Copyright 1999
By
Bruce E. Marsee |
by Bruce E. Marsee
I have always been known to be healthy.In fact, before 1969, my only disease was the childhood measles, and that occurred while growing up in the foothills of southeastern Kentucky.
Then in 1969 at the age of thirty my tonsils had to be removed. A year later, the Mumps landed me in the hospital for eight days.
Now almost thirty years later at the age of fifty-nine and retired for three years, I'm told that I have Prostate Cancer (PC). During the next few months, you will be hearing from me via this column.
I will focus on my condition, both mental and physical, and the prognosis of my PC.
I will touch on the diagnostic procedures, evaluations and treatments as well as the potential side effects, if any, of various medications.
In approximately three months when I am compelled to select either Radiation, Radical Prostatectomy, Cyrosurgery or do nothing, I will try to explain the rational behind my decision.
I will also review with you the current body of research that hopefully will assist in the eradication of PC. Support groups, including the Internet will likewise be explored. There is a world of information and support relative to PC. However, one has to take it upon themselves to obtain it. I am one of 244,000 adult males in the United States, and one of 8,000 in the state of Michigan that was diagnosed in 1998 with PC.
However, I consider myself somewhat lucky because it was detected early. I say somewhat for since age forty I have had an annual PSA examine, so it was not all luck;
I do try to take care of myself.
After all, there is only one me.
Annually more than 40,000 males in the United States are not lucky; they die because the disease was not detected early enough. The irony is that nine out of ten of these deaths could have been prevented if they had their annually PSA test. Some clinics and hospitals will perform the test for as little as ten dollars. PSA or Prostatic Specific Antigen is an enzyme produced by the prostate gland cells. An elevation of the PSA in the blood stream indicates that an abnormal condition is present.
I have always understood that the normal range for one's PSA is 0.0 - 4.0 and my PSA had always fallen within the range. However, my PSA in 1996 indicated a value of 1.9. In 1997, it was 2.4, and had risen to 3.2 by July 1998.
A closer look at the numbers showed a trend, a trend I became concerned with.
Nevertheless, it was within the clinical's published range so I decided to wait and see what my 1999 PSA would indicate. Some months later I read an article about PC and a new procedure that involved freezing the prostate to a minus 320 degrees that spiked my interest.
The article went on to suggest that a PSA value greater than 3.0 could be a warning sign that cancer might be present.
The article went on to say that in addition, one should not rely on PSA alone since of patients with localized prostate cancer have a normal PSA value.
With my PSA value at 3.2, I wanted more information and needed to speak with this Doctor.
I called for an appointment.
An appointment was schedule for the next day -- December 15, 1998 at Crittenton Hospital in Rochester, Michigan.
With less then ten days before the holidays I was to receive a Christmas present I did not need and one I could not take back.
For some reason reading an article about Prostate Cancer (PC) and a new procedure that involved freezing the prostate piqued my interest.Probably because the Doctor featured in the article went on to suggest that a PSA value greater than 3.0 could be a warning sign that cancer might be present.
However, the article continued, one should not rely on PSA alone since of patients with localized prostate cancer have a normal PSA value.
PSA or Prostatic Specific Antigen is a specific antigen produced by the prostate gland cells. An elevation of the PSA in the blood stream indicates that an abnormal condition is present.
With my PSA value at 3.2, I wanted more information and needed to speak with this Doctor.
I called Crittenton Hospital's Prostate Center in Rochester, Michigan and asked for an appointment with Doctor Fred Lee.
Dr. Lee is Director of the Prostate Center and has perfected the Cyrosurgery technique.
Dr. Lee's technique uses ultrasound, which provides detailed images allowing safe and precise freezing of the prostate to minus 320 degrees.
The appointment was scheduled for the next day-December 15, 1998.
I arrived at the hospital early the next morning and was registered rather quickly.
Within a few moments I was escorted to the Prostate Center where I took a seat and waited for my turn with Dr. Lee.
I find it to be most interesting what goes on in ones mind as one sits and waits in a hospital for their turn.
What will the examination include?
Will it be painful?
I sure hope the insurance covers the cost.
Gee are these nurses busy.They all seem to be in a rush.
After reading and speaking with another older gentlemen who is also waiting, it is now my turn. Dr. Lee's nurse appears from behind a curtain and calls my name, "Mr. Marsee".
Once in the examining area, I recognize Dr. Lee from his picture in the paper, he is seated behind a color monitor beside the examining table.
After a brief introduction, Dr. Lee's nurse holds a small towel in front of me and asks that I lower my slacks and shorts down to my knees and lay on the table.She continues to hold the towel in front of me while I ascend the table.
Once I am on the examining table the towel is placed where I have nothing on.
I am then instructed to turn onto my left side, bring my knees to my chest, leaving my back to Dr. Lee so that he may do what ever that is he has to do. Another color monitor is positioned across the room directly in my line of sight.
As Dr. Lee begins the ultrasound examination, I can see the image of the prostate on the monitor. For several minutes I watch as Dr. Lee rotates the instrument across the prostate.
While I have no medical experience, I do notice something on the monitor that appears different; for some reason it just does not look right.
Instinct maybe?
I say nothing.
The three of us have been doing the usual chitchat that is carried on during a normal routine exam.
Dr. Lee's nurse indicates that she had read an article of mine that appeared in the June, 1998 Issue of Lands' End Catalogue and enjoyed it.
So she said.
Finally, Dr. Lee refers to the monitor I am watching and points out the gray area I was concerned about and says he wants to look at that further. With this comment, his nurse leaves for a moment and returns with a sterile tray filled with medical instruments. Here goes that instinct again.
I immediately sense a biopsy is coming. I am asked by Dr. Lee not to move, he says I will feel some pressure and hear a sound similar to a mousetrap and he assures me there will not be any pain.
Within a few moments I feel the pressure, "click" and sure enough, something is caught by the mousetrap.
I hear it again.
There it goes again, again and again and again and finally the last target is seized.
In all, seven biopsies are taken.
I get off the table; sheepishly pull up my slacks as Dr. Lee's nurse hands me some antibiotics to take for the next three days to prevent any infection that might occur from the biopsies.
As I leave the area, I noticed Dr. Lee walking toward the sink with the blood stained needle attached to that intolerable gray molded mousetrap. Approximately five o'clock on the 16 of December, 1998 Sharon and I are having a glass of wine while I prepare dinner. (Since retirement I do 99% of the cooking-which by the way I enjoy).
The phone rings.
Sharon answers and it is Dr. Lee.
She hands the phone to me.
"Mr. Marsee that's cancer", Dr. Lee informs me in a low voice.
Dr. Lee goes on to say the cancer is localized to both nodes of the prostate and is 100% curable. With this latest bit of evening news also come some recommendations.
Dr. Lee says his office will schedule a Chest X-ray, a CAT Scan and a Bone Scan to further verify that the cancer has not metastasized. His office will also schedule an appointment with an Urologist for further consultation.
The Urologist will explain various options and start me on Combination Hormonal Therapy (CHT), the first and mandatory treatment regardless of the initial stage of the disease.
After three or more months of CHT, Sharon and I will select one of the treatments; either a Radical Prostatectomy, Cyrosurgery or do nothing.
