were cancerous. the second opinion showed that i had 3 of those 12 cores showing cancer. that's what i mean by--

- so that's what you mean. because other people who had this will understand exactly what you're saying. - they will, i think. - all right. so at that point, you're processing, you have a decision to make. what did you go through in making that decision? who did you consult? because you made a decision-- all right, you would have the surgery, right? - yes, i did. i started back with my primary-care physician, who referred me to the urologist, and he agreed with his decision, or opinion, that i have the surgery. i also checked with a few friends who were going through this same sort of dilemma. i consulted with my family, of course, my wife, and we were all in agreement that i should have the surgery. in the meantime, though, i thought it made sense, because i s not completely comfortle with the idea of having the surgery, that i get a third opinion... which i'm glad i did. thank god. - but we should say-- so surgery was scheduled? - yes. yes. - scheduled. on the books. but then it was still in the back of your mind, "hmm...let me just get one more opinion here." right? - i think the issue for me was that those two analyses

were a bit different. - because they were different? - yes. so that raises a red flag for me automatically. and also i'd been reading, by this time, a book that you mentioned in your previous segment, "invasion of the prostate snatchers," and the authors there ggested that it makes sense to get a high-quality cancer research facility to look at those samples. i picked johns hopkins because i was born at johns hopkins. i grew up in baltimore, and it's sort of the gold standard for me. so i sent the samples. actually, i had the urologist send the samples, and they were more than happy to. - should we point that out? that they happily complied with your request, right? - there was no resistance, none at all. and then 5 days before the surgery, as you say, i get a call from the urologist at my office, who says that he has to put the surgery off because hopkins found no cancer. - they found no cancer. at first, you were disappointed. right? - i was, because i made peace with my decision. i'd wrapped my mind around having this surgery,

so i was...i was crushed in a way, surprisingly. - you also, though--and this is astonishing to me and a lot of people-- you don't blame anyone, and you made a conscious decision not to. so talk about that process. - i don't because i understand that this is not an exact science, medicine, despite what many people think. mistakes do happen. they happen all the time. and i just felt relied and fortunate to have caught this mistake before it happened. that's kind of where my mind was at that point, i think. - was there ever a sense, though, where you said, you know, "how could this happen?" - oh, sure, sureyou think, "well, how did this happen? aren't these guys supposed to be so smart?" well, they are smart, but again, my urologist is at the mercy of pathologists, and studying these samples is not an exact science, as we've discovered. - all right. talk about where you are, because you have to have ongoing monitoring, because it turns out you did have, not cancer, but atypical cells. so what does that mean for you? - that means that i have to have a routine psa test, blood test, every 3 months, as opposed to having it every year,

which is the standard for a man my age. it means going in, having a test, and it also means monitoring the results. if the results show any increase at all, that i'm probably going to need another biopsy at some point. and i may do that just as a routine in another 6 months or so. - what would your message be to other men and in particular african american men, who we do know are at higher risk for prostate cancer, and mortality is higr? what would you s abt the need for screening and as you said, being a partner in your own health care? - i think, number one, you should start with a screening. i think, especially for black men, when you hit 40, 45, you should start the screenings right away. and i know there's some dispute about how valuable they are, but i think if you take the step, then you can decide what to do with the results. i think you have to start somewhere. i think you should also, yes, see yourself as a partner in the treatment of your health. it's your health. you may have to be a junior partner unless you have a medical degree.

but nonetheless, i think you should be a participant, an active participant in how doctors treat you. - well, thank you so much for coming in, calvin lawrence, and for sharing your story. we appreciate it. continued good health to you. - my pleasure. thank you. - coming up, here's the clue, 14 letters-- a crossword puzzle constructor or enthusiast. the answer straight ahead. - for more on prostate cancer, go to insideestreet.org. - here's a good word across or down-- cruciverbalist. oh, how they love their crossword puzzles-- building them, solving them. every year, hundreds fill a huge hotel ballroom in brooklyn, new york, to compete to be the champion word nerd. - ♪ i love words ♪ i love words ♪ i love glorious, uproarious, notorious words ♪ - and perhaps no one loves words

more than this man. - my name is will shortz. i am crossword editor for the new york times, puzzle master for npr, and founder-director of the american crossword puzzle tournament. i have the world's only college degree in enigmatology, the study of puzzles. on your mark, get set, go! - for 34 years, shortz has presided over a kind of march madness of crossword fanatics, who dazzle even the longtime observers. - i can solve puzzles in an afternoon. they can solve them in 5 minutes. it's astounding. - speed and accuracy are vital to win. just ask al sanders, who made a fatal error in a dramatic finish 5 years ago that cost him the championship. - i had been to the finals a lot of years, but i had never won before. i'd never finish it. so for once, i get up there, and i'm going through the final puzzle, and i'm going pretty fast. i yelled "done!" and then i step back and take off my headphones, and i look, and there's two squares up on the top corner i had not gone back and filled in.

so i take my headphones, and i throw them down on the ground with this big boom, and i just kind of went off and cried to myself, because that was my best shot ever at winning. - that year, 20-year-old tyler hinman became the youngest contestant to win the top prize. he would keep the title for 5 straight years, until last year, when dan feyer stole the crown. - when i saw the movie "wordplay," i started doing upwards of 10, 20 puzzles a day, because i just kind of got addicted. yeah, i hope they haven't taken over my life. - finalists have 15 minutes to finish the puzzle on stage, and feyer's addiction paid off again this year. - and our returning champion, champion again, perfect in 6 minutes, 33 seconds, dan feyer. [cheering and applause] - crosswords activate many parts of the brain-- your vocabulary, your knowledge of things you learned in school, older popular culture, what's going on today, your mental flexibility. - the grande dame of the crossword tournament,

miriam raphael, collected her 26th trophy at this year's contest, claimed the senior's title, and was honored on her 85th birthday. - ♪ siegfried had a way with tigers ♪ ♪ darwin had a way with birds ♪ what can i say? ♪ i have a way with words [piano playing] - next "inside e street," grandparents flexing their muscles, concerned about their grandchildren's well-being. - what's in the child's best interest? what's in the child's well-being? and i knew we had to change that, and we could only change it by changing the law. - grandparents on a mission. thanks for joining us. i'm lark mccarthy. see you next time "inside e street."

- "inside e street" is a production of aarp, in association with maryland public television. - "inside e street" is made possible by... auto and home insurance from the hartford, helping to make a difficult time a little less difficult for drivers 50 and over. information about our program, including how to find an agent, is available at hartfordautoinsurance.com. to purchase a dvd of "inside e street," order online at insideestreet.org or call 800-873-6154. please include the show number.

which foot was it? best make that "best wishes." we don't want them getng their hopes up, do we? no, i suppose not. have always done it. why should she watch the flowers? nobody really remembers,