Saturday, December 11, 2010

Winning the Battle With Prostate Cancer: a very personal story in four parts.

Through FaceBook messages, e-mail and phone calls from many of you I've been asked, "Hey, where is The Sage of Tampa? We haven't heard much from him over the past several months." I'm flattered by that and glad to know that for a few of you the voice of The Sage was appreciated and missed. So, where has it been? Well, honestly, I have a pretty good excuse for where The Sage has been for the last 10 months.

Battling prostate cancer- -a battle I am winning- - left me with precious little reserve energy to deal with anything other than my own immediate needs, especially since I was determined to keep the burden of coping with this disease off the backs of my family and friends and on my own back instead. I just didn't have the time or the energy to be prostate cancer's meanest adversary and the voice of The Sage too. Now I do.

Within the past 10 months there have been three very memorable days; one shocking day, one very frightening day and one highly rewarding day. The shocking day was February 24, 2010 the day my doctor confirmed the lab tests and confronted me with the diagnosis of Prostate Cancer. The frightening day was May 28, 2010 the day 53 radio-active seeds were surgically implanted in my body and began bombarding the cancer cells with radiation on a 24X7 basis- -a process for which all my research and the best information the doctors at Moffitt Cancer Center could provide me- - had left me inadequately prepared for the impact on me physically and mentally. The highly rewarding day was Monday, December 6, 2010 when after just six short months from implantation the docs at Moffitt Cancer Center officially declared me to be "in full remission".

Of course, being "in full remission" is not the same as being "cured". That pronouncement will come when I have been cancer free for 5 years. But being in remission with "no current evidence of disease" is the first major milestone in that journey and it's one I'm happy and lucky to reach.

Some may ask, "why tell this highly personal story?" I’m telling it in the hopes that it will spur more than one man over the age of 40 to listen carefully to his doctor or cause more than one woman to push her stubborn mate to get an annual PSA test. I also share this story because when I first started researching my treatment options last February I was amazed at the lack of non-clinical, first person information available to me. So, I made the decision that when, NOT if, I prevailed against the disease I would put the information out there for others in hopes of helping them understand what happens AFTER the diagnosis and how they can take a proactive approach to winning the battle with prostate cancer. So that's where this story begins, with the diagnosis.

The long run up to that diagnosis began with the usual annual DREs (Digital Rectal Exams) - - -a procedure that leaves men over 40 very wary of the sound of rubber gloves being snapped into place behind them- - - and later, continued on with 15 cautious months of monitoring a PSA (Prostate Specific Antigen) level that steadily climbed from 1.8 ppn (parts per nanogram) to 8.4 ppn.

Why is the PSA level (determined through a simple blood test) so important? Because any level over 2.0 ppn raises red flags. It tells your doctor that something is going on. And a level beyond 4.0 ppn sets off alarms and sirens alerting your doctor that more information is needed and some action needs to be taken. But this test is known to have flaws and there have been many instances of false positives. Men with levels well under 2.0 have died from in situ prostate cancer and men with levels approaching 20.0 ppn or higher have been found to be cancer free. The only sure way to find out if it’s prostate cancer rather than some other prostate malady is the dreaded “needle biopsy”.

The needle biopsy, although done in the doctors office with a local anesthetic, is a highly uncomfortable and very undignified procedure that most men would like to believe doesn’t exist and very few will discuss. It is also a procedure women liken in terms of discomfort and lack of dignity to having a breast biopsy once a mammogram identifies a suspicious area. In fact, the two procedures are nowhere close in comparison.

For women, when a mammogram turns up a suspicious lump or nodule they too, are often subjected to a needle biopsy to confirm the presence (or absence) of cancer cells. And while moderately painful (as my wife has told me) it usually involves only one needle stick which, thanks to the mammogram images of a comparatively easily x-rayed breast, can be quickly guided to the suspicious area. But, because the prostate is small- -about the size of a large walnut- -and located deep inside the lower abdominal cavity, prostate cancer cells cannot be “seen” by x-ray, CT Scan or MRI processes. Thus, there is no way to locate a “suspicious” area much less any imagery to be used to guide a needle probe to a specific spot. Enter the “biopsy gun”. Literally.

The biopsy gun is a hand-held device with a spring-loaded, slender needle. It is inserted into the rectum and, along with the use of trans-rectal ultra sound to locate and image the prostate, the gun’s needle is propelled through the rectal wall into the gland. This is repeated anywhere from 6 to 18 times (12 in my case) making sure that core samples are taken from all quadrants of both hemispheres of the gland.

No matter what the doctors tell you- - -no matter how much literature they give you to read prior to the procedure- - - nothing can adequately prepare you to deal with the sound of that needle being snapped through the rectal wall and into the prostate; the incredible discomfort of the gun being in there, the pain of the repeated needle pokes and, certainly not, the terrible indignity of the ordeal. But, the process is a must if one is to correctly diagnose the disease, select a treatment protocol and, hopefully, save a life. And for heaven's sake don't be fooled by claims of being accurately diagnosed by x-ray or ultra-sound. In the end, the needle biopsy is the ONLY effective method of determining the presence of cancer cells and to what stage the disease has progressed. The earlier it is found the better, of course, thus the needle biopsy though nasty is worth enduring. So when faced with it, the only choice is to man-up and shut-up.

Once the biopsy confirms the presence of cancer and its severity the patient and his doctors select a treatment method that can range from external beam radiation to internal radioactive implants or, in the most advanced cases, to radical surgical removal. Chemo-therapy is NOT a viable option for this form of cancer- - -yet.

Because my cancer was at its earliest stage- - - stage T1C- - - I had the luxury of time after that awful diagnosis to fully research my treatment options and make an informed choice. In the next blog post, I'll share alot of that information with you and show you the best sources I found for getting that information on your own. I’ll also share with you some important decisions I made while doing that research, why I made them and how they can save your life as they have mine.


Leslie said...

What you are doing is important, and I applaud you for it.

Anonymous said...

Thank you for sharing your story Hal. You are an inspiration. Love you. Katie