So Now You Have Prostate Cancer

As many of you know I have recently had to go a round or two with prostate cancer. Fortunately for me I have been monitoring my PSA score for the past ten years. During the first nine of those ten year there was a slow steady increase in the score but nothing dramatic or alarming. In fact it averaged over the nine year period about 2.5 . Then in year ten my annual PSA score came back at 6.0. That means that over a 12 month period it had increased at a rate of  almost 0.2 points per month 3 months later it was 6.5. This indicated it was increasing steadily at about .167 of a point per month.  

Men, this is just common sense. You need to know what your PSA score is as well as you do your golf score. In my case I had no of the usual signs that something was going on with my prostate. In fact I felt good. In fact, I would have never know, until it was too late, that there might be a problem were it not for a simple, inexpensive, painless and harmless blood test. 

However, because the PSA score was above the 4.0 level and because it was steadily going up I decided that I needed to have it checked out. So after going over the test results with my health care co-coordinator I that I wanted a referral to a Urologist to get my prostate checked out a little further. He offered to fax it to the Urologist of my choice and I said, "No, his office is just down the hall . . . I'll walk it down there myself."  

I have to tell you I was a bit uneasy about seeing a Urologist. Mostly because I anticipated what he was going to do . . . .the dreaded digital exam. I 'm not going to lie . . .it was uncomfortable but not nearly as bad in reality as in my mind. Unfortunately, he said that the prostate had a rough bumpy feel to one side and that I should probably get a biopsy. I immediately said, "Let's set it up." 

Now guys, I'm not going to lie about this either. The prostate biopsy is very uncomfortable. If your religious minded like myself you'll be praising the Lord for deadening medicines. This is a needle type biopsy guided by an ultrasound probe. Do not look at it just relax and let the Doc do his thing. With the addition of the deadening medicine it is a painless but less than comfortable process. The Doctor will, as in my case, usually take just 12 samples but depending on your PSA score may take twice that number. No real after affect except some people, (I didn't) will have a little blood in their urine for a day or two. 

When the biopsy comes back from the pathologist the best news you can hear is that apparently you have a benign enlargement of the prostate and you'll just need to continue to monitor your PSA. However, in my case the biopsy came back that I had the most common kind of prostate cancer (adenocarcinoma) and that about 30% of the prostate was involved.  

Now I have cancer. Up until then I always assumed I could have cancer but until it had a name it wasn't real yet. Now it had a name and the really hard choices begin. Fortunately, prostate cancer does  not in most cases demand an immediate decision about treatment regimen. It is at this point where I suggest that you do not get caught up in what I call the "Doctor Merry-Go-Round" but do get the soft tissue scan and the bone scan done to help eliminate any spread of the cancer. Prostate cancer usually spreads to the bone and/or the lung. This is important because it will weight heavily on the course of treatments you will need to decide upon.  

Whatever you do don't be passive . . . take charge. You are the command sergeant in this battle and you must take charge of the decision making. Insist on the Doctors explaining clearly all the alternative available to you. Do your own research. Get opinions from other specialists in the field.   

Fortunately for me I had a friend whose husband was a Urologist in another city to whom I sent my test result. One of the best pieces of advice he gave me was, "Remember, Urologist make their living doing surgery and Radiologist make their living doing radiation treatment." In short, each may be subconsciously biased toward their own approach to treatment based on source of income. 

In my case, once we had determined that it appeared the cancer apparently had not spread my Urologist met with me and my wife for more than an hour explaining all the various treatment options (2 surgery options and several radiation options and a handful of other treatment options) and offered to arrange for me to speak with Doctors in all of the treatment specialties.  

He also explained that each method of treatment had potential undesirable consequences such as incontinence and impotence as well as a few others. He then said that I should, "Take a few weeks and think about it an let me know and I'll help you arrange it." 

This is precisely what I did and I believe it is what everyone should do. You are the Command Sergeant. Take all the information you have gathered, assimilate as best you can, decide on a course of action and then pursue it. Your health is your responsibility do not abdicate decisions that relate to it to anyone. Most people are competent to do this. 

Now I have to tell you that once friends and family discover you have prostate cancer you'll get all sorts of recommendations about what treatment options you should choose. What I have discovered is that whatever seemed to work for someone was the best thing since sliced bread and ice tea. What didn't work, even if it were the same thing, was a bad option. In my research I found that the risk and failure/success rates were about the same for all of the treatment option. However, in my mind doing nothing was not an option.  Do your research and decide on what's best for you. 

For me it was relatively straight forward. I had a cancerous prostate that does not appear to have spread it's cells to any other part of my body so let's get rid of it before it does. However, I had a choice of two approaches to the surgery. I could either have the regular open wound surgery or the Da Vinci (Robotic) minimally invasive. Statistically they have about the same rate of effectiveness. I chose the open wound approach. 

The robotic minimally invasive approach was certainly appealing but was available at only one hospital in my area and the doctor I wanted to use was still training, as were all the others here, on the procedure.  Several factors were involved in my decision:  

·         First, the hospital that offered the robotic procedure was not my hospital of choice and I did not wish to travel to Houston. I wanted to make it easy on my wife and children since the level of care would not be significantly different at M.D. Anderson given my diagnosis;

·         Second, the doctors, including my choice of doctor, were still training on the procedure;

·         Third, the procedure was far more expensive than the open wound procedure;

·         Fourth, my chosen Doctor has done many hundreds if not thousands of these open wound procedures and is considered by his colleagues as among the best in the country.

·         Fifth, my chosen Doctor was on staff at my hospital of choice and was happy to do it where I wanted.

·         Sixth, and this may seem odd but the chaplain at my chosen hospital has been a friend for many years.

 Now I am not suggesting this should be your thought process. I offer it simply to say you need to have a thought process that leads to a decision as to who, how and where to treat you prostate cancer. 

Prostate cancer is the number one killer of men and more men will die from it than women will die from breast cancer. I do not begrudge the ladies one cent of the funding that goes into breast cancer research. I do think that something needs to be done to bring more attention to the risk men face with prostate cancer and the need for greater funding for research.  This is America people . . .  WE CAN DO BETTER!