Welcome to The Prostate Advocate website. This site is dedicated to providing useful resources towards understanding prostate cancer, its treatment, and the treatment of the side effects of most treatment options. The papers on the "Observations" page have been authored or compiled by Charles (Chuck) Maack, Prostate Cancer survivor, continuing patient since 1992, advocate, and mentor, or papers provided by Medical Professional friends. Physicians and patients have suggested he put the information together in a book. Chuck says that this IS his "book," prepared with patients and caregivers in mind for easy access to subjects available reasonably alphabetically and as comprehensive as possible. That reasoning compliments the words he most always includes in his signature block when addressing patient or caregiver concerns: "Always as close as the other end of your computer to help address any Prostate Cancer concerns." To know more about Chuck please click HERE

Awards and Recognition:

  • 2016 Certificate of Appreciation from Us TOO Intl., Inc. recognizing 20 Years membership
  • 2012 recipient of the PCRI "Harry Pinchot" Award
  • 2008 recipient of the Us TOO Intl., Inc. "Edward C. Kaps Hope Award”

Published papers with medical and scientific journals:

At 90 years of age, and health issues (as noted in my paper #21 below) “GNAWING ON A ROCK,” it appears I had best call it a day in submitting my opinions for publication in medical and science journals (published on merit at no cost to me). There comes a time in everyone’s life when slowing down becomes a necessity. However, I intend to continue as a online, worldwide, mentor to men diagnosed with Prostate Cancer and to their caregivers until my fingers can no longer type, or my eyes can no longer see the keys, or my constant fatigue and lack of energy, dictates otherwise. It has been a long but fruitful and rewarding three decades as a mentor!

“A Prostate Cancer Patient’s 24-Year (1992-2016) Continuing Journey from Diagnosis to Treatment to Recurrence to Mentoring” Published in JCPCR-04—201604 Volume 4 issue 4 – 2016: "http://tinyurl.com/hcxuxv9

“Newly Diagnosed with Prostate Cancer? - A Mentor/Patient Discussion” Published May 23, 2017 Biomedical Journal of Scientific & Technical Research (BJSTR) http://biomedres.us/pdfs/BJSTR.MS.ID.000110.pdf

“A Wake Up Call To Men & The Women Who Care For Them” Published in JCPCR-06-00189 Volume 6 issue 1 - 2016: http://tinyurl.com/3djfgve

“Considerations necessary regarding Prostate Cancer with the options of surgical removal of the prostate gland or with Androgen Deprivation (aka testosterone inactivating)Therapy (ADT) as follow-on or primary treatment” published June 13, 2019 in Global Journal of Medical Research GJMR Volume 19 Issue 4 Version 1.0. https://globaljournals.org/GJMR_Volume19/1-Considerations-Necessary-Regarding-Prostate.pdf

“Evidence Based Medicine” Published in the Journal of Radiology and Diagnostic Imaging Published November 19, 2018, Radiol Diagn Imaging, 2018 doi: 10.15761/RDI.1000143 Volume 2(5): 1-1 ISSN: 2515-0200 https://www.researchgate.net/publication/331201281_EVIDENCE_BASED_MEDICINE

“Fluoroquinolones – Be Aware” Published in the Journal of Cancer Science and Clinical Oncology, Volume 5, Issue 2 ISSN: 2394-6520 Published July 30, 2018: http://www.annexpublishers.com/articles/JCSCO/5202-Fluoroquinolones-Be-Aware.pdf

“IAD/Intermittent Androgen Deprivation: When is it appropriate?” Acta Scientific Cancer Biology 3.8 (2019): 19-21. Published Date: July 26, 2019 https://www.actascientific.com/ASCB/pdf/ASCB-03-0150.pdf

““Importance of Patient Attention to Physician Care”?” Acta Scientific Medical Sciences Special Issue 1 (2019): 04-05. Published: September 05, 2019 https://www.actascientific.com/ASMI/pdf/ASMI-SI-01-0002.pdf

