Monday, July 11, 2016


A lot of water has flowed under the bridge since my last blog post. It's been more than a year since I posted about buying some furniture. We still have it, but haven't reupholstered it as we wanted to. That will still have to wait.

Earlier this year during my annual physical, my GP noted that my PSA had risen again from the previous year. At that time, the PSA had risen also, he noted this then and wanted to make sure we watched this number. For those who are unfamiliar with PSA, it stands for Prostate Specific Antigen (PSA) and is a blood test that is commonly used to help predict the presence of prostate cancer. It refers to a protein first identified in 1979 that is made only by the prostate gland. After some discussion, he strongly suggested that I see a Urologist to further investigate this number. I figured the Urologist would look at the number and say lets watch it, but he was more for an aggressive approach, which meant doing a biopsy on the prostate gland. This is done through the rectum. Not an appealing prospect.

At this point, I must digress. Prostate cancer has a history in my family. My uncle (mom's brother) had Prostate cancer which eventually metastasized and killed him. This was years before more modern methods were available for treatment. Also, my 2nd cousin on my dad's side, who is a year younger than me, had his Prostate removed when he was 46 due to cancer.

Obviously, from my history, I could not ignore the numbers. However, the prospect of having a biopsy done was not appealing due to the methodology and the possible side effects. A prostate gland biopsy is a test to remove small samples of prostate tissue to be examined under a microscope. To perform the biopsy, a thin needle is inserted through the rectum (transrectal biopsy), through the urethra, or through the area between the anus and scrotum (perineum). A transrectal biopsy is the most common method used which was the method used on me. The tissue samples taken during the biopsy are examined for cancer cells.

I scheduled the biopsy with much apprehension due to the possible side effects and the potential results. The day of the biopsy soon arrived and went off with no issues other than the indignity of having something being shoved up my butt!

It wasn't but a few days and the Urologist called to schedule an appointment to review the results. I tried to keep positive thoughts in my mind, telling myself that there was no way I could have cancer and that my number was the result of something else going on. The power of positive thinking? We (my wife and I) arrived at the Urologists for the results and found that I was positive for Prostate cancer. I was characterized as having stage 1 Prostate cancer with a Gleason Score of 6. The Urologist caution us against panicking. He explained that this was a very slow growing cancer and that we had time to think about my options. He presented me with a book on Prostate cancer to read, suggested several web sites to consult, and an appointment to discuss options in about 3 weeks. He also encouraged me to seek a second opinion and was willing to help me find another Urologist if I wanted.

Even though I knew this diagnosis was possible, it was still mind numbing. It took me about a week to finally wrap my head around it and started reading about the options for treatment. Basically, treatment consists of either removal of the prostate gland, radiation, or do nothing. My Urologist was recommending complete removal of the Prostate based on my age. Whether you do the removal or radiation, there are also variations of each that need to be considered. Each one had it's own set of pros and cons. As I know from my wife's experience with Breast cancer, the decision(s) can be tough to make. There is a lot of information out there and not all of it is reliable or easily understood. In my mind I had decided which direction I was leaning....but had not made up my mind completely.

My appointment arrived for the consultation. The Urologist was curious if we had made a decision about my options. Since we had time to make this decision, my wife and I decided we would seek a 2nd opinion in regard to the diagnosis and options. My Urologist suggested 2 different doctors, one at UVA and the other at Johns Hopkins. We chose the latter based on Hopkins reputation in the Prostate cancer field. Since they were med school associates at Hopkins he was able to contact him directly to schedule the consultation quickly.

We drove up to Baltimore on the day of the consultation. Location and parking were fairly easy which lent itself to less anxiety. Always good. The Urologist's assistant met with us prior to meeting him to gather additional information from what we had previously provided. In addition, she requested that my Urologist have the biopsy slides sent to their expert for interpretation/confirmation of the diagnosis. The doctor came in for the consultation not long after we were done with his assistant.

Based on what he saw from the biopsy results and my age, he also recommended complete removal of the Prostate. While radiation was an option, the issues doing radiation on someone my age are numerous. 1st, once the radiation is done, it cannot be done again in the future if the cancer returns. 2nd, since radiation causes damage to the surrounding tissue, Surgeons are very reluctant to remove the Prostate after radiation therapy. This makes your treatment options in the future rather limited. While side effects for radiation are similar to the removal option, both occur for either method. With removal the chance of the cancer coming back are basically zero. Obviously, this doesn't eliminate other forms of cancer. At 56, I still have potentially many years to live and realized that this would be the best option. I was originally leaning towards a targeted type of radiation available, but realized this was not the best option for my age.

It was not long after the consultation that Hopkins called to confirm the diagnosis after they had reviewed the biopsy slides. Next up was making a final decision for treatment options, as once you start on one path for treatment it is difficult to start on a different one. Traditional removal methods for the Prostate used to condemn you to a future of incontinence and impotence. With the advent of technology, robotics, and advances in cancer research, more modern methods for Prostate removal are available. Hopkins is considered the leader in this field and offers numerous ways. I decided that Hopkins would be the place to have the surgery performed.

The surgery method was to be "Robotic Nerve-sparing Prostatectomy" performed Laparoscopically. By definition, the prostate is a walnut-sized gland located between the bladder and the penis. The prostate is just in front of the rectum. The urethra runs through the center of the prostate, from the bladder to the penis, letting urine flow out of the body. The traditional surgery would slice right through the nerves that control the bladder and the sexual function of the penis. Not a very desirable outcome for one of the slowest growing known cancers. Explains why many men choose not to do anything. Typically, they are in their 70's, 80's or older. The benefit for removal at that age is not very high. Not an option for me.

Surgery was scheduled for July 5, 2016 at 7:30 am. I would need to report to Johns Hopkins at 5:30 am. Pre-Op prep would require a bowel prep regiment that does not need to be spelled out here. We spent the night in Baltimore, at a local hotel less than a mile from Hopkins, to save us the 1 1/2 hour drive the morning of. We arrived on time and I was in the operating room by 7:30 am. According to my wife, I was in the operating room only about 2 hours, but in recovery about 5 hours.

Take the pain meds! There is a reason for this. You will be in pain. By the time I reached my room, I was starting to feel sore. Laprascopic surgery is performed through small incisions. Including the hole they installed a drain through, there were 5 other incisions (stab wounds as the nurse described them) ranging in size from 1/2" to the largest at 2" in my abdomen. Important to try and stay ahead of your medication as by the time you start feeling sore again, it's too late. I alternated between Oxycodon and Tylenol initially and then Advil.

My Insurance company had approved an overnight stay of one night. It would seem that this is standard for this type of surgery and it would prove to be my case also. By the next day, I was feeling well enough to walk and move around pretty freely. I was released after the drain was removed with only the catheter still installed. This gets removed 10 days after surgery.

This morning, my Urologist called with the results of the pathology on the prostate gland. He was able to remove the prostate with clear margins, meaning it was still self contained within the gland. The actual Gleason Score was now a 7, up one point from my initial diagnosis, but not significant since I am now cancer free.

I guess the moral to this story is to visit your doctor on a regular basis and pay attention to the numbers. Several years ago, I was at my accountant for our taxes. He greeted us with a question: When was the last time I had been to the doctor? I looked at him quizzically, as this was not your typical question from your tax professional, whereupon he proceeded to tell me that he had Stage 4 Prostate cancer. He had not been to the doctor in 14 years. He finally went after the symptoms he was experiencing were too difficult to ignore. I relayed to him that I had a family history of Prostate cancer and was checked annually. Our taxes were completed on time as always. He passed away on April 15.

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