One of my early experiences as an apparatus operator was checking out a piece of fire apparatus every morning. Right after going on duty, I would go out to the bay and look under the hood of the fire truck. The interesting part about that check-up was that I would do it even if that truck hadn't moved for the previous 24 hours.

What's that got to do with you? If you're a chief officer, you probably aren't in the apparatus bay checking on daily maintenance anymore because you wouldn't be able to do your job as chief. However, you are responsible for personal check-ups, so let me ask you a very straightforward question: When was the last time you checked under your own hood?

The most valuable thing you have is your health, yet it's often one of the most neglected aspects of the preventive maintenance programs for a healthy work force. In fact, our health is often an uncomfortable topic to even discuss. It may not be addressed until it affects a close friend or family member.

Beyond line-of-duty deaths

Let's face it: When a firefighter dies in the line of duty, there's an awful lot of concern. That is as it should be, but an increasingly serious problem is firefighters becoming disabled and experiencing health problems that may or may not be job-related. This is especially onerous if these problems occur during retirement.

A lot of fire chiefs simply don't want to talk about the health problems that may crop up as they approach retirement. Over the last few years I've had numerous conversations with individuals who suddenly discovered health problems that weren't related to the job of firefighting, problems that creep up on many people sooner or later, such as diabetes and prostate cancer.

What's the initial remedy? The answer is so simple that it's overlooked by a lot of individuals — an annual physical to identify potential problems. You don't want to do it? Well, let me try to startle you into realizing that it's time to start doing it. I recently researched prostate cancer because several of my friends have been diagnosed with it. These are people who led hale and hearty lives but now, faced with this diagnosis, have completely different feelings about the future. Almost all of them agreed that an ounce of prevention was worth a pound of cure. The sooner symptoms are diagnosed, the more likely a patient will be able to opt for a less-invasive remedy.

Approximately 180,000 instances of prostate cancer are discovered every year in the United States, and about 38,000 of these cases result in mortality. It affects rich and poor alike, the common laborer or the world leader.

Dr. Christopher Evans of the University of California — Davis, Department of Urological Surgery, says that “one out of 11 American males are likely to develop prostate cancer at some point in their life. If the American male is of African-American descent, than it is almost four times as high a possibility.”

It doesn't take long to calculate that if 180,000 males are going to contract this problem, then some of them may be among those in the fire service. Because we tend to be a male-dominated industry in the first place, it's possible that a disproportionate number of our personnel could experience this phenomenon.

Initial testing

The prostate gland is a part of the male reproductive system and is linked with the urinary system. Most of the time this gland is latent, but by age 50 about one-third of American men will have microscopic signs of prostate cancer.

Prostate cancer can be detected with a simple blood test that looks for prostate-specific antigens. This PSA test can be administered easily as part of an annual physical. It's recommended that men over the age of 50 have a PSA test and prostate exam every year; African-American men should start at age 45.

If a person has normal results, this first test can be used as a baseline to identify subsequent PSA changes. If an elevated or increasing PSA level is detected, then a biopsy should be taken. Diagnosed cases are classified by the Gleason grading system, which assigns a score to cancerous tissues ranging from a low of 1 to a high of 5. The two largest areas of cancer are rated and added together to derive a cumulative Gleason score between 1 and 10.

The biopsy to diagnose prostate cancer is vital to determining appropriate treatment. Untreated cancer can spread or metastasize to other parts of the body. Prostate cancer may be confined to the prostate, locally advanced to the regional lymph nodes or disseminated to other sites, usually bone. The term used to evaluate how widespread the cancer might be is called “staging.”

Treatment options

Prostate cancer is a slow-growing condition. Often the initial treatment consists of “watchful waiting,” working with a doctor to monitor the situation.

The two primary ways of treating localized prostate cancer are radiation and surgery. Individuals who have been diagnosed should research these options before determining a course of action. Dr. Evans strongly suggests that a person diagnosed with prostate cancer should get a second opinion. A second opinion assures that the patient is adequately informed of his options and that a diagnosis results in similar recommendations.