At this point Radiation is out of the question.
It was also suggested that I call PAACT, an organization in Grand Rapids, Michigan that maintains constant research of medical documents and clinical studies on the most advanced methods of detection, diagnostic procedures, evaluation and treatments for PC.PAACT also is committed to furnishing patients, physicians and advocates with the results of these studies.
I hang up the phone, sit down, we looked at each other.
I remark, "Now you really know someone who has cancer".
With Christmas only nine days away this was one Christmas present I would never forget and one I could never return.
December 22, 1998 was a typical Michigan winter day; knee-deep in snow, cold, windy and absolute miserable.With only three days left before Christmas, this was not going to be a shopping day.
Having a PSA of only 3.2 and diagnosed with Prostate Cancer (PC) just seven days earlier, Dr. Fred Lee's office had scheduled a Bone Scan, CAT Scan and chest X-ray for me.
Dr. Lee is Director of Crittenton's Prostate Center in Rochester, Michigan and has perfected the Cryosurgery technique Using color-flow Doppler with ultrasound. The Doppler with ultrasound provides detailed images of the prostate allowing safe and precise freezing of the prostate to minus 320 degrees.
A PC option that was only in the experimental stages five years ago. Sharon and I arrived at Crittenton Hospital at 7:30 a.m. She had taken the day off from work to be with me and in some small way share the experience.
In the thirty-eight years of our marriage, we have shared everything and in all probability, it was going to be a long day to reminisce.
After all, once we select the treatment option she too will have to live with the decision.
First on the agenda was a regular chest X-ray. Take off everything above the belt and put on that ugly piece of cloth provided by the hospital. Then twist your arms out of shape trying to tie the strings of the cloth behind your back. Once that feat is accomplished sit and wait.
Fortunately, the waiting was not very long and the X-ray took only a few moments.
Next was the CAT Scan.
Prior to leaving the house and on the way to the hospital I consumed a "shake" or thirty ounces of liquid dye to make the intestines visible for the CT. It is the white chalky substance one must take prior to having a CAT Scan or Computerized Axial Tomography also known as CT.
CT is a method of combining images from multiple x-rays under the control of a computer to produce cross-sectional or three-dimensional pictures of the internal organs, which than can be used to identify abnormalities.
It is like being able to look at the internal organs without surgery.
While in my case the CT was used to identify any abnormalities and the prostate size, CT is not effective for assessing the stage of PC. The staging is done by a pathologist in a lab using specimens from the biopsy.
The CT is significantly more accurate when used for evaluating metastases of the Lymph Nodes or more distant soft tissue sites. I was instructed by the technician to lie (fully clothed) on the flat table of the CT equipment with my right arm extended above my head.
An IV was inserted into my right arm to allow a dye solution to enter my body.
As it began to flow into the vein, I started to feel very warm inside.
The sensation was taking place while the table slowly moved me through the inside of the CT scanner, much like going through the middle of a "doughnut".
When a small overhead light came on, I was to hold my breath until it disappeared which lasted only for a few seconds.
Pain, claustrophobia; none what so ever. Once off the CT table I was ask to proceeded to the Nuclear Medicine room for the final test.
Within the Nuclear Medicine room is where the Bone Scan takes place.
The Bone Scan is a technique more sensitive than conventional x-rays which uses a radioactive isotope to identify abnormal or cancerous growths within or attached (attached here is the key word) to the bone. In the case of PC, a bone scan is used to identify bony metastases which are definitive for cancer that has escaped from the prostate and appear as "hot spots" on the film. However, the absence of' hot spots do not prove the absence of tiny metastases.
Hot spots frequently occur along the spine, ribs and skull.
The spine is the most common site outside the prostate for prostate cancer growth. Prior to having a bone scan, the radioactive isotope is injected into the bloodstream.
The small vile containing the isotope is kept in a secured metal box and only opened when the technician is ready to give the injection.
Once injected the patient has a three-hour wait period before undergoing the bone scan. The waiting period allows the isotope to circulate throughout the body and be absorbed by the bones. It was around lunchtime that my injection was given so Sharon and I left the hospital, planning to have lunch and take in some shopping. After doing lunch and walking for exercise, I purchased a few bottles of wine.
I like to cook with wine (and consume it) while I am preparing a meal.
After all, a couple of glasses of red wine a day is good for the body (and soul). Once back at the hospital it was time to lie on the Bone Scan table and go through another doughnut, but the middle of this doughnut was longer and took considerable more time.
In fact, movement of the body while being scanned is a no-no and the doughnut moves very slowly.
While scanning the pelvic area, the equipment is quite close to the body.
As with the CT I experienced no pain nor was I claustrophobic. Later in the afternoon, it was finally time to go home and wait for someone to call with the results.Dr. Lee called December 23, and informed us that the results was negative, however there was a spot on my right lung and he suggested another X-ray for comparison.
I had a portable chest X-ray taken in 1996 and Dr. Lee said the spot was probable just a fluke. Fortunately after the follow-up X-ray and a comparison, that is what it turned out to be; a fluke. With all the testing concluded, an appointment with the Urologist was scheduled to place everything in proper perspective.
The PSA numbers, results of the DRE, Biopsy, Gleason score, X-rays, CAT Scan and Bone Scan would all be compiled to help assist in the best treatment as well as suggest some options. These options Sharon and I would have to consider in the next few months. Whatever option we choose, and no matter what happens, she will have to watch it from the sidelines, but after the Urologist visit we will need a break -- some vacation time in one of our favorite locations -- CANCUN.
The January snow continued to fall as I pulled into the Medical Building parking lot behind Crittenton Hospital in Rochester, Michigan.
My appointment was originally scheduled for the previous day but with the snowstorm it had been rescheduled for 3 p.m., January 14, 1999. Instructions were for me to take the elevator to the fourth floor and continue down the corridor to suite 420.
Having been recently diagnosed with Prostate Cancer (PC), today I was to speak with one of the Doctors who would help guide me through the next few months of uncertainly.
After glancing at all the nameplates and room numbers I spot one that reads, "420 - Dr. Robert Badalament - Urologist".
Since this was my first visit with Dr. Badalament I sign in, find a seat in the waiting room and fill out the medical history and insurance forms. The walls are decorated with paintings by Robert Kincad.
While Kincad has a unique way of painting outdoor scenes and cottages, I find them a little to brilliant for my taste.
I prefer the more subtle scenes painted by Paul Sawyier.
Mr. Sawyier was from Kentucky.
Shortly a side door to the waiting room opens and a young lady motions for me to come with her. Tracy, Dr. Badalament's nurse introduces herself and directs me to one of the nearby exam rooms.Wouldn't you know it; Kincade's pictures are all over the walls.
The top of the work area has something more interesting; molded models of the prostate and other internal organs.
After taking my blood pressure and pulse, Tracy informs me that the pressure is 140 over 80, a little higher than usual and the pulse; 84. She then proceeds to ask family history questions, then personal questions and if that is not enough intimate questions.
Some very intimate.
When I respond to one question, "Paula Jones could answer a question like that", a laughing Tracy retorts, "everyone says that". Tracy completes her part of the examination and leaves the room when a very pleasant Dr. Robert Badalament enters, still in surgical blues.
