I first realized I was at significant risk for getting prostate cancer 15 years ago, when my older brother, who was then in his mid-forties, informed me that he had been diagnosed with an enlarged prostate and later prostate cancer. He had surgery in 1997 to remove his prostate.
My father had prostate surgery about 35 years ago. I knew little about the disease at that time, and other than knowing that he had had the surgery to remove his prostate, I don’t remember much about it. I do know that when he was hospitalized in 2005, his doctors asked about a large scar on his abdomen. I informed the doctors that it had resulted from prostate surgery. The doctor later advised me that the prostate cancer had returned but that no treatment was recommended because at his age he would die from something else. The doctor’s prognosis proved prophetic as my father passed shortly thereafter from natural causes.
My PSA readings were generally uninteresting, showing an upward trend but in the 1.3 to 2.4 range. However, between September 2009 and January 2010, my PSA level jumped a full point, from 2.3 to 3.2. Although relatively low, the sudden and elevated increase was a source of concern to my urologist. Doctors are concerned about the level as well as the rate of change over time, called velocity. A rise in the PSA of 0.75 or more in a year may be an indicator of cancer. After antibiotics did not lower my PSA level, my urologist recommended a prostate biopsy.
In February 2010, prostate cancer reared its ugly head, and I became one of over 192,000 men who are diagnosed with prostate cancer each year. I had not been spared the dreaded cancer as some of my relatives had speculated. Prostate cancer was like a rite of passage into mid-life for the men in my family.
While the diagnosis was not surprising, knowing I had cancer caused a lot of fear and anxiety. The mere thought of prostate cancer translated into thoughts of getting old, chemical castration, sterility, pain, suffering, having to wear a depend — and even death. In my mind, prostate cancer would transform me from being thought of as healthy and virile to weak and sterile.
It — the big PC — is such a cruel and unforgiving disease, challenging one’s self-esteem and attacking the fabric of manliness. Treatments for the cancer are equally cruel and unforgiving, often causing sterility and robbing men of their manhood, while leaving intact innate desires and needs.
After the diagnosis, prostate cancer became a constant companion, silently doing bad things to my man-organs and dominating my waking hours’ thoughts. I liked things the way they were. I did not want to deal with this obstacle in my life. I was an avid bicyclist, averaging 40 miles per week. I had just turned 58 years old, had recently taken early retirement, and was feeling good about the next station in my life.
The good news was that my cancer had been caught in an early stage, meaning I had treatment options. My urologist discussed the various options available to me and associated side effects. He also indicated that I had time to decide. To my surprise and without my asking, he recommended that I seek the opinion of a radiation oncologist.
My first visit with my radiation oncologist was insightful. One of the things I learned was that radiation is not like the smart bombs we hear about. To the contrary, radiation in its current form goes in and zaps everything, both cancerous and noncancerous cells.
My initial reaction after being diagnosed was to “man-up” and deal with it. After all, prostate cancer is successfully treated every day. Everyone knows someone who has survived prostate cancer. It is such a common disease for men that it is trivialized and almost a non-event. Cut it out or radiate it and you will be okay. The problem is that men who undergo prostate treatment typically are not okay. The psychological toll on men from the side effects of a prostate treatment is like the effect that a mastectomy has on women. Men afflicted with life-changing side effects from a prostate cancer treatment come to terms with their decision and accept their impotence and/or incontinence, much as a wounded soldier accepts missing limbs.
My next reaction was that I would start watchful waiting, which entails monitoring the cancer’s status through routine PSA and biopsy tests. There is a whole school of thought that this is the way to go for men with early-stage cancers. My plan for watchful waiting was to do what I had been doing, which was to have a prostate exam every six months. This was not exactly what the doctors were prescribing. I didn’t mind getting a PSA or even a prostate exam, but I did not want to deal with an irritated prostate and the nagging side effects of a biopsy every six months.
When I told my radiation oncologist about my plans, she said: “Don’t outsmart yourself.” This statement resonated loud and clear. After all, thousands of men with access to far more information and the best facilities undergo some form of prostate therapy every year. I eventually rejected watchful waiting because I felt it was only delaying the inevitable. I also did not want risk being 70 years old, incontinent, with painful metastasized prostate cancer.