“Medical Advice” or “Opinion” – The Important Difference Published in Acta Scientific Medical Sciences Volume 2 Issue 1 January 2018: https://www.actascientific.com/ASMS/pdf/ASMS-02-0019.pdf

“Orchiectomy – A Surgical Procedure in which One or both Testicles are Removed – is it Sufficient to Inhibit Androgen (Testosterone) from Access to Prostate Cancer Cells?” Published in Acta Scientific Cancer Biology Volume 3 Issue 4 April 2019. https://www.actascientific.com/ASCB/pdf/ASCB-03-0120.pdf

“Prostate Cancer Advocacy and Mentoring Support” Published November 22, 2017 in the journal “Holistic Approaches in Oncotherapy” HAOT-17-OPN-0004 1.1 (2017): 14-15; https://scientiaricerca.com/srhaot/pdf/SRHAOT-01-00003.pdf

“PSA Rising While on Routine ADT, No Metastasis Evident; should Chemotherapy with Docetaxel/Taxotere be Added? (Apparently NOT!)” International Journal of Cancer Treatment (Int J Cancer Treat Vol: 2, Issu: 2 (54-56) Published Date: 25 July, 2019, https://innovationinfo.org/articles/FRCM/IJCT-2-118.pdf

“PSA Testing? Over-Treatment? Active Surveillance? Biopsy value? No PSA for Elderly?” American Journal of Biomedical Science & Research Am J Biomed Sci & Res. 2018 - 4(5). AJBSR.MS.ID.000836. DOI: 10.34297/AJBSR.2019.04.000836. Published Date: August 22, 2019 https://biomedgrid.com/pdf/AJBSR.MS.ID.000836.pdf

“The Battle with Prostate Cancer” Published in Scientia Ricerca Chronical of Medicine and Surgery – Manuscript ID: COMS18OP-0027 ISSN: 2576-8298 Volume 2 Issue 2 May 22, 2018: https://tinyurl.com/42pqzjh

“Triple-hormonal Blockade (ADT3) – a Patient’s Perspective” Published in ONCOGEN - Independent Peer-Reviewed Cancer Journal 2019; Volume 2, Issue 1(2019;2(1):6) https://tinyurl.com/y2ryey3h

Published August 10, 2021 – American Journal of Biomedical Science & Research
ISSN: 2642-1747; Am J Biomed Sci & Res.
202113(6).AJBSR.MS.ID.001923. DOI: AJBSR.2021.13.001923

Intimacy - Often Challenged by Surgery, Radiation, Cryotherapy, or ADT
Published May 4, 2022, Academic Journal of Microbiology & Immunology
Intimacy - Often Challenged by Surgery, Radiation, Cryotherapy, or ADT

METFORMIN Aka Glucophage – Prescribe, or Not? Is There An Alternative?
TRMC-01-106.pdf (tess-research.com)

THE PROSTATE GLAND IN MEN - What is it? Where is it? Important Annual Screening
Published April 6, 2023 - American Journal of Biomedical Science & Research< br /> ISSN: 2642-1747
THE PROSTATE GLAND IN MEN - What is it? Where is it? Important Annual Screening

“Prostate Cancer - The Disease Specific to Men – Continues over Decades to Affect Men by the Hundreds of Thousands; Why? What Must be Done?” Published May 18, 2023 in PROGRESS IN MEDICAL SCIENCES ISSN: 2577-2996, 2023 VOL 7, NO. 3, PAGE 1 – 1 DOI: doi.org/10.47363/PMS/2023(7)189
Prostate Cancer - The Disease Specific to Men

“GNAWING ON A ROCK” – A Man’s Long Journey Living With Prostate Cancer Case Reports and Reviews (ISSN: 2693-1516) Received: May 23, 2023 Published: June 07, 2023

"Physician Responsibility to Patients – A Patient’s Opinion”
Journal of Clinical Cases Received Date: 04 May 2023
Published Date: 08 June 2023
Physician Responsibility to Patients – A Patient’s Opinion