A quick greeting is exchanged and we get down to business, after all; I have a list of questions I want answers to.
For the next hour Dr. Badalament and I discuss the PC and my prognoses.
According to Dr. Badalament and the lab reports my cancer is diploid; having one complete set of normally paired chromosomes, i.e., a normal amount of DNA.
The cancer is a six on the Gleason score, which indicates its growth is moderate and will double in size approximately every four years.
The combination of my PSA (3.2), Clinical Stage (T2C, by Ultrasound) and Gleason Score (6) predicts the following; it is confined to the prostate with a seventy-eight percent chance it will stay confined.
In other words, there is a little better than twenty percent chance the cancer will penetrate the prostate wall and enter the blood system. Reviewing the Parton tables further with Dr. Badalament's showed there is only a one percent chance the cancer will involve the Seminal Vesicle. These glands, located at the base of the bladder, are connected to the prostate and provide nutrients for the semen -- the fluid emitted at ejaculation. Ninety-nine percent of the semen is Seminal Vesicle fluid, which is rich in fructose, and prostate fluid. The fructose provides a high-energy source required by the sperm while swimming a marathon race and entering a hostile environment.
There is zero to one percent chance that the cancer will also involve the Lymph Nodes.
Currently I would say pretty good odds; the type you bet on. Even through the cancer is very small at this stage and cannot be felt via a DRE (Digital Rectal Exam), it can still be very deadly if left unchecked.For completely eliminating this nuisance Dr. Badalament and I agree on two options. (Sharon and I have ruled out radiation with the prognosis, my age and health.)
The first option is a Radical Prostatectomy, an operation to remove the entire prostate gland and Seminal Vesicles. (Dr. Badalament had just completed two radicals - the reason for surgical blues.)
Cost is approximately $25,000.
The hospital stay can be anywhere from two to five days with a catheter inserted for the next three weeks.
Follow up can last for the next few years.
Possible side effects are; risk of impotence, incontinence and complications after surgery.
The downside of a radical; should the surgeon cut through or disturb the cancer while removing the prostate from the base of the bladder, the cancer can spread.
Once the cancer is removed, there are no other options, with the exception of radiation or chemotherapy. My other option is Cryosurgery; the use of liquid nitrogen probes to freeze the prostate to a minus 320 degrees to kill the cancerous cells, including any cancerous tissue.
Cost is approximately $13,000 with an overnight hospital stay and an inserted catheter for the next three weeks.
Follow up for the next five years including intervals of biopsies.
Possible side effects are; the cancer may not be destroyed, risk of impotence and disturbance of the urinary function.
On the positive side, Cryosurgery can be repeated and a patient would continue to have other options. For the next few months, Dr. Badalament places me on Combination Hormonal Therapy (CHT), the first and mandatory treatment regardless of the initial stage of the disease.
CHT includes Casodex - a small white tablet that blocks the conversion of testosterone, produced by the testicles and adrenal glands (adrenal glands also produce a small amount of testosterone), into Dihydrotestosterone (DHT).
In prostate cancer, DHT stimulates the cancer cells' uncontrolled growth.
Proscar - a small blue tablet that blocks the formation of DHT in the prostate. When DHT is removed, the prostate shrinks in size.
Both medications are to be taken daily. I returned five days later January 19, 1999 for Zoladex.This small capsular implanted in the abdomen will cause the brain to send a signal to the Testicles for the next three months, instructing them to stop producing testosterone. In other words, I would have to learn to live with chemically induced celibacy. I walk out of the office with a handful of sample drugs, two prescriptions, Dr. Badlalment's business card with an appointment scheduled for March 29, 1999 and written answers to my questions.
As I drive out of the parking lot I shake my head, "what-a-way to start 1999".
Sharon and I were sitting outside Dr. Lee's office when he arrived at 7:45 a.m.
We had braved the cold and windy Michigan morning to speak with Dr. Fred Lee, a radiologist and Director of Crittenton Hospital's Prostate Center.
My appointment had been scheduled for January 19, in regard to the Prostate Cancer (PC) I had been diagnosed with the previous month.
The consultation was to be followed-up in the afternoon with another chest x-ray and an abdomen implant of Zoladex.
Approximately fifteen years ago Dr. Lee, too, had been diagnosed with PC, however, his PC had found its way into the lymph nodes.
He was given five years to live.
That was in 1984.
After a two-year sabbatical and devoting his time to researching early diagnosis of PC, today Dr. Lee is a pioneer in the field of early detection of PC using transrectral ultrasonography (TRUS) with color flow Doppler (CFD).
Dr. Lee defined what PC looked like in transrectal ultrasound and his work has lead to its widespread acceptance as the preferred method of diagnosing PC.
In 1999, the International College of Surgeons awarded Dr. Lee with an "Honorary Fellowship." He is the first radiologist in history to receive this distinction.
Dr. Lee is also one of the team members helping to guide me through a valley of uncertainty.
Dr. Lee is a very soft-spoken person and is intensely precise in his explanations. As Sharon and I listened, he illustrated on paper the stages of prostate cancer to us.
He wanted to make sure that we both understood what was taking place inside my body, especially inside the prostate, and what my treatment options were.
He also tells of a close friend and surgeon that he lost to PC.
He wanted to know if we had any questions.
I had a myriad of questions and I have always encouraged Sharon to ask questions. After all, we are partners in love and life.
Additionally, she may have to function as my 24-hour nurse should problems develop after the treatment.
According to Dr. Lee, the results of his TRUS with CFD and biopsy, the lab reports, my PSA and other data indicated that the location of my cancer is in the right and left base of the prostate.
In other words, I have two cancers.
Their sizes are 1.5mm and 6mm respectively. Small but potentially deadly.
Rather than aggressive they are moderate in their growth.
The chances of their penetrating the prostate wall and entering the lymph nodes are very slim, in fact only two percent.
While Dr. Lee's specialty is Cryosurgery (freezing the prostate to a minus three hundred and twenty degrees) he explained and detailed other treatment options.
The first option was a Radical Prostatectomy -- an operation to remove the entire prostate gland and seminal vesicles.
Option two was Radiation Therapy -- the use of x-rays and other forms of radiation to destroy malignant cells and tissue.
And number three was Cryosurgery.
The second option we immediately ruled out because of my age, excellent health and damage to other internal organs that can result from radiation.At this stage of the game, I did not want my body to receive massive doses of radiation.
After all, many doctors believe that radiation only "stuns" the bad cells, and there are cells that could escape, especially if the doses and the focusing of the radiation are not absolutely accurate.
While nothing is guaranteed, Dr. Lee said my cure rate is close to 100%. This is because my PC was detected at an early stage with my PSA at 3.2.As Dr. Lee explained, often times when the PSA reaches 4.0 the cancer has penetrated the prostate capsule and spread into the lymph nodes. This is a further incentive for men to have a TRUS with CFD anytime their PSA level start to trend upward.
He went on to illustrate why it is so important for women to have mammograms.
Once a lump is felt, often times it is too late. The cancer has spread.
Only the TRUS and CFD for the prostate and Mammogram for the breast can detect the early stages of cancer.
Before I left Dr. Lee's office, he handed me the paper he had been writing on.