The more I read and learned about prostate cancer and prostate cancer treatments, the more frustrated and angry I became. The literature on the subject was generally discouraging and conflicting. I was looking for a cure — a treatment that would kill the cancer without disturbing my quality of life. What I found was that there was no silver bullet, no consensus regarding the best treatment.
Six months after the prostate cancer diagnosis and after much research, prayer and soul searching, I decided to undergo radiation seed implantation (brachytherapy). I was interested in preserving both my life as well as my quality of life. Most of what I had read suggested that my chances of a good post-operation quality of life were better with radiation than with prostate removal.
By the time of my procedure, I had come to terms with cancer and the side effects of the various treatments. My fears and anxieties with my genetic predisposition had dissipated. I had exhaustingly researched the subject and knew that death was not imminent. I was comfortable with my network of doctors and confident that they would provide excellent care.
I recalled a David versus Goliath sermon I had heard a month before my procedure. In that sermon, the preacher said we all have Goliaths in our life. Prostate cancer was one of my Goliaths, and I had to deal with it. I would deal with it and all its side effects. I would adjust to a new normal way of living. And, at the end of the day, I would be okay.
As I am finalizing this piece, it has been 10 years since my cancer diagnosis and subsequent therapy. My quality of life is excellent, and my PSA level has been stable at about 0.2. Issues I have with urgency and frequency are managed through medication and awareness. The decision I made 10 years ago was the best for me.
· Get Tested Early — I am often asked if I had any warning of cancer and whether I felt any pain. Except for issues associated with an ever-enlarging prostate due to age, the answer is no. The only way to determine the likelihood of the existence of prostate cancer is through a PSA test. And, the sure way of determining whether you have the cancer is through a biopsy.
· Get Informed — It is important to know not only about prostate cancer but also the risks to the quality of life associated with the various treatments as well as the experience of your doctor. You can do this by researching the subject, by questioning your doctor or getting a second (third) opinion.
· All Prostate Cancer Treatments Have Side Effects — Regardless of treatment option and marketing propaganda, there is no cure for prostate cancer as one might traditionally think of a cure for a disease, where treatment is administered and the patient returns to the pre-treatment state. Surprisingly, newer technology does not translate into better results. And, cancer can return. Even the “gold standard,” prostate removal, carries a risk of recurrence.
· There is Considerable Uncertainty Surrounding All Aspects of Prostate Cancer — I was surprised at the amount of judgment that is used in diagnosing and treating prostate cancer. I was expecting an exact science where doctors knew with precision how to diagnose and fix cancer. What I found was an inexact science and considerable debate regarding every aspect of the prostate cancer treatment process, from the need for and validity of PSA tests to the best treatment option to the risks associated with the various options.
· Be Careful Who You Talk to About Your Diagnosis — My experience is that there are two extremes when it comes to the general public’s knowledge about prostate cancer — those who think your death is imminent and those who think that prostate cancer is a trivial matter. I did not want sympathy, nor did I want people to minimize what I was going through. I wanted to talk to people who could understand my pain. Thus, I limited the discussion of my diagnosis to immediate family and a few select friends. My discussions with select friends proved most beneficial as they often provided leads to others who were similarly afflicted.
· Include Your Spouse/Significant Other in on Your Doctor’s Visits — Being diagnosed with prostate cancer can be a traumatic experience, one that you should not go through alone. Because of this, your spouse, significant other or friend should attend doctor’s visits with you to provide support, help you retain the information provided by the doctor and to ask questions you may forget. It is also important for them to hear about the potential side effects of the cancer treatments, as they will be impacted as well. It is equally important to sensitize your doctor to the fact that the results of the procedure he/she performs will impact you as well as your family.
· Remember That There Is No One Best Solution — I chose brachytherapy but this may not be the best solution for you. There is no “one-size-fits-all” solution. All the standard therapies can be effective against prostate cancer; however, some have more significant side effects than others. The therapy that is best for you depends on your age, your health, the stage and grade of your cancer, your concerns about possible side effects, your financial situation, the therapies available to you and your personal preference.
· You Can Survive and Thrive — While there is the occasional story of a man going berserk due to the side effects of a prostate cancer treatment, most men adjust, adapt to a new normal and thrive. While I continue to have anxiety over periodic PSA tests, I am cautiously optimist about my prospects of having beaten cancer.