New York Yankees Manager Joe Torre
From the Johns Hopkins Prostate Bulletin
As his New York Yankees struggled to hold onto first place in their division during one of the team's worst Septembers in history, Joe Torre took time out from his hectic schedule to call. He didn't want to talk about the Yankee ball team he's been managing for five seasons, but about his prostate cancer, and of the tremendous help he received from his wife, Ali, in dealing with all the complex issues he faced immediately after being diagnosed in early 1999. (For those of you who don't follow baseball, the Yankees eventually came out of their late-summer funk weeks later and went on to win their third consecutive World Series title.)
"Unfortunately, heart disease runs in my family," says the 60-year-old Torre, whose brother Frank received a heart transplant in 1996. "So in February, 1999, just like I do every year, I took my series of medical tests. Only this time, my cardiologist told me that my PSA level appeared to be a bit elevated and I should have it checked out again when I got down to Florida for spring training, which I did. My PSA came back at 4.5 ng/ml and my free PSA was extremely low. A biopsy that was performed shortly after came back positive. I was told that I had an aggressive cancer.
Woman with a mission
"Up until the final biopsy test result came in, Ali was in her own form of denial, in that she hoped that I didn't have cancer. But once she knew for sure, she was on my case. She is the one who did all the researching. She went on the Internet for background medical information. She bought all the books on the subject of prostate cancer and later came up with a written list of questions we needed answered by the doctor to help us in the tough decision-making process. By the time we eventually went to see the urology specialist in St. Louis, we were extremely well prepared for our appointment.
"I was numb when I got the cancer diagnosis and I don't know what I would have done if Ali hadn't been there to get me through it all. It later became very clear to me that you need a spouse or a good friend to be there for you, to keep you on level ground and to give you hope. Otherwise, saddled with the cancer diagnosis, it becomes so easy to think of your cancer as some sort of a dark hole, and that there is no way out for you.
"Ali and I are very lucky to have each other. I don't think I've ever felt closer to her than I did after I was diagnosed. One of the reasons we want to talk about the "couple effect" of prostate cancer is to encourage men not to shut their spouses out after they've been diagnosed but instead to work with them in fighting this disease. Your wife is your partner in the truest sense of the word. After my own diagnosis, I found that I began thinking a lot of negative things. Talking about it with Ali, however, made it less morbid. And then there was a tremendous amount of medical information to absorb. A lot of it was conflicting and confusing. But I knew if I missed something or didn't really understand it, Ali would be there to talk it over with me.
A winning strategy
"So many people have asked me how I dealt with my prostate cancer. Well, I knew for sure as a baseball player for 17 years and then as a manager of pro teams that I had to start practicing what I preached. This basically boiled down to the fact that if you have a bad day or week, and if you or your team are not doing particularly well, you need to find effective ways to deal with it. You must become proactive and get into the attack mode, doing everything you can to get answers.
"This approach is what I had to bring to my own cancer treatment. What scared me initially, in addition to my cancer, was that I didn't have the answers I needed. It certainly was a very difficult time emotionally. I was a mess, my blood pressure had skyrocketed—all from being scared about the cancer and what I had to do about it.
"When we finally got to St. Louis, the specialist went over all my test results in detail and eventually said that, based on the aggressiveness of the cancer and my age, he'd recommend that I have a radical prostatectomy. Ali and I listened as he described the intricacies of the surgery and what my post-operative experience would be like. Hearing his description helped to calm me down enormously.
"The ultimate decision about what to do, the doctor said, was mine to make. He got up and headed for the door, saying he would leave us alone for a while to make that decision. Ali and I sat together and discussed the pros and cons of the various treatment options. We finally decided that surgery, with its strong chance for cure and limited side effects, was what we wanted to do.
"My surgery proceeded without any complications and the specialist said it had been successful. In addition to getting all the cancer out, he was also able to save both nerves on the prostate that control sexual function. Back home from the hospital, I had some post-operative problems with incontinence but they cleared up very quickly. One thing I really noticed after the surgery, however, was a distinct energy loss. I felt that the fatigue came from a combination of factors, which included the physical trauma of the surgery, having the urinary catheter in for three weeks, and finally just the psychological fatigue that came from knowing that I had cancer. Put them all together and you get pretty tired.