He then instructed his secretary to make a copy of all records and lab reports pertaining to my PC and give them to me.
He also made sure I had a copy of the latest study he had participated in and had presented in, "Seminars in Urologic Oncology, August 1998".After spending some time in conversation with Dr. Lee, one soon comes to the realization that here is a man truly dedicated to his work, and to the well being of his fellow man.
I drove Sharon to her office, then returned to the hospital where another chest x-ray was taken, (which turned out to be negative,) and went to have the Zoladex Implant.
After an injection of lidocaine, a numbing agent, the small capsule was implanted into my abdomen, leaving a nasty bruise the size of a half-dollar.
For the next three months as the little capsule dissolves, it will send a signal to the brain instructing the testicles to stop producing testosterone.
Finally -- just finally -- I was done with insurance forms, examinations, needles, x-rays, consultations, charts, driving, sitting and waiting.
Now while on Combination Hormonal Therapy (CHT), the first and mandatory treatment regardless of the initial stage of the disease, I could read, research and speak with others who had encountered PC and chart my progress.
Moreover, I would do some of this while Sharon and I cruise the Grecian Isles.
In the next few weeks, after weighing the risks and the long term benefits, Sharon and I will select one of the treatment options that we both feel will be most appropriate for my condition, and one we both will be comfortable with.
I have never been one who feels that I must belong to an organization, or any group for that matter, just to fill my days with something to do. Since being diagnosed with Prostate Cancer (PC) in December, I definitely now belong to a group.
I am one of the 8,000 male victims in the state of Michigan who was diagnosed with PC in 1998.
As the hours now turn into weeks and the weeks into months, I have accepted the fact that I am a cancer victim.
Once this ordeal is over, I expect to advance to an opposing group called, "Cancer Survivors."
January 19, 1999, Dr. Badalament started me on a daily Combination Hormonal Therapy (CHT). CHT includes Casodex - a small white tablet that blocks the conversion of testosterone produced by the adrenal glands (adrenal glands do produce a small amount of testosterone) into Dihydrotestosterone (DHT) and Proscar -- a small blue tablet that blocks the formation of DHT in the prostate.
In PC DHT stimulates the cancer cells' uncontrolled growth.Removing DHT shrinks the prostate and starves the cancer cells.
There is also a small Zoladex capsule, implanted in my abdomen, which causes the brain to send a signal to the testicles instructing them to stop producing testosterone for the next three months.
On Saturday January 23, five days after the Zoladex tablet implant, I began to have the flu syndrome with aches and pains. (Possible side effects according to printed documentation.) Accompanying this was nasal congestion, sinus pressure, back pain but no fever. Around midnight I finally had a sweat-out and felt somewhat better the next day.
The following Monday I continued to feel bad enough to place a call to my urologist Dr. Robert Badalament, to verify if this was a CHT side effect. I was feeling so miserable that my son and his wife, feeling sorry for me, cleared the snow from our driveway.
With only four days until we were supposed to leave for Cancun, I had started on my second box of tissue. Finally, I took an Alka-Seltzer and slept the afternoon away.
Later Monday evening Dr. Badalament returned my call.
For the next hour we discussed Prostate Cancer, the articles I am writing, family, and colleges (Ohio State his alma mater).
Dr. Badalament also informed me that he was offered a position with Memoral Sloan- Kettering in New York following his fellowship in 1987.
In 1995 in came to Crittenton Hospital in Rochester, Michigan.
Although I felt miserable I also felt I was in good hands as he prescribed Zithromax, a powerful antibiotic.
By the time we arrived at the airport in Cancun I was so tired that standing in line for an extended period of time holding our passports did not make me impatient.
By dinnertime, totally exhausted and with a flushed face, I was not interested in the appealing dinner set before me.
I went to bed.
After finishing the last three capsules of Zithromax in Cancun, my old self begin to come around.Whether this setback was a side effect of Zoladex, CHT in general, or the common flu, we will never know.
Nevertheless, it was good to get it over with.
Now, periodically and almost instantly, I will be completely wiped-out. An adverse reaction I contend with.
One definite side effect with Zoladex is an increase in appetite.
In fact, I weigh a little more now than I did prior to the implant, and it is not due to staying indoors caused by all the snow we have had this winter.
Hot flashes -- I have had my share of them, too, and believe me, they are not so bad during the cold winter nights.
Crying for no apparent reason is something else.
I have never considered myself to be a very emotional person.
It takes a lot to upset me enough to produce tears. However, that little Zoladex capsule can cause tears to flow, but at least you know why they are flowing.
With Proscar, a finasteride, it attacks the potency.Forget about one's libido -- it is nonexistent.
All the beautiful models in the world could strip down bare butt, but while taking this very small tablet you would request they put their clothes back on.
As of this writing, I have encountered no side effects that I can attribute to Casodex, a bicalutamide.
While it is said to cause high blood pressure, itching of skin (maybe a little of this) mental depression, anemia, short-term memory loss (I have always had this) and other side effects, I have not felt them.
These symptoms may show up after six months on CHT due to the significant fall in serum testosterone.
I do not expect to exceed the six months.
On the positive side, most of the side effects can be treated with a proper diet, vitamins, exercise, and prescribed drugs to help maintain one's overall health.
I have found that I can control the hot flashes with soy products. The milk is very tasty, especially on cereal.
Tofu takes on the flavor of whatever it is prepared with.
Annually since 1984, I have paid a visit to Dr. Ned Winkleman, a plastic surgeon, who removes small skin tabs from my neck area.
All of these tabs have been benign until recently. I neglected to have one removed in 1998.
While this particular skin tab grew during 1998 and 1999, it begin to shrink as I continued with CHT.
Being concerned I immediately scheduled an appointment with Dr. Winkleman for a biopsy.Two days later Dr. Winkleman called and informed me the biopsy was Squamous Cell Carcinoma, not melanoma and not likely to spread but it should come off.
On Thursday, February 18, and 18 stitches later it was off.
With PC inside me and Squamous on my neck, I questioned Dr. Winkelman as to a correlation.
Dr. Winkleman's explanation: Squamous Cell Carcinoma is seen primarily in older patients (I'm sixty), mostly men.
Like Basal Cell Carcinoma, its prime cause factor is solar radiation.
Hereditary factors are important also.
While there is not a known direct correlation between the shrinking of the Squamous Cell Carcinoma and CHT, my urologist stated, "You may be on to something," when I informed him.
As is readily apparent I am not a passive patient.I believe in taking my health care into my own hands.
If ever there was a reason to become an educated consumer, this is the one.
After all, I am the one who has to live the life, not the radiologist, the urologist, the physician or the surgeon.
I am also the one who pays what the insurance company does not.
There continues to be a great deal of controversy surrounding the treatment of Prostate Cancer (PC). In recent days treating PC has made the major television networks, the radio talk shows (one of which I participated in) and comments from the American Cancer Society (ACS).