Following from Chuck:
DISCLAIMER: Please recognize that I am not a Medical Doctor.  Rather, I do consider myself a medical detective. I have been an avid student researching and studying prostate cancer as a survivor and continuing patient since 1992. I have dedicated my retirement years to continued deep research and study in order to serve as an advocate for prostate cancer awareness, and, from an activist patient’s viewpoint, as a mentor to voluntarily help patients, caregivers, and others interested develop an understanding of this insidious men’s disease, its treatment options, and the treatment of the side effects that often accompany treatment.  There is absolutely no charge for my mentoring – I provide this free service as one who has been there and hoping to make their journey one with better understanding and knowledge than was available to me when I was diagnosed so many years ago.  IMPORTANTLY, readers of medical information I may provide are provided this “disclaimer” to make certain they understand that the comments or recommendations I make are not intended to be the procedure to blindly follow; rather, they are to be reviewed as MY OPINION, then used for further personal research, study, and subsequent discussion with the medical professional/physician providing their prostate cancer care.

What has been successful for me may not be as successful for another. I expect it boils down to how much cancer was in development at diagnosis and in what location(s) was that cancer in development; biopsy indicates supposed areas, then removed gland indicates supposed areas, but neither can determine if, and how many, cancerous cells may have migrated elsewhere away from the removed prostate gland, if removed, or radiation to the prostate gland and its periphery.
I have suspicions that pelvic lymph nodes are not given enough attention because of their deeper location away from the prostate gland, thus not usually extracted as part of surgical removal, as well as not included with sufficient radiation when any form of radiation is prescribed.

The surgeon who removed my prostate gland in December 1992 did remove lymph nodes adjacent to the gland, but not pelvic lymph nodes, and did remove the seminal vesicles and vas deferens, with none of these organs beyond the gland showing any evidence of cancer presence/development. But he did remark that an area of a tumor in the prostate gland had extended too far into some fatty tissue that he wasn’t comfortable “cutting” any further. As a result of that decision and uncertainty that all the cancer was removed, I was scheduled and received a full series of salvage external beam radiation (SRT) as soon as I healed from the surgery. My radiation back in those days with the now antiquated 2-dimentional (2D) radiotherapy was much less precise a form of radiotherapy than currently available, having thankfully since improved over the years.

PSA following SRT dropped to <0.1ng/ml so the physician and I were of the opinion all cancer had been eradicated. However, three years later, in 1996, my PSA began slow but steady elevating and it was obvious cancer cells were left behind “somewhere” and both surgical removal and SRT had failed to find/eradicate those now developing cells.
Imaging was unable to identify any tumor activity so it was obvious that though somewhere in development, not sufficiently developed in cell numbers to have evolved into a tumor of sufficient size to show up in usual imaging. With the uncertainty of where this development was occurring I began androgen deprivation therapy (ADT) with the antiandrogen Casodex (generic bicalutamide) to block androgen receptors from testosterone access and LHRH agonist Lupron to shut down testicular testosterone production. My PSA dropped again to less than 0.1ng/ml and my testosterone to near though not below 20ng/dl. And it was shortly following this recognition that I had a cancer that “didn’t go away” that I realized I had better start studying what “Prostate Cancer” was all about!

