Legendary radio talk show host Don Imus, 79, who died in a hospital in College Station, Texas, over the Christmas weekend, made his name with misogynistic, racist, homophobic, off-color, and antagonistic on-air comments. He was a pioneer "shock jock."
I didn't listen to his show, "Imus in the Morning." But to me, as a man on active surveillance (AS) for low-risk cancer, Imus also made a mark as a pioneer celebrity on AS, a subject most showbiz types shun.
Imus was diagnosed in 2009 with a cancer confined to the prostate gland. It was called stage II cancer. There was no mention then of his Gleason score. Entertainment reporters and showbiz publicists aren't well-informed or especially interested in such details.
Imus' family said he was admitted to Baylor Scott and White Medical Center with a lung ailment. He had been treated for emphysema in the past.
At least -- apparently incorrectly -- that Imus's death stemmed from his prostate cancer. The accompanying story said the exact cause of death was unknown.
When he was diagnosed with stage II cancer with a digital rectal exam, Imus made the rounds of urologists at high-profile institutions trying to discuss his options.
Peter Carroll, MD, MPH, a long-time leader in AS and chairman of urology at the University of California San Francisco, had fond memories of Imus as a patient. "When he and I met, I found him to be seriously interested in understanding all treatment options in great detail," Carroll told me.
The private Imus projected a different image than the public shock jock.
Carroll said Imus "was intelligent, respectful, and warm. I enjoyed working with him at the time. He had a great sense of humor, but crossed no lines when I was with him. I think his wit and sense of humor were likely an asset when dealing with his cancer."
Imus said in a broadcast that some famed urologists urged him to undergo radiation. Imus declined. He likely figured that all things considered, active surveillance was a good choice because it had a favorable survival rate and avoided some nasty side effects, such as incontinence and impotence. The 10-year survival rate for his stage II cancer was 98% with AS as well as for radiation and surgery.
Aaron Katz, MD, a self-described "holistic urologist," invited Imus to be treated at Columbia University's .
Katz, who now is urology chairman at New York University's Winthrop University Hospital, could not be reached for comment. Imus used to give him a health spot on his radio show.
Katz said on the program that the other doctors had told Imus "immediate treatment or else what? That something bad would happen." Nothing happened.
Katz put Imus on a plant-based diet, prescribed him 80 vitamins, and ordered a rigorous exercise plan. Imus groused that he spent hours and hours on a treadmill. In September 2011, Imus said he has been on the treadmill 1,297 days in a row.
Imus was especially impressed with active hexose correlated compound (AHCC), a Japanese medicinal mushroom product, aimed at enhancing the immune system. AHCC apparently had some extra benefits.
"You know, I haven't had a cold in three years?" Imus told Katz on a broadcast in 2011 promoting the urologist's book, .
Katz described his holistic protocol for the broadcaster on "Imus in the Morning": "The risk of doing just an active, holistic surveillance is that maybe the cancer could get worse.... [We are] monitoring it. We're managing it. We're getting a PSA every three months. We do an MRI every so often. But the upside is you feel healthy. You look great. You have great energy. Your sexual function, urinary function, none of that is impaired."
Then shock jock Imus emerged, noting that he had a digital rectal exam every three months and asking Katz: "You're going to check me today."
Imus asked Katz if he had brought his gloves along for a DRE. Katz admitted he didn't have the gloves, but he said, playing along, "I brought the lubrication." Rimshot. Badum-ching.
Imus pressed his doctor about whether he was honest in his book about impotence. The shock jock called it "the wiener warranty," meaning the odds Viagra could help men after a radical prostatectomy. They agreed about half of men could be helped with the Little Blue Pill, Viagra.
Katz said: "In medicine, you have to weigh the risk-and-the-benefit ratio." Imus responded simply: "You just have to be honest."
I know several other men on versions of holistic active surveillance. They drink alkalized water, shun meat, eat plant-based foods, and take loads of vitamins and exotic herbal remedies. They seem to be doing fine.
They tend to be evangelistic, strong believers in what they are doing.
I am following a different path with AS. I am still experimenting with diet, having tried low-fat, keto, and Paleo diets. I take a few vitamins based on counseling at the University of California San Francisco. My PSA scans, DREs, MRIs, and biopsies have been okay, whatever I have done.
My own urologist, Brian Helfand, MD, PhD, of NorthShore University Health System in suburban Chicago, told me he is skeptical about holistic urology.
He said, "There are many things that you can label anything. Certainly, the concept of holistic urology is not considered standard of care. As is true of many parts of holistic medicine, we do not have evidence from randomized trials demonstrating superiority of a holistic approach to prostate cancer compared to traditional medical approaches. Further studies have to be performed before we offer these type of interventions as 'standard of care.'"
Still, he said he encourages his patients on AS or those undergoing definitive treatment to meet with a dietitian and to exercise. "I believe that tight sugar control, exercise, and a cardiac-healthy diet have been proven to be good for overall health. There is emerging evidence that this may also be true for men with advanced prostate cancer. Finally, the reason why this supplement to standard therapies (such as active surveillance, surgery, radiation, etc.) is good is that it gives the patients some feeling of control of their overall health."
Imus appeared to do well in the intervening years. He retired in 2018 after 50 years on air. He died in his 10th year after being diagnosed.
The thing that impressed me about Imus was that he opted publicly for active surveillance -- unlike other celebs who, for various reasons, opt for a "definitive cure."
Kudos to Imus for being public and talking about his cancer and his decision to live with it on holistic active surveillance. He ought to be a role model for other celebs who could guide fans to consideration of non-invasive choices.
Howard Wolinsky is a medical journalist based in the Chicago area. He has been blogging for ѿapp about his experiences with active surveillance for low-risk prostate cancer since February 2016. Read more of his posts here.