However, Dr. Robert Leibowitz of the Compassionate Oncology Medical Group in California is very assertive in his video titled, "Emerging Concepts and Management of all Stages of Prostate Cancer." Leibowitz considers PC systemic, therefore it should be treated as such. Prescribing a thirteen-month triple dose of Combination Hormonal Therapy (CHT), the first and mandatory treatment regardless of the initial stage of the disease, for localized PC (confined to the prostate) Leibowitz claims a 100% cure rate. While some individuals may think Leibowitz to be somewhat extreme (considering a triple dose of CHT for thirteen months at a cost of $900 per month and the potential side effects) some of his tenets make sense and the video is worth watching. In fact, I delivered a copy to my urologist for his review and comments. (The video may be purchased for $15 by calling (310) 229-3555. A refund of $10 is given if the tape is returned.)
Dr. Fred Lee, Director of the Crittenton Prostate Center in Rochester, Michigan and a recipient of the 1999 International College of Surgeons "Honorary Fellowship," claims eighty to ninety percent success with his cryosurgery. (Cryosurgery is a freezing technique using ultrasound as a guide to provide detailed images allowing safe and precise freezing of the prostate.)
However, cryosurgery is not for everyone, the same way radical surgery, radiation or seed implant (SI) is not for everyone. The impotency rate for cryosurgery is currently eighty-five percent. Incontinence is four percent for cryosurgery, thirty-one percent for a radical and eleven percent for radiation.
This is precisely the reason an individual with PC needs to do his homework.
He cannot sit by and be a passive patient.
After all, research is done before a new home or new car is purchased.
I think PC to be a little more important than either of these.
Today there are those in the medical profession who believe that cryosurgery will eventually replace the radical prostatectomy (Gold Standard) as the procedure of choice.
In other words, radical surgery will become obsolete.
In fact, as of July 1999, cryosurgery will be removed by Medicare as an experimental classification procedure and Medicare will begin to pay for the treatment.
In a support group that I attend, many of those scheduled for radical surgery have canceled and opted for cryosurgery.
"Man to Man, Surviving Prostate Cancer," written by Michael Korda and published by Random House, is a must read for cancer victims and an excellent gift for males of the family.
(I give the name "victims" to individuals who have yet to undergo treatment. Survivors are those cured.)
Korda is a survivor of a radical prostatectomy and his writing style makes for interesting reading, even if you are not a PC victim. Korda describes in detail the problems he encountered prior to, during his diagnosis, later treatment and recovery.
However, Korda had the foresight (and means) to purchase items he would need post surgery, i.e., rubber sheets, adult diapers, sterile gauze and tape. Being a vice president of Simon and Schuster, Korda's income allowed him the luxury of a part time nurse and a male attendant while recuperating at home.
Korda also employed a private plane to take him home from the hospital. (Having corresponded with Korda, he also writes an interesting letter.)
Another book worth the purchase is, "Prostate & Cancer, A Family guide to Diagnosis, Treatment & Survival" by Sheldon Marks, published by Fisher Books.
Marks, an urologist, have taken various questions he has been asked during his years of practice, puts them in book form and supplies the answers. Marks conclude his book with a final chapter on death, but caution the reader, prior to reading the last chapter.
"The Prostate A Guide For The Men And The Women Who Love Them" by Janet Farrar Worthington", published by Warner Books is the most biased reading material, promoting the radical surgery, that I have read.
The book in effect promotes Dr. Patrick C. Walsh, who pioneered the nerve sparing procedure, and Director of Urology at Johns Hopkins University School of Medicine.
While the author did present some excellent information relative to how PC is stimulated and controlled, she focused too much, I felt, on the surgical removal of the prostate.
While having my annual colonoscopy recently, my proctologist informed me that he, too, had undergone a radical prostatectomy. In our chitchat prior to the procedure, he was very clear in that he considers radical surgery to be the best option, and as a surgeon, he was absolutely against cryosurgery. In fact, we are scheduled to have lunch and discuss his concerns and my defense of cryosurgery.
PAACT, "Patient Advocates for Advanced Cancer Treatment, Inc.," a free quarterly magazine out of Grand Rapids, Michigan ((616) 453-1477)) is a Cancer Communication Newsletter.
The magazine is an excellent source of valuable information for those with PC. It features everything from helpful hints, food recipes, and cryosurgical reports, to up-coming symposiums and vitamin sources.
PAACT Web Page is located at http://www.osz.com/paact.
The magazine "PCRInsight" published by The Prostate Cancer Research Institute out of Marina del Rey, California focuses more on the current research on PC.
Again, this is free literature with a Web Page at: www.prostate-cancer.org.
Relative to local support groups for PC: one meets the first Tuesday of each month at 7:PM in the auditorium of McLaren hospital in Flint. Crittenton Hospital support group meets the third Tuesday at 7:PM in the Wessels Conference Room and may be contacted at (248) 652-5269.
A local group meets the second Thursday of each month at 6:PM at St. Johns Activity Center in Fenton.
All groups welcome spouses or significant others.
Relationships and friendships often change. A stigma is sometimes attached to cancer by those who are uninformed or do not take the time to learn about cancer.
The controversy over PC will continue until the disease is eradicated.
Yet, when an individual is diagnosed with PC he can no longer afford to sit-by and be a passive patient.
He must take control of his life and not allow the medical profession or the insurance companies to dictate his future quality of life. PC is not to be taken lightly, and no one should rush into any treatment option.
Obtaining a second and even a third opinion should always be a consideration.
It may, in fact it will, consume many hours of reading, researching (including the Internet) discussing, seeking sound information and formulating one's own opinion in order to reach a decision that he and his family must live with for the remainder of his life.
During discussions with those in the medical profession concerning PC, life is spoken of in terms of "five and ten year survival rates." PC is a silent killer, with a war raging inside the victim's body. The body has become a war zone.
If total victory is to be the outcome, the war has to be fought with every weapon one has access to in his defense arsenal.
One would think when a cancer victim spends six months becoming an educated patient on Prostate Cancer (PC) by reading, researching and speaking with other PC victims and survivors, making a decision for treatment would be rather easy.
Believe me it is not.Because the long-range side effects are very similar between cryosurgery and radical surgery, the decision does not come easy.
Vacillating between radical surgery (complete removal of the prostate) and cryosurgery (turning the prostate into an ice ball at minus 320 degrees) it was time to resolve the uncertainty and make a decision, a decision that cannot be put off any longer.
It is at moments like this that ignorance could be bliss. Having been diagnosed with PC in December, 1998, and spending six months on Combination Hormonal Therapy (CHT), the first and mandatory treatment regardless of the initial stage of the disease, it was time to rid myself of the cancer and the medication and get on with my life.
Supposedly after six months of CHT the cancer cells have shrunk by fifty percent. During my own clinical adventures, I accompanied my young son and his wife to the Mayo Clinic. Spending twelve days in Rochester, Minnesota, provided me with the opportunity to visit Mayo Clinic's cancer information area and further increase my knowledge of PC. (It also provided me the opportunity to discuss PC with my son. Now that I am a victim, both of our boys have a fifty-percent chance that one day they too will become victims.) The clinic treats over one and one-half million patients a year, a good many of those with PC.
While there are certainly very good clinics and hospitals in most major metropolitan areas, we found that Mayo Clinic is the place to go for prompt diagnoses.
Especially when it involves the gallbladder, my son's medical problem. Later while vacationing in Greece and Turkey, Sharon and I ran into an urologist from Kentucky. During one of our many conversations, and after learning of my PC, he asked my age. When I told him sixty, he responded that if I were seventy he would suggest that I do nothing. However, since I was only sixty and in excellent health, his suggestion was that I have the prostate surgically removed. Coming from an urologist who has been practicing for over thirty years, it sounded like good advice -- but advice I was not ready for. I was also surprised to hear the same advice coming from my proctologist during a discussion on radical surgery versus cryosurgery. He had undergone a radical prostatectomy in 1998. Although he experienced a collapsed lung during surgery, caused by improper administering of the anesthesia he said, he continues to believe that the radical is still the "Gold Standard" and is the only way to go. He too is quite young, in good health and has a positive outlook, plus a very good medical practice. One aspect of cryosurgery helped me reach a decision.
Currently cryosurgery requires five years of biopsies as a follow-up.
Nine biopsy's over five years (fifty-four single needle punctures) in what would be left of my prostate would be required after cryosurgery. One needle puncture certainly does not appeal to me, let alone fifty-four. And since the tissue around the urethra and other areas of the prostate are not frozen, (only where the cancer resides) the potential exists for the return of the cancer in the remaining tissue.
Of course follow-up cryosurgery can be performed if needed. In any event, one lives with the certainty of biopsies and the possibility of the return of PC. The final incentive for the decision came as I left the home of a friend of mine. He is in his eighties, a musician and artist, and recently suffered a small stroke. As we talked, he informed me that he was having some lower back pain and problems urinating, which I understand to be probable signs of prostate trouble.
Walking to my car, I kept thinking to myself that if I do not get that little sucker (prostate) removed I could one day be experiencing the same thing.
All the way home I kept telling myself that the prostate had to come out -- not frozen, not radiated, but completely removed. As Sharon and I viewed many educational videos produced and distributed by large pharmaceutical firms, it became obvious to us that PC is a "we" disease: While the tumor obviously is not shared, everything that accompanies PC is: the doctor visits, the support group meetings, the uncertainty of what lies ahead, trying to understand the cause and effect on relationships, and making the treatment option decision. June 18, I met with my urologist, Dr. Robert Badalament and informed him of my (our) decision. We discussed the surgery and post surgery; wearing of a Foley catheter for three weeks, no driving for six weeks, and also the potential side effects: impotence, incontinence and blood clotting. Since the decision was now made for radical surgery I asked Dr. Badalament what his success rate was and had he lost any patients. He informed me that, "yes" he had lost one patient. It seems after returning home from surgery and a short hospital stay the patient did not do any walking as he was instructed. Consequently, a blood clot was formed leading to the patient's death. On June 24, I went through pre-admission at Crittenton Hospital with blood taken, chest X-ray and electrocardiogram.
I spoke with the anesthesiologist and discussed the anesthesia and the placement of the epidural (I also suggested that he keep me under until August).
Prior to my leaving the hospital, a nurse gave me a plastic jug full of powder that I was to mix with water the day prior to surgery.Once cooled, the gallon of cherry flavored liquid was to be consumed within four hours. I was to be one clean individual when I checked in for surgery the following day.
Now that was a challenge! To be placed with my medical files in the hospital I left a copy of my Living Will, giving Sharon the right to tell the doctor not to prolong my life under certain conditions.
While Sharon does not like for me to talk about death it does happen during surgery, sometimes. Since a radical prostatectomy is no minor surgery, I like to prepare for the worst-case scenario.
I wanted to make it clear that I did not want to be kept alive by extraordinary or artificial means.
In addition, I did not want to be revived if it was certain that I was dying.
Additionally this is not something that can be left for the last moment, that is unless you know the final outcome. Once the decision had been made to have the radical, I immediately begin to prepare myself both physically and psychologically for the surgery.
A regimen of exercise to build up my muscle mass included arm and leg curls.
Since a patient can lose up to five units of blood during radical surgery, a daily intake of 320 mg of slow releasing iron tablets was included in my daily diet. I was not interested in a blood transfusion at any stage of the game.
I also continued taking vitamins E, C and Flax Seed.
And to improve my chances of being continent, I began the Kegels, or exercising the urethral sphincter muscle at the base of the prostate. (After surgery it would be located at the base of the bladder.)
All of this preparation was to pay big dividends post surgery.
July 6, 1999, Sharon and I were up early. At the home of our son and his wife, they were in the process of making coffee, strong coffee.
This was a day the four of us would not soon forget.
Having been diagnosed with Prostate Cancer in December 1998, today the bad body parts would be removed.
My surgery was scheduled for 10:45 with urologist and surgeon Dr. Robert Badalament. Badalament is noted for his research on cancer and has authored over one hundred medical articles. I felt I would be in good hands with Bob as our caravan of two cars headed for Crittenton Hospital in Rochester, Michigan. After being admitted, I was directed to a prep area where I disrobed and once again put on that ugly thing of a gown. (I had already provided the hospital with my Living Will, giving Sharon the right to tell the doctor not to prolong my life under certain circumstances. I wanted to make it clear that I did not want to be kept alive by extraordinary or artificial means. And I did not want to be revived if it was certain that I was dying. Since a radical prostatectomy is no minor surgery I like to prepare for the worst-case scenario.) few moments later a nurses-aide entered my private curtain area and shaved me where the radical prostatectomy was to be performed, then I was given a mild sedative.
The anesthesiologist who would place the epidural, with my head resting on my wife's shoulder, arrived soon thereafter. The epidural is intended to control the pain during and after surgery, and it would be left in place for approximately three days.
I was also informed by the anesthesiologist that there was a fifty-percent chance that the epidural might not work. (Little did I realize the significance of this statement.) At the appointed time, a nurse rolled the gurney I was on into surgery room number one.
The last thing I recall, as the mask was lowered over my face, was Dr. Badalament standing to the side, rolling up and taping an object.
(Later I learned that the object was placed under my spine to arch my body upward.)
Once in never-never land a Foley catheter was inserted into me, which would aid in the removal of the prostate.
Dr. Badalament then made an eight-inch incision below my navel, all the way to the pubis.
Before the prostate was reached, the left and right lymph nodes were removed and immediately sent to the pathologist. If they are free of cancer cells, the doctor continues the surgery.
Should the report come back positive, the surgery will be stopped and the incision closed.
The lymph nodes are a "free system"; consequently, cancer cells can be carried and circulated throughout the body if the nodes have been invaded. Having been informed that the lymph nodes were negative, Dr. Badalament, with his hands inside my abdomen, continues with the surgery.
In order to maintain a bloodless field to operate in, the Dorsal Venus Complex, a large group of veins located over the top of the prostate and extending down the sides must be separated and tied to obtain full exposure of the prostate. Should these be accidentally severed, Dr. Badalament would have to perform the surgery in a pool of blood and race against the clock.
