Master Of Your Own Destiny

Stephen Eisenmann’s youngest grandchildren are 5-year-old twin girls.

They’re spunky, perceptive beyond their years and they adore their 64-year-old grandfather, whom they call Bebop.

“I’m telling you – I’m gonna be here for when they get married,” Eisenmann says.

And, judging by the resolve in his voice, it’s tough not to believe him.  

But that wasn’t the expectation four years ago, when a diagnosis of stage four metastatic prostate cancer blindsided the otherwise healthy New York City resident, who lives part-time in Clearwater.

“When you hear the words ‘stage four cancer,’ you think ‘death sentence,’” Eisenmann says. “But I’m a fighter. I wasn’t going down without a fight.”

And, in the battle he’s waging, he’s certainly not alone. Cancer of the prostate – the gland between the base of the penis and the rectum that produces the fluid that mixes with sperm – is the most common cancer for men in the United States apart from non-melanoma skin cancer, according to the U.S. Centers for Disease Control and Prevention. This year, there will be an estimated 191,930 new cases nationwide, according to the American Cancer Society. 

Diagnosed at an early stage, prostate cancer is highly treatable, and many prostate cancers are so small and slow growing that they may not require treatment at all. 

“About 50 percent of men are diagnosed with the type of prostate cancer that we know can be safely observed and does not require immediate treatment,” says Dr. Scott Eggener, director of the University of Chicago’s High Risk & Advanced Prostate Cancer Clinic.

Nearly 100 percent of patients with localized prostate cancer (meaning the cancer hasn’t spread beyond the prostate) survive for at least five years, according to the American Cancer Society. That five-year survival rate drops to 30 percent of patients once the cancer has spread widely.

Eisenmann was diagnosed only after his cancer had spread to his lymph nodes and bones. At the time, he and his wife, Elizabeth (dubbed Me Mom by their grandchildren), knew the chances were slim that he would live to see the twins each tie the knot.

Being Proactive

After years of chemotherapy; traveling the East Coast for second opinions; and, ultimately, trying an experimental treatment as a leap of faith, Eisenmann is a strong proponent of early detection and seeing specialists from the onset.

“Had I been diagnosed a year earlier, there’s some chance that I wouldn’t have been a stage four prostate cancer patient at diagnosis,” he says.

However, cancer wasn’t on Eisenmann’s radar because he didn’t have a family history of the disease and was in great shape. In retrospect, he acknowledges that he was experiencing symptoms – including frequently waking during the night to urinate – but he didn’t think much of it. 

“I drink a lot of water throughout the day,” Eisenmann says. “It didn’t seem like a big deal.”

One of his biggest pre-diagnosis missteps was that he didn’t immediately visit a urologist in 2015, when his PSA test, a blood test used to screen for prostate cancer by measuring prostate-specific antigen, revealed a dramatic increase. Had Eisenmann seen a urologist then, he might have been diagnosed earlier. Instead, he stuck with his general practitioner.

Eisenmann doesn’t fault his GP, however. Many factors can increase PSA levels, including age, prostate size and non-cancerous conditions such as prostatitis (an infection) and benign prostate hyperplasia (an enlarged but non-cancerous prostate).

“My general practitioner was a great doctor,” he says. “But, with a PSA differential like mine – 1.9 to 7 in about a year – you need to see a urologist.”

In 2016, a urologist ultimately diagnosed Eisenmann with stage four prostate cancer.

Questions Surrounding Screening

In the world of prostate cancer, Eisenmann’s experience is rare. It’s more common for men to have what Dr. Eggener calls “wimpy cancers,” meaning localized cancers that grow slowly and don’t require immediate treatment. 

In recent decades, a widespread increase in PSA screenings has saved thousands of lives, he says. But it’s something of a double-edged sword.

“It’s way more likely that men are diagnosed with cancers they never needed to know about,” Dr. Eggener says. “Then, they’re treated for something that was never going to cause problems.”

Dr. David Taub, director of urologic oncology at Boca Raton Regional Hospital, agrees: “The ‘C’ word freaks people out, but not all cancers are created equal.”

So how do doctors differentiate between men like Eisenmann, for whom screening is imperative, and those for whom screening is unnecessary?