Of course, the courses of treatment have consequences. One of the individuals I interviewed for this article was Steve Hart, a former fire marshal, who was startled to learn that choosing radiation as the primary source of mitigation eliminates the possibility of surgery later on, because the use of radiation in the past makes it more difficult for doctors to perform surgery. There are two types of radiation dosage that can be used, low dosage and high dosage. The former is applied through the insertion of tiny seeds of radioactive materials; the latter is administered from an external radiation source

There are consequences to surgery as well, because it results in the removal of specific muscles in the prostate area that control the urinary tract. One of the byproducts of surgery is the need to learn specific techniques to maintain continence.

At this point you're probably grimacing just a little bit. These are not easy things to contemplate. As a matter of fact, these are quite private issues that often affect how a man feels about himself and how he relates to his family and society — all the more reason why prostate problems need to be exposed and talked about. Diagnosing a problem and doing something about it is a lot different than being confronted with a set of circumstances that are virtually irreversible.

Tough to accept

Do you know of anyone who has contracted prostate cancer? I personally know of more than a dozen. Do you know anyone who has died from this disease? I know of three. If you haven't, then you are among the lucky in our population. However, if you have borne witness to this phenomenon and can't see how it relates to you personally, it's time to engage in a little bit of introspection.

When someone is diagnosed with prostate cancer, it's time to become much more knowledgeable. The American Cancer Society maintains a Web site at www.cancer.org that provides information on this disease, and there are several other Web sites that also provide information on prevention and treatment.

There are many people who are ready to help patients and families cope with prostate cancer. Local and national agencies can help with sexual counseling, emotional support, financial aid, home care and transportation. Local support groups consist of people who have cancer. Many men find it helpful to meet and talk with others who face similar problems. Sharing experiences may provide support, encouragement and understanding. A list of local and national support groups usually can be obtained from the social service office of your local hospital or clinic.

One of the ways of ensuring a long and healthy retirement is to make sure that you are taking care of yourself in the time period just prior to it. I once interviewed a doctor who discussed the health issues by using the following analogy: The human life is like a light bulb in that we should glow for a long time and go out all at once. Long, lingering diseases are hard on families, and they're hard on relationships. If we are thinking of all of the people in our lives, then the investment in remaining healthy for as long as possible is time and money well spent.

In the fire service we are always saying things like “information is power” as if we can control our lives through acquiring information. In this case it's true. Here, information about your health truly is power. If you have knowledge of what is happening to your body, then you are in a position to do something about it. If you were checking under that hood of a fire truck and saw that the vehicle was low on oil, you would act on that information. This is an area of checking up that is every bit as essential.

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A 40-year veteran of the fire service, Ronny J. Coleman is the president of the Fire & Emergency Television Network, which features career development and succession planning in its Command Transfer series. He has served as fire chief in Fullerton and San Clemente, Calif., and was the fire marshal of the State of California from 1992 to 1999. He is a certified fire chief and a master instructor in the California Fire Service Training and Education System. A Fellow of the Institution of Fire Engineers, he has an associate's degree in fire science, a bachelor's in political science and a master's in vocational education.

Useful Web sites for more info

American Prostate Society
www.ameripros.org

The American Prostate Society is a nonprofit volunteer organization that provides services and materials at no charge. Newsletters and other information are available at the Web site.

CancerSociety.com
www.cancersociety.com

CancerSociety.com is an effective tool for patients, families, physicians and educators to gather information, discuss topics of interest with one another and provide necessary resources.

Cancerdata.com
www.cancerdata.com

Cancerdata.com is an Internet-based network of physicians and health care professionals committed to providing patients with the most current, accurate and relevant information. Cancerdata.com will enable patients and their support people to fight cancer through the use of modern technology and access to individualized information.

Association for the Cure of Cancer of the Prostate
www.capcure.org

Founded in 1993, the Association for the Cure of Cancer of the Prostate is the world's largest private source of prostate cancer research funding.

International Cancer Alliance
www.icare.org

The International Cancer Alliance for Research and Education is a nonprofit organization that provides individualized cancer information to patients and physicians. Through ICARE's Web site, patients can register to receive newsletters, updates and other information.

National Cancer Institute
www.cancer.gov

The National Cancer Institute is a component of the National Institutes of Health, one of eight agencies that make up the Public Health Service in the Department of Health and Human Services. The National Cancer Institute coordinates the National Cancer Program, which conducts and supports research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention and treatment of cancer; rehabilitation from cancer; and the continuing care of patients and their families.

National Prostate Cancer Coalition
www.pcacoalition.org

Based in Washington, D.C., the National Prostate Cancer Coalition is dedicated to boosting the level of federal funding for prostate cancer research. NPCC includes the American Cancer Society, American Foundation for Urologic Disease, American Urologic Association, Association for the Cure of Cancer of the Prostate, B'nai B'rith International, Cancer Research Institute, CaPCure and Men's Health Network, as well as prostate cancer survivors, family members, researchers, and health professionals.

Prostate Cancer Research and Education Foundation
www.prostatecancer.com

PC-REF conducts prostate cancer research for possible prevention; for seeking new diagnostic and therapeutic tools; and for providing education to the general public with the goal of increasing awareness of prostate cancer, its management and the need for patient involvement in treatment decisions.

Prostate Cancer Research Institute
www.prostate-cancer.org

The Prostate Cancer Research Institute's mission is to end prostate cancer. PCRI is dedicated to educating the public about prostate cancer, pursuing research into its prevention and treatment, and improving the present level of care for men with the disease.

Prostate Cancer Resource Network
www.pcrn.org

The Prostate Cancer Resource Network is a charitable foundation that maintains a toll-free information line at 800-915-1001 to answer questions and provide additional resources. The network also publishes and distributes patient information Web sites and videotapes about prostate cancer diagnosis and treatment, and provides information about patient support groups.

Prostate Health Council, American Foundation for Urologic Disease
www.afud.org

Founded in 1987, the American Foundation for Urologic Disease is a nonprofit organization dedicated to supporting research, education, and patient support services for those who are affected by or may be at risk for developing a urologic disease or disorder. The organization provides educational information about urologic diseases and conditions to the general public and health care providers. Materials are available that discuss prostate disease, prostate cancer, enlarged prostate and prostatitis.

US TOO International
www.ustoo.org

US TOO International provides prostate cancer survivors and their families with emotional and educational support through a network of groups, and it offers literature on prostate cancer, a quarterly newsletter and a toll-free hotline at 800-808-7866.

Questions for your doctor

How advanced is my prostate cancer? It's important to know the stage of your cancer and if it has spread. The higher the risk group, the greater chance that it has or will soon spread. Patients with prostate-specific antigens less than 10 ng/mL and a Gleason score of 6 or lower are considered low-risk; those with PSAS between 10 and 19.9 ng/mL and a Gleason score of 7 are considered intermediate-risk; and patients with PSAS greater than 20 ng/mL and a Gleason score of 8 or higher are considered high-risk.

What is the grade of my cancer, and why is this important? The grade, or Gleason score, is a measure of how rapidly the cells are growing. Gleason scores over 6 indicate rapid cell growth.

Do I need further tests, such as a cat scan or bone scan? Additional tests are recommended as they will determine whether the cancer has spread.

Do I need a second opinion? A second opinion is important, especially if only one method of treatment has been strongly recommended, such as surgery. Without careful discussion of other options, including seeds and radiation, you won't be able to compare each procedure, including the rate of success in treating your particular cancer or the degree of complications associated with a particular treatment.

What are the pros and cons of each treatment choice? What are the risks and complications? Impotence occurs in about 50% to 60% of surgical cases, in about 30% of those treated with radiation, and in 10% to 15% of men treated with seeds. Incontinence occurs in 1% to 5% of those treated by surgery and almost never in men treated with seeds.

What are the cure rates for each treatment in my stage of cancer? For low-risk patients, cure rates with surgery are 87% and 95% with seeds; intermediate-risk patients have a 66% cure rate with surgery and an 88% cure rate with seeds; and high-risk patients see a 66% surgery cure rate and an 86% seeds cure rate. Results for combination treatments that add radiation to seeds are even better. In addition, patients who undergo surgery have a greater risk for cancer to reoccur.

How many days will I be in the hospital? A patient will be in the hospital for up to five days for prostate cancer surgery. Seeds are a one-hour outpatient office procedure.

What is the recovery time after each treatment? Recovery from prostate cancer surgery averages six weeks. Treatment with seeds has the patient returned to his daily routine in two to three days.

What is likely to happen if I choose watchful waiting? This is not generally advisable as early detection means an early cure with minimally invasive treatments.

Once I have been diagnosed with prostate cancer, how frequently will I have to see my doctor? Every six months for a PSA test and physical exam for the rest of your life.
— Dr. Jerrold Sharkey Urology Health Center, Port Richey, Fla.