I am 59 years old. Every year I go to the doctor's office for a physical exam. For the past 15 years, I have had a PSA test included in my screening blood work. The Prostatic Specific Antigen (PSA) is a screening test for prostate cancer. My dad had been diagnosed with prostate cancer in 1990 when the PSA test was relatively new. Many other relatives have also been diagnosed with prostate cancer. Unlike my father, they have died from it, mostly when they were in their seventies. So I knew I had a good chance of getting it.
In April of this year my old friend and brother-in-law was told he had prostate cancer. He is a brilliant doctor, and so he did extensive research on his options. We talked often, not just because I cared about him, but I knew that someday in the distant future I would probably face the same situation. Whereas my father opted for radiation, my brother-in-law opted for surgery. He is a surgeon. His motto is " A chance to cut is a chance to cure." He had a radical prostatectomy last spring, and he is doing well.
Over the past decade my PSA has ranged from 1.2 - 1.8. The normal range for someone my age is 0 - 3.5, so I felt confident I was cancer-free. In June 2005, it was 1.5 but in March 2006 it jumped to 3.1, which was still in the normal range. During the digital rectal exam (DRE), my urologist found firmness in the prostate. He referred me to a specialist in urologic oncology. The specialist suggested that I have a biopsy.
Due to a planned summer vacation with my children, I put off the biopsy until after the trip. When we returned from our vacation I had a problem with a sciatic nerve that took a couple of months to resolve before I could get the biopsy. Meanwhile, I had another PSA test in July. It was 2.58, which, once again, is in the normal range.
On September 15, the doctor took six biopsies from my prostate. It was a simple procedure. It didn't hurt at all. I left the office feeling confident. I was told that I should meet with my doctor on September 22 at his office. On the appointed day I noticed that he was smiling when he greeted me, which gave me a feeling of comfort. Then he said that he hadn't yet seen the results, but that it should be on the computer now. I watched and waited while he logged in to his pc.
For those of you who have AOL there is a bell that goes off that says "You've Got Mail". Well, at approximately 10:15am on a beautiful Friday in September I was told "You've Got Cancer". When I heard that my reaction was surprisingly calm even though I hadn't even considered it a real possibility over the past six months. He went on to say that my so-called Gleason score (which measures the aggressiveness of the cancer) was a 6. Any score above a 6 is bad news. He told me that I had a several months to consider what I wanted to do as far as treatment. He said that I could have radiation, surgery or just do nothing. He suggested I have a CT scan to see if any cancer had spread to the lymph nodes. I had the scan the next week, and was told that the lymph nodes looked clear. The results of the scan helped relieve some of my concerns but not totally alleviate them.
During the weekend after I had been told I had prostate cancer, I went on the internet and read dozens of articles about options available, patient comments, hospitals and doctors. I also talked to my brother-in-law about his experience. By the time I met with three doctors on October 2 to hear their opinions about radiation, chemotherapy, surgery and "watchful waiting," I was 99% certain what course of action I was going to take. But I wanted to hear what they had to say first before making a final decision. "Watchful waiting" made absolutely no sense to me, not at my age. My dad is 89, goes to the office seven days a week when he is not traveling the world. And my grandmother lived to be101 years of age. Radiation might have made sense if I were in my seventies but not at my age. Chemotherapy is something I would consider as a last resort.... not a first resort. That left me surgery as a choice. And I wanted it done as quickly as possible. I had been told that one should wait approximately six weeks after a biopsy before having surgery. So the soonest I could have surgery was around the last week of October.
After much research, I decided to have my surgery done at the Henry Ford Vattikuