I wrote earlier in this blog about my own experience with Prostate Cancer. If you are a man over 50 and haven't had your PSA level checked, go out and get it done. It may save your life.
This is what I got published in the La Crosse Tribune yesterday:
Doctor learns about being on other side of the equationDr. Robert Freedland | La Crosse
“Two out of the ten biopsies came back positive.”
I can remember these words from this past summer as my urologist came into my own clinic where I was taking care of my patients with their eye problems to let me know that things weren’t quite perfect for me. I let my wife know the result of the biopsies. My son hurriedly rushed in from Madison that evening; his best friend’s dad had recently died from cancer and he was shaken. I called my other children and my sisters and brother in California to share with them the news. I was at times fearful of this event; but I knew enough to be guardedly optimistic.
After the age of 50, as is recommended, I started having PSA levels drawn with my physical exam to screen for prostate cancer. The science of Prostate Specific Antigen levels is somewhat imprecise. What is most important is called the “velocity” of the test levels. For me, a year ago, I had a level of around 3.0. On the upper-level of acceptable, I was encouraged to get this repeated this year and indeed this time it came in at 5.3—enough to warrant further investigation to rule out cancer; this included an ultrasound test and a series of 10 or 12 needle biopsies of the prostate.
My urologist reassured me that odds were in my favor—that the tests were unlikely to come back as cancer. Thus when he showed up in my office and told me we should talk further about the biopsies a few days later, I knew my luck hadn’t been that great, and that indeed I now faced further decisions. I made an appointment to visit with him with my wife and decide about the next steps.
It is estimated that about 180,000 men in America were diagnosed with prostate cancer in 2008. I was one of them. Fortunately, early detection of this disease now meant that a cure was within reach regardless of my choice of treatment. At 53, ‘watchful waiting’ which might be appropriate for a man in his 80’s for this slow-growing cancer wouldn’t be an acceptable choice for me. Thus, I could choose surgery—either the traditional radical prostatectomy or the newer robotic approach—-or I could decide to have either a seeding procedure with radioactive particles or external beam treatments. Either radiation or surgery has yielded similar outcomes with over 85% of men at 10 years being cancer-free.
I wasn’t really convinced that 85% was so great. After all, that meant that one man out of seven would experience a recurrence in that time period. And in fact, it is estimated that 28,000 men died from their prostate cancer in 2008. Nothing was for sure.
Being a surgeon myself, I leaned towards a surgical approach. I recall how the surgical residents would always joke that “a chance to cut is a chance to cure”. Personally, I liked the idea of removing any cancer from my body and dealing with the post-op surgical challenges rather than dealing with any small but real side-effects of radiation therapy. To understand my options better I visited with both a surgeon skilled in the new robotic approach to surgery on the prostate and a radiation oncologist who advised me about that regimen.
There wasn’t a “correct” answer to which was better. I chose robotic surgery and as suggested I took a month off to recover from surgery before getting back to my own medical practice. It was very different being a patient on a gurney waiting to be rolled into an O.R. as opposed to being the surgeon waiting for my own patients to arrive for their own operations. It was comforting to be cared for by talented medical personnel at every level of the process.
The results of surgery were encouraging. The tumor was limited to the prostate and all lymph nodes were negative. At this point, I just needed to be monitored and have PSA levels drawn on a regular basis. Other men have required hormonal therapy or radiation treatments. If my own tumor recurs, I shall also need additional therapy.
It has now been three months since my surgery. My first PSA test has returned at levels near zero so the outlook continues promising. Just like so many other cancer survivors, I too am anxious about my next medical exam to know if I am free of disease. But I have been fortunate to have a disease that is potentially curable; not every cancer patient is that lucky.
Dr. Robert Freedland is an ophthalmologist at Franciscan Skemp Healthcare.