Next the tendon that attaches the urethra to the pubic bone area is cut, freeing the urethra. The location for cutting the urethral sphincter away from the prostate is quickly decided upon, and the urethra is cut through the Foley catheter while the surgeon hold the catheter upward. If the urethra is cut to close to the prostate some cancer cells might be left behind; but if it is cut to far away from the prostate, the urethral sphincter might be damaged -- thus incontinent. Badalament then lifts and rotates the prostate from side to side while he separates the prostate from the rectum. Bit by bit the two seminal vesicles, which manufacture and store seminal fluid, are removed together with the prostate. If nerve sparing is attempted the neurovascular bundles (bundles of nerves that control erection) have been separated from the prostate and tied off. However, they cannot always be saved in which case the result is impotence: (The primary goal here isn't to preserve potency, but to get rid of the cancer.) Next, the bladder neck is opened, and the prostate is dissected away from the muscular wall of the bladder leaving an opening the size of a quarter. After the old catheter is removed, the opening in the bladder neck is reconfigured so that its new size matches the urethra. Finally a new Foley catheter is inserted through the penis and up through the urethra and into the bladder. The urethra and bladder are sewn together. To allow for proper healing, the catheter is left in place for approximately three weeks. This allows the urine to flow freely from the body while healing takes place. Two hours and ten minutes later, another successful radical prostatectomy is over without any requirements for blood. (The prostate, and the seminal vesicles are sent to the pathologist for further study. In my case the Combination Hormonal Therapy (CHT), had done its job. One cancer had shrunk over fifty-percent and the other, as the lab report described it, was "indistinguishable from the surrounding tissue.")
At long last the abdomen is sewed up and the anesthesia equipment is turned off.
Now it is to the recovery room and time to wake up.
With the epidural still in place, the pain should be minimal, if any.
Was I in for a surprise.
When I awoke, on a scale of one to ten, the pain was a twenty-five.
The epidural was not working.
I felt like someone was poking a hot iron into the fresh wounds.
I was in Hurt City, big time. A shot of morphine was immediately injected into my body while the anesthesiologist worked to reposition the epidural. The epidural delivers the narcotics based on a scale of one to twelve. With the morphine in me and the epidural repositioned, the mechanizing controlling the delivery of the narcotic was set on one, with twelve being the maximum.
Both narcotics relieved the pain but every time I dozed off, I stop breathing.
This is not something you want to happen in the recovery room.
A nurse keeping vigil kept awakening me and asking me to breathe.
Approximately four hours later I was taken to the ICU where my family had gathered and waiting my arrival. Only this time when they got me up to walk, I had to sit down.That was all I remembered.
I stop breathing again.
One of the male nurses instinctively "kissed me" a couple of times (breathed into me) and thumped my chest.
Sharon, our son Kevin and his wife Karen were quickly ushered out of the room.
A nurse kept them company.
I woke up back on the bed breathing pure oxygen with lots of bodies above me saying, "Bruce breathe. Breathe Bruce."
I never did see that tunnel, the bright light or even hear someone call my name.
I was out.
Time was non-existent. Everything was fine until around 1:30 the next morning.
With the morphine worn off and the epidural set to one, once again I was in Hurt City.
This time on a scale of one to ten, it was a six, maybe seven. Who knows when you are in that much pain?
Fortunately, Sharon had spent the night and was resting with her head on my bed.
After complaining several times to the nurses, she finally got through to them that the epidural was set too low.
Sixty minutes later they reset it to an eight, this setting relieved most of the pain and I was able to get some much needed rest. Wednesday morning I was visited by the anesthesiologist who agreed I had been through more pain than was necessary.
After a short conversation and prior to leaving my room, he turned the epidural up to its maximum of twelve.
Now I had no pain at all, but a heck of a lot of itching.
Finally it was agreed that we would leave the epidural on eleven.
It stayed on eleven until it was removed four days later. After six long days, I was discharged from the hospital and Sharon took me to our lake home for continued recuperation.
I could not believe the extreme to which she had gone to make me comfortable. She had purchased larger clothing, things that I could wear over the catheter. The bed, with stacks of pillows, was arranged to let me sleep more comfortably. Pads were laid where I usually sit, and reading material was at my disposal. Later our son Kevin brought more reading material including Tom Brokaw's, "The Greatest Generation."
Words cannot express the gratitude one feels when surrounded with love and care such as this. Five days later, the staples were removed from the incision.
Eighteen days from surgery, the catheter was removed.
I have experienced no incontinence whatsoever, not even a drip, and Sharon said removing the catheter alone made me look twenty years younger.
(While I had gained weight caused by CHT, I lost fifteen pounds while in the hospital.)
Any pain and discomfort was caused either by the improper placement of the epidural or that damn catheter.
In fact, bladder spasms caused by the catheter nearly make you climb the wall.
The ball of my left foot is still sore from trying to climb the wall during several of those spasms.
A small amount of discomfort was caused by the scrotum being swollen the size of a softball, but after a couple of weeks it returned to its normal size. Once recovery began, walking was not only necessary to prevent blood clotting, it was mandatory.
But the stairs were a no-no.
It was only after three weeks that I was able to visit my computer and to work on these articles.Sharon kindly helped me with all the filing I had to catch-up-on. Now it's one day at a time, and each day is better. Better because you can walk without a catheter running down your thigh to the bag taped to your leg.
Better because you do not leak or have to wear adults Depends.
Better because you can bathe and dress yourself. Better because you can change positions in bed at night.
And better because you are not laying in a hospital bed where it is evident that good nursing must be hard to find.
But the very best is: you have rid yourself of the medication you have been taking for the past six months, and that disgusting cancer is no longer in your body.
It has been a little over seven months now since I was diagnosed with prostate cancer.Seven months of an unpredictable medical journey for our family.
Seven months a cancer victim.
Seven months families can do without. It is estimated that in the United States 179,300 men will be diagnosed with prostate cancer in 1999 and 37,000 will die of it.
In the state of Michigan alone, 6,400 men will be diagnosed with prostate cancer. Approximately 1,300 of these diagnoses will come too late.
The incidence of prostate cancer increases with age; and more than 75% of all prostate cancers are diagnosed in men over age 65.
If anyone has obtained anything out of this series of articles, I hope it is that you will start or continue to have your annual PSA.
If you are over forty and not scheduling it -- start now because very little in research dollars is being allocated to eliminate this disease.
In fact, 1997 statistics show that for every AIDS death $66,000 had been spent on research.
For each death from prostate cancer, you guessed it; only $452 had been spent on research.
This is worth repeating: you cannot afford to sit by and be a passive patient, you must take an active part in your own health care. At the very least know your PSA level and monitor its elevation. If I had it to do over knowing what I know now, would I do anything different?
I would use the same urologist, Dr. Robert Badalament of Rochester, whom I consider an excellent surgeon, and with whom I have developed a good relationship. As to the epidural, it is a must, but it would be positioned correctly the first time.
I would unquestionably again prepare myself both physically and psychologically.
A regimen of exercise to build up muscle mass is worth all the effort.
Since a patient can lose up to five units of blood during radical surgery, a daily intake of 320 mg of slow releasing iron tablets would once more be included in my daily diet.
Again, vitamins E, C and flax seed would also be included.
And to improve my chances of being continent, I would certainly repeat the Kegels, exercising the urethral sphincter muscle at the base of the prostate. (After surgery it is located at the base of the bladder.)
All of this preparation will pay big dividends post surgery. The hospital?
That is another question worth considering:
While I was in the recovery room, in pain and ceasing to breathe every time I dozed off, some nurses were complaining relative to their hours and pay checks loud enough for me to hear while I was awake.
Not very professional.
