Thursday, May 04, 2006

Prostate Cancer

I guess I’ve become “the other guy.” You know, I never thought I’d be the one with cancer. It wasn’t a part of my plan of things to do and to get during my life. So, it was certainly a surprise to find out it was my turn. Like most things that have happened to me in my life, the diagnosis came by accident.

In February 2006, I went for my first annual physical up here in Massachusetts. During the exam I mentioned that I was having intermittent issues with maintaining an erection. I figured it was age related; you know, the older you get what you used to be able to do all night now takes all night to do. I was relieved, and heartened, to learn that all my other signs and signals – cholesterol levels, blood pressure, all the stuff done at an annual physical showed me to be healthy. Anyway, the Dr. added testosterone testing to my blood work and it came back as being low.

She referred me to a specialist who, like my primary care Dr., also found via the digital exam that my prostate was normal for my age, as was the psa level in my blood. The specialist decided, before starting me on testosterone therapy, to just make sure that I didn’t have cancer. He said that about 10% – 17% of guys with low testosterone levels were found to also have prostate cancer. So he did a biopsy of my prostate. Two of the 10 tissue samples came back as cancerous, one at a low risk level (a 6 on the Gleason scale) and the other at a 7, which is intermediate. Eventually I learned I had T1c prostate cancer. When the specialist told me I had cancer, I decided to take the rest of the day off, rather than going back to work.

I guess it’s natural that one’s mind begins to spin away with all kinds of conflicting thoughts. I went from “OmiGod, I’m gonna die” to “I can beat this thing,” like a ping-pong ball – back and forth, back and forth. Eventually I had to shut my mind down as I was driving myself nuts and listen to what was being laid out for me to do with what I had.

The specialist gave me four scenarios (in the primary care Dr.’s office I told her I had a fifth option, which was to just walk away from it altogether. She discouraged me from continuing with that train of thought): The first option was watchful waiting, in which no treatment gets done. Since Prostate cancer is a slow growing disease, theoretically, it could be a while before anything would “need” to be done. The level of my cancer indicated, on the charts at least, that I had a 100% chance of living the next 5 years, and then it went down from there. Then there is open radiation therapy as another option.

Tiger Woods’ dad just died (May 3, 2006) from prostate cancer. He had been treated using open radiation therapy; at first, the cancer was killed off but then apparently came back with a vengeance.

The third option is to have radioactive “seeds” implanted. This is known as brachy-something surgery. About 75 – 80 seeds, each about the size of a grain of rice, are implanted in the prostate, which is about the size of a walnut. The idea is that the radioactivity will kill off the cancer. I was a marginal candidate for “seeding.” While my prostate and psa was normal, the fact that I had an intermediate grade level of cancer in at least one tissue sample (you have to figure that since the biopsy is just a sample of the whole, there had to be more that wasn’t found) compromised this as a choice.

The fourth option is to have the prostate removed. Cut it out! Get rid of it! Bad prostate! You can’t have a cancerous prostate if you don’t have one. If only it was that easy.

Fortunately, in my case, results of an MRI suggest that the cancer is confined to the prostate, as opposed to it having spread to my bladder, lymph glands, seminal vesicles, etc. This was good news, relatively speaking, since it appears that nerve sparing will be able to be done which suggests a return to sexual functioning. And also, that I won’t be incontinent. The procedure is formally called Radical Prostatectomy with Nerve Sparing.

It was this last choice that I’ve chosen. I believe it’s the right choice, given the options.

Before arriving at this conclusion, I talked with different people,including a couple guys who’d had prostate cancer. One had the prostate removed, the other ended up having seeding. I talked with my girlfriend, my sisters, my kids, people at work. I emailed some buddies back in Baltimore. I did a lot of Internet research, soul searching and lots of walking around thinking about it.

One thing I found is that while the current thinking, pretty much across the board for people my age and with my stage of cancer, is to have the prostate removed, everyone I talked to knew someone who knew someone who went to the “guy who had the best hands.” I found myself interviewing surgeons, questioning their success rates and, surreptitiously, looking at their hands. Very quickly it started to get nuts. I went to get a second opinion from a surgeon who told me that while he was the best, I was in good hands with any of the three guys on my list (which included him and the surgeon I was originally sent to).

At some point, you just have to go with your gut feeling.


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