Dr. Taub says it’s a balancing act: “If we catch someone with aggressive disease, that could be lifesaving. We don’t want to miss that, but we also want to minimize diagnoses with non-aggressive disease.”

When it comes to who should get screened for prostate cancer, the official guidelines from the U.S. Preventative Services Task Force are vague: “For men aged 55 to 69 years, the decision to undergo periodic prostate-specific antigen-based screening for prostate cancer should be an individual one.”

In making screening decisions, clinicians and hospitals consider age, family history, race and ethnicity (men of African-American descent are at a statistically higher risk), existing medical conditions and personal preferences.

Following a PSA test, the results should be considered alongside other information, including prostate size, which doctors can determine through a digital rectal exam (“digital” meaning finger), says Dr. Eggener. To assess the full picture, doctors may recommend additional tests before a biopsy, including MRIs or other blood or urine tests.

New Treatment Options

Treatment methods vary depending on a cancer’s stage and how aggressive it is. For prostate cancer, doctors use a system called the Gleason score, which ranges from 6 to 10, with 6 being the least aggressive cancer. 

“I’m fairly convinced that there’s never been a man in the history of time who’s died of Gleason 6 prostate cancer,” Dr. Eggener says. 

Many men with Gleason 6 cancers follow an active surveillance approach, in which they don’t receive treatment but keep close tabs on the disease through frequent tests and scans. Other men diagnosed with localized prostate cancer may opt for a radical prostatectomy, which is surgery to remove the prostate, or undergo other forms of targeted treatment, including radiation.

Both surgery and radiation have seen major advancements in recent years. With the former, most men now receive a minimally invasive, robotic procedure. 

With radiation, men have myriad options, including photon beam radiation (using X-rays or gamma rays) or proton beam radiation therapy. Protons are thought to cause fewer side effects than photons because they don’t leave behind an “exit dose” of residual radiation. Another benefit of proton therapy is that it can minimize radiation hitting the rectum, in turn reducing side effects like bowel urgency, says Dr. Marcio Fagundes, medical director of radiation oncology at Miami Cancer Institute, where he administers proton therapy. 

Doctors debate the superiority of proton therapy because clinical trials evaluating the latest versions of the technology are ongoing. And, in the absence of definitive results, some insurance companies won’t cover it.

“The study is being done to quantify how much better proton beam therapy can be in terms of quality of life and the reduction of side effects,” says Dr. Fagundes.

Later-Stage Decisions

When Eisenmann was diagnosed, he learned that he would need a more systemic treatment than surgery or radiation because his cancer had spread so widely. Initially, this included chemotherapy alongside a hormone therapy drug, leuprolide, which slows prostate cancer growth by limiting testosterone production. This combination worked for a while, but Eisenmann’s disease eventually continued to spread. 

His oncologist, Dr. Dana Rathkopf at Memorial Sloan Kettering Cancer Center in New York City, ultimately found an unconventional next step for Eisenmann: immunotherapy. Currently, immunotherapy drugs, which empower the body’s own immune system to fight cancer, are an option for a very small percentage of men with prostate cancer. Success depends on specific factors, such as the presence of gene mutations. 

Genomic testing revealed that Eisenmann was one of about 7 percent of men with a rare gene mutation that made him a potential candidate for pembrolizumab, an immunotherapy drug. The chances it would work were slim, but he gave it a shot. 

When he went to get his results from the treatment, it was an emotionally charged moment.

“I’ll never ever forget it,” Eisenmann says, his voice breaking. “Dr. Rathkopf brought in her entire team to tell me the news.” 

After three cycles of the drug, his cancer had entered near total remission. 

Today, he’s still receiving injections of pembrolizumab every three weeks. He isn’t sure how long this will continue, but he doesn’t mind. For now, he’s focusing on his job, his family, and healthy diet and exercise. He’s also doing everything he can to give back to the prostate cancer community. 

His advice for others? Check out the Prostate Cancer Foundation, a nonprofit that connected him with his oncologist, Dr. Rathkopf, and which supports research into new treatments like the one that saved his life. Plus, he says, the information it provides online is clear and accurate. 

“When I was diagnosed, I went on the internet,” Eisenmann says. “And a lot of the stuff is scary. It’s not accurate. If you are diagnosed with prostate cancer, go do your own research. You are the master of your own destiny.” O