Later, in a private room, consider this: A diuretic to rid my body of some of the excess fluid was prescribed for me fourteen hours apart. Had I not been listening to Dr. Badalament I would have received it two hours apart.
Fortunately I spoke up.
Otherwise, the medication would have drained me completely dry, or at least it would have felt like it. And in another incident, pain medication was injected into my IV instead of into my buttocks, where it was supposed to go. Later during my hospital stay, I accidentally dropped a pillow and could not pick it up. When a nurse's aide came in, she just walked around it and left the room.
It stayed on the floor until I asked someone to pick it up.
And on response time: one morning after I rang the nurse's station, ninety minutes later someone showed up, but only after Dr. Badalament brought it to their attention. This is not the nursing care that I experienced in the 1970's or I expected in the 1990's.
Most individuals that I have spoken with, who had a hospital stay, had a like experience.
In today's world where the bottom line rules, hospitals are greatly under staffed and many have to resort to nurses from contract houses. Consequently, there is not much loyalty to the hospital or the patient.
While the parting words of a nurse was, "Your bag is full, you had better empty it", within my six day stay, there were some very good nurses and a couple of excellent nurse's aides. hile I do not mean to pick on the hospital, we do have a major flaw in our medical system. According to former surgeon Dr. Lucian L. Leape of the Harvard School of Public Health in the December 1994 Journal of the American Medical Association (JAMA), 180,000 hospitalized Americans can die each year because of errors made by hospital personnel.
A sobering thought while one is lying in their hospital bed. Regardless of the nursing care, I consider the operation to be successful.
Successful because of Dr. Badalament's knowledge and experience, and the final pathology report which came back very favorable.
In addition, the six months on Combination Hormonal Therapy (CHT) had done its job. One cancer had shrunk over fifty-percent, and the other, as the lab report described it, was "indistinguishable from the surrounding tissue."
Additionally the vas deferens and seminal vesicles were found to be cancer free.
Presumably, the bladder neck was also free of cancer.
All of this means I have no medication to take nor do I have to submit myself to radiation.
Fortunately the cancer was caught at a very early stage when my PSA level was 3.2. For the next five years, my PSA will be monitored every six months. Not only was the operation successful because of Dr. Badalament's expertise, but it was also successful because prayers on my behalf were being offered from Florida, Michigan, North Carolina and Virginia.
Our daughter-in-law from Indiana said she would pray for the surgeon's hands.
With this much intercession the surgery had to be a success. And finally, when the question comes up, "Would you do it again?" the answer is not simple.
If this radical prostatectomy has not added at least five years to my life, then the answer is, No.
But on the other hand, Dr. Badalament says with the clean pathology report statistically I can count myself in a group that can expect to have a greater life span. So -- of course it was worth it.
After seven months a cancer victim, now I am a cancer survivor.
Any way you look at it, if the prostatectomy gives me some more good years with Sharon -- that alone will be worth all the pain and agony.
One year ago today, December 16, 1998, Doctor Fred Lee of Crittenton Hospital in Rochester, Michigan caringly informed me by telephone that I had Prostate Cancer (PC).In fact, there were two cancers, one in each prostate node. Under the watchful eyes and skillful hands of Doctor Lee I had underwent an ultrasound with colorflow doppler the previous day. Later, after the conversation with Dr. Lee, I was to learn that I was one of 244,000 adult males in the United States, and one of 8,000 in the state of Michigan that was diagnosed in 1998 with PC. I considered myself somewhat lucky because my PC was detected early. I say somewhat for since age forty I have had an annual PSA examine, so it was not all luck; I do try to take care of myself. Annually more than 40,000 males in the United States are not lucky; death comes early because the disease was not detected soon enough. The irony is that nine out of ten of these deaths could have been prevented if only they had obtain their annually PSA exam, which some clinics and hospitals will perform for a mere $10, and others free. PSA or Prostatic Specific Antigen, is an enzyme created by the prostate. An elevation of the PSA in the blood can signal prostate cancer. While the PSA can be elevated with no indication of cancer, the PSA can also be low with cancer. (As in my case.) I had always understood the normal range for one's PSA to be 0.0 - 4.0 and my PSA had always fallen within the range. However; my PSA in 1996 indicated a value of 1.9, and had risen to 3.2 by 1998. A closer look at the numbers showed a trend, a trend I became concerned with. In other words, it was almost doubling every two years. Once the diagnosis was made, surgeon and urologist Dr. Robert Badalament of Crittenton hospital started me on a regime of Combination Hormonal Therapy (CHT), the first and mandatory treatment regardless of the initial stage of the disease. The object of CHT was to shrink the PC by fifty-percent prior to freezing or surgical removal of the cancers. As with most therapy's, there are certain side-effects. In the case of CHT it was hot flashes, weight gain, fatigue, loss of muscle mass and libido. The hot flashes can be controlled with soy products while vitamins and exercise help with the other. Since deciding on and undergoing a Radical Prostatectomy by Dr. Badalament (a surgical operation to remove the lymph nodes, prostate gland, seminal vesicles, and vas deferens) on July 6, 1999 the recovery has been excellent. The six months on CHT had done its job. One cancer had shrunk over fifty-percent, and the other, as the lab report described it, was "indistinguishable from the surrounding tissue." Additionally the vas deferens, seminal vesicles and bladder neck were found to be cancer free. I take no medication and underwent no radiation. My three-month check-up showed the PSA to be less then point one and the testosterone 112. The average male's testosterone is between 224 and 800. In addition, it will be another four to nine years before I am certain that I am cancer free. It will be another twelve to eighteen months before the testosterone level will be revealed in my beard and libido. Most men, or women for that matter, do not fully understand how the sex organs really function and the relationship with libido. Moreover that erections and orgasms are mutual exclusive. In other words there can be an erection without ever achieving orgasm - or an orgasm can be achieved without ever having an erection. This has created a demand for a product called a penile implant for those males who cannot achieve an erection after surgery but who can still enjoy sex. In fact there are a variety of penile designs that can be implanted by an urologist. However, they can be very expensive and are not one-hundred percent fault free. During the past year, Sharon and I have been attending one of the many cancer support groups where we continue to hear physicians discuss a variety of ways to treat PC. The controversy over the treatment for PC will continue until the disease is eradicated. Yet, when an individual is diagnosed with PC he can no longer afford to sit-by and be a passive patient. He must take control of his life and not allow the medical profession or the insurance companies to dictate his future quality of life. PC should not to be taken lightly, and no one should rush into any treatment option. Obtaining a second and even a third opinion should always be a consideration. There is plenty of information relative to PC; however, one must make a concerted effort to locate it. It will not come to you. If you are over forty and not scheduling a PSA -- start now. This is worth repeating: you cannot afford to sit by and be a passive patient, for you and your family's interest you must take an active part in your own health care. At the very least know your PSA level and monitor its elevation. In other words, do not rely on the physician to tell you it is OK. Ask for you PSA number on paper and maintain a record for your own confort. About the author Bruce Edward Marsee a native Appalachian, is a Freelance Writer and Lecturer after enjoying a successful career in Business Intelligence.
Bruce and his wife Sharon reside in Michigan, and spend their spare time Traveling and Porch Sitting. Prostate Cancer appeared as a series of articles in the Tri-County Times during 1999.