When the results are in, what are your options?
May 8, 2000 -- It's Monday, February 7, 2000. I've just had my second prostate biopsy within six months. The results are expected by Friday at the latest. On Friday afternoon, there's a voice mail message from the doctor: "We have the results. I'll call again Monday." Frantic, I call from the car. He's not there. The wait until Monday is agonizing. Have I got cancer? I need to know.
I call at 8.30 a.m., Monday, February 14. "Doctor won't be in 'til 9." I call back at 9 precisely. "Doctor's with a patient."
"Tell him I need to talk to him now. Please."
He comes to the phone. He's sorry to say that one of the six tissue samples examined is cancerous, and he asks if we can we have a "talk" next Wednesday.
As I put down the phone I think to myself, "So that's it." I'm among the estimated 180,400 American men who will be diagnosed with prostate cancer this year, according to the American Cancer Society. Now I know that deep within the most intimate recesses of my body there lurks a silent killer. Silent because there are no outward and visible signs, no pains, no perceptible changes in my health or in my body. When I urinate, it's the same as it's been all my life.
I had always been vaguely aware that older men get "prostate trouble," which I imagined as an inability to urinate easily and difficulty in getting an erection. "That's not me," I hoped. Ever since my late 50s, as part of my annual physical exam, I'd had blood tests for PSA (Prostate Specific Antigen), but I'd never paid much attention to them.
Then my PSA level, at 2 in 1998, doubled in early 1999 (there is a 20% to 50% risk of cancer when PSA levels are between 4 and 10). The rapid rise was a clear danger signal, so I had a biopsy in July 1999. My PSA had risen to 6.3 by that time. The July biopsy was negative but inconclusive, so the second biopsy was needed this year, just to be sure.
The news that I definitely have cancer provokes many questions and some knee-jerk reactions. Is this to be a slow but inexorable decline? Must I undergo the agony of an operation? Short of cutting out the prostate gland, is there any other cure? My eating habits must change immediately. I switch to soy milk and soy proteins. No more eggs, butter, milk, red meat. Then I recall that a friend had a radical prostatectomy and urgently arrange to meet with him.
We talk with him and his wife. Like my own wife, she is wonderfully supportive. She researched the options, found the "best" hospital, the "most expert" surgeons. He elaborates on the operation, the positive results of the surgery, and his rapid recovery.
"Within a few days of the operation, I was going for walks with the catheter still attached, carrying the little bag. Like a briefcase, really," he says. I am not encouraged. Little else I hear allays my fears.
My wife and I have our "talk" with the doctor. I have focal prostate cancer, which means it is present in only a few small areas. There are four options: surgery, external radiation therapy, brachytherapy (radioactive seeds implanted into the prostate, with or without hormonal therapy), or "watchful waiting." My wife asks, "If Anthony were your father, which would you propose?" Surgery, he says.
We begin to feel that the offending gland should be cut out, but I dread the two "evil I's" -- Incontinence and Impotence. After all, a report in the January 19, 2000 issue of the Journal of the American Medical Association estimates that about 60% of men who have their prostate removed are impotent and more than 8% are incontinent for at least 18 months after surgery.
We decide that we need further opinions. Our family doctor listens carefully as I explain my inability to understand the implications and decide upon the best course of action. In this sort of situation, a second opinion is necessary and comforting," he says. "Fortunately, here in Charlottesville we have the University of Virginia Medical Center, which is a leader in the field." Among the prostate cancer specialists is a surgeon of considerable renown who has also become an expert in brachytherapy."
And so we meet Jay Gillenwater, MD, the Harvey S. Dabney professor of urology. He is calm and reassuring. In addition to discussing the treatment options, he immediately lists vitamins and supplements that may control or even lessen the growth. It is a refreshing surprise to hear a surgeon advocating such things. He will examine the slides, study the results, and give us his opinion.
A few days later he calls. "I'm happy to report that you have the smallest focal prostate cancer it's possible to have. It's like a woman being almost pregnant."
He recommends brachytherapy without hormonal therapy. Too soon to rejoice, but the earlier confusion gradually evaporates with each conversation, each new step. There's an examination by the radiation oncologist, a preoperative medical exam, ultrasound "mapping," and other tests.
Yet still I wonder, why not "watchful waiting," instead of all this? A final, reassuring conversation with Dr. Gillenwater dispels my doubts. I agree to undergo brachytherapy to kill the killer. The operation is scheduled for May 9 at 8 a.m.
With a sigh of relief, a glorious Te Deum, and a glance at the calendar, we grab at low seasonal airfares to take a quick vacation in England. And, as each day passes, we find it a little easier to get our lives back together.
Anthony Hamilton is a freelance writer and actor. He and his wife live in an old Virginia farmhouse in the Blue Ridge Mountains near Charlottesville.
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