"People often ask me if I made any changes in my diet after my cancer diagnosis. Since heart disease runs in my family, I have always been conscious about eating healthful, lowfat meals. But since Ali and I had read about the possible effects of nutrition on prostate cancer, we consulted nutritionists after my surgery to find ways of replacing all the cholesterol-laden foods still in our diet. We were given tasty recipes that were low in fat, high in fiber, and rich in phytochemicals. I also decided to extend my nutritional changes to the snacks I eat in the dugout. During the sixth inning of every game I have a soy shake and throughout the game I will drink anywhere from six to eight cups of iced green tea. Both are supposed to play a preventive role against prostate cancer and since I like the taste, it's not a problem.
"Regular exercise was part of my recovery program. I'm a believer in the power of exercise so I was religious about the walking routine I followed daily. I have to admit, though, sometimes I worked out too rigorously in the early days and had to back off in order to recover.
"With the 1999 major league baseball season in full swing during my recovery period, I was anxious about getting back to the team as soon as I was able. When to do this was left completely up to me by our team owner. Managing the team is a 7-day-a-week job with many late nights, and it takes a certain level of stamina to keep up the demanding pace. If I worked a 9-to-5, 5-day-a-week job, I think I could have gone back to work much earlier than I did because I could have rested up on the weekends and recovered in time for work the following Monday. Baseball doesn't offer that luxury.
"The most difficult time came near the end of my recovery, when I was feeling pretty good during the day. But then I routinely found myself nodding off at about 10 pm. I had to be realistic. If I had been back managing the team, I would have been nodding off like that in the dugout in the sixth inning of a game. To do the job right, I needed to be able to stay awake until at least one or two o'clock in the morning, so I decided to hold off my return to the Yankees until I could do that. Finally, two months after my surgery, I was back in the Yankee dugout. Energy-wise, I was fine and could do my work without a problem."
A spouse's perspective
Joe passed the phone to Ali, who told about her father's successful prostate cancer surgery 12 years earlier and how it had helped to prepare her for her husband's upcoming ordeal. "When Joe told me he had cancer, I was sad because of all the mental and physical anguish I knew that he would have to go through. There were many dark moments for Joe after his diagnosis and in the time prior to his decision to have the surgery. I could see the anxiety and stress he was under. However, once he made the decision to go forward with the surgery, he felt much better. His surgeon and the hospital staff made the procedure such a positive experience for him that it relieved a great deal of his stress.
"Prostate cancer is a difficult experience to go through. Although the prostate cancer was first and foremost about my husband's life, it would be the two of us who would have to fight this disease, both on our own and as a couple. One thing every spouse needs to do is to educate herself about prostate cancer. Get all the information you can so you are on the same page as your doctor and can ask intelligent questions.
"Communication is critically important, also. Even though he may never verbalize it to you, understand that your man is going through an extremely emotional time, with so many conflicting and oftentimes dark thoughts racing through his mind throughout the waking hours. Of course, you will console him as best you can. But perhaps just as important, you need to communicate and tell him exactly how you feel emotionally because of his diagnosis. Tell him of your own fears and your hopes for the future.
"Since the day that I finally sat down with Joe and opened up to him, telling him how lousy I felt because of his cancer diagnosis, I felt that we made great strides. This was the ice-breaker that let us talk freely about what he and I were going through and it allowed us to make plans for handling our problems. Prostate cancer is a long journey and we knew we were going to have to confront some intimate issues, including possible erectile dysfunction and incontinence.
"What also proved to be very important for us was an effective and extensive support system. I was lucky enough to have my sisters, parents, and a wonderful group of friends who were there for me when I needed to cry on someone's shoulder. Having support, whether from your loved ones, or from a prostate cancer support group such as US TOO! or Man To Man, allows you to feel less alone in this truly dark time. Outside support allows you to vent your feelings, to zero in on what's really important, and offers you the necessary arena for solving problems."