And so began my educational journey. Over time I began to realize that my Urologist, though appearing to care for my well-being, actually knew little about just what androgen deprivation can do to a man’s well-being over time (or at least didn’t show much care), and when questioned about impotence and erectile dysfunction gave only the glib response that “we have medications that will help you get over that.” I learned of ultrasensitive PSA testing so arranged that my future PSA levels were to have that form of testing and learned that my PSA was actually as low as <0.01ng/ml and remaining that low over the years since starting androgen deprivation. I learned that my neurovascular bundles on both sides of the prostate gland had been removed with the removal of the gland. I learned that at the time of surgery my prostate gland had a volume/size of 101cc, which is huge and should have been reduced in size with medications prior to open surgery, since because of its size the Urologist performing open surgery was likely restricted in “feeling” his way in separating the bundles away from, and before, excising the gland thus had little option but to remove the neurovascular bundles along with the gland. This ignorance or lack of concern by the Urologist caused certain life-long impotence and consequent erectile dysfunction. I ultimately left this Urologist and moved to a Medical Oncologist I felt was showing interest in Prostate Cancer and evident concern for his patients and moved to intermittent androgen deprivation (IAD) and with future returns to ADT or to IAD I had learned the importance of a 5Alpha Reductase (5AR) inhibitor in ADT to inhibit testosterone from converting to the more powerful stimulant to prostate cancer cell growth, dihydrotestosterone (DHT) and added dutasteride/Avodart to my arsenal of appropriate medications.

As I learned more and more about appropriate treatment for prostate cancer depending on the patient’s status from diagnostics and imaging and posting comments in response to patient concerns on online prostate cancer support lists, others began to recognize that I was accumulating an abundance of reasonable information with reference material to back my comments, and more and more men or their caregivers were emailing me with their concerns. This dependence on my comments concerned me to the point that I knew I had to research even deeper and study even more thoroughly our insidious men’s disease so that the comments/recommendations I provided to these people could be supported by reference material, while at the same time telling them that the information I was providing was necessary for them to research even further to satisfy themselves whether the information was reliable, then discuss what they learned with their treating physician. The more I researched and studied, the more I recognized that this disease can cause multitudes of side effects that were occurring to many, while less a problem for others, yet treatment methods were changing and improving regularly. The more I learned the more obsessed I became with having to continue daily research and study of medical and scientific information by way of monitoring several such informational websites in order to stay on top of changes/improvements occurring. I involved myself in scientific research regarding prostate cancer by serving two years in a row in the Washington, D.C. area as a panelist with several research scientists reviewing Prostate Cancer research proposals submitted by other research scientists seeking funding for their research from the Department of Defense (DOD) Congressionally Directed Medical Research Program (CDMRP). I also made it a point to attend annual Prostate Cancer Research Institute (PCRI) Conferences on Prostate Cancer in Los Angeles to meet and hear presentations from top medical professionals regarding prostate cancer and its treatment. I was fortunate, as well, to have been invited and attended a gathering of 600 top research scientists - and several prostate cancer survivors like myself who had served on CDMRP panels - at an IMPaCT conference (“Innovative Minds in Prostate Cancer Today”) in Atlanta. Video at IMPACT conference showing my photo www.tinyurl.com/3a69vfc9 
As I typed remarks addressing concerns of one patient or caregiver, I would receive an email from yet a different person with the same concern, and found I was repeating myself and typing addressing of these concerns over-and-over. I realized that with any new concern arising, it was better for me to research and study that concern and compile a paper addressing the concern so that I could simply provide that paper to anyone having the same concern; thus began what has become my “Observations” webpage that is available on my personal website www.theprostateadvocate.com currently containing over 200 papers on the many varieties of issues that have arisen over my many years mentoring/counseling patients and/or caregivers. All are listed alphabetically to hopefully aid the reader in finding the subject for which they have concern. Admittedly some subjects contain information also available under another subject since there is often information that can over-lap into other subjects of concern.

I have fortunately been successful with the several years I have been on/off androgen deprivation in making my own decisions as to appropriate medications, when to stop, when to resume, when to change, etc. and fortunate in having a Medical Oncologist who has become interested in better understanding prostate cancer and its treatment because of encouragement from me and what he has learned from me. He has remarked that from what he has learned, and what he is aware I have learned, that he sees me as much a colleague as a patient. And he has been surprised on how well and how long I have been able to control and manage my prostate cancer. Another very prominent internationally respected Medical Oncologist specializing specifically in research and treatment of prostate cancer, Stephen B. Strum, M.D., FACP, had this to say: “I wish all MDs were as responsive as Chuck. To me, Chuck represents what I call the CPR of what the medical profession should be all about, but rarely is. CPR (courtesy, professionalism, respect).” At another time to me he remarked: “.… since I regard you as one of the few brightly shining lights in the world of PC support….” To a patient he remarked: “…. In my 31+ years of working with men with PC, I find a minority of men who truly comprehend the basic principles/concepts of this disease like Chuck.” More recently he remarked: “You have led an exceptional life and you truly are an exceptional human being. When someone is good, very good, they should be extolled. I believe eulogies are best served while the person being praised is in the here and now to hear them. Your life is very praiseworthy. I have to say that I have met some damn good people in my lifetime. Thank you for being one of them.” In adding this to this webpage, I am almost overcome with tears that such an eminent specialist physician in prostate cancer would think this highly of me and my work to help prostate cancer patients and their caregivers.

I was honored in 2008 receiving the Us TOO Intl., Inc., Prostate Cancer Education and Support Network “Edward C. Kaps Hope Award” and in 2012 receiving the Prostate Cancer Research Institute (PCRI) “Harry Pinchot Award” recognizing my contributions to Prostate Cancer patient and caregiver support through my years of mentoring.

On 8/6/2018 my PSA had advanced to 2.03ng/dl and shortly thereafter I learned newer imaging with the isotope/radiotracer  flucoclovine  (Axumin) with F18 PET/CT was available at the University of Kansas Medical Center so traveled there and received that imaging.  For the first time this imaging was able to identify the precise location of continuing prostate cancer cell activity as being slightly larger than 1cm in the area between the bladder neck/urethra connection area and the rectum.  With this information, I began five, every other day, radiation procedures back in Wichita under the guidance of my Radiation Oncologist, with 600cGy administered for a total of 3000cGy.  My PSA then began a slow but steady decline wherein by 18 months later, 2/27/2020, my PSA level had declined to 0.043ng/ml since completing the targeted radiation to the only location having identified PCa cell activity that had been occurring, though managed with ADT medications, ever since 1996 when my cancer returned following surgical removal as well as salvage radiation. Unfortunately, though thankfully finally eradicating the cancer, the radiation caused scarring within the urethra resulting in blocking open flow releasing urine and requiring exerting pressure to push the urine past the scar tissue; as long as I can still empty my bladder, I have adapted.  There is occasional minimal bleeding from the scar tissue but posing no problem.  The radiation has apparently also had an effect on bowel movements since muscle contractions to void are not as strong as prior.  I find these a small price to pay considering the cancer has been eradicated.

The foregoing is about as brief a relating of the story of my life as a continuing Prostate Cancer patient since 1992 and as a mentor regarding Prostate Cancer beginning somewhere following my recurrence in 1996. More is available by visiting my website.

As an aside, it is my opinion that as the result of a weakened immune system from long-time androgen deprivation therapy I experienced two separate diagnoses of cutaneous squamous cell carcinoma.  The first and worst broke out on the right side of my face in front of my ear.  Not aware this could be a form of cancer, I thought it would subside and disappear.  Because of my putting off concern, the growth developed so significantly that surgery was required and administered by my Otolaryngologist with experience in the location of numerous nerves that extend down that side of the face.  It required a long incision down that side of my face to my chin bone and deep enough to insure all cancer removal – and was successful.  The second, and noticed early on, occurred on the left back of my neck.  This time, because of early recognition and low development, a Dermatologist was able to surgically remove that growth with success.

I will continue to remain “Always as close as the other end of your computer to help address any prostate cancer concerns.”
"What you leave behind is not what is engraved in stone monuments, but what is woven into the lives of others."

Charles (Chuck) Maack – ECaP - Prostate Cancer Patient, Activist, Advocate, Mentor (A mentor should be someone who offers courtesy, professionalism, respect, wisdom, knowledge, and support to help you achieve your goals; would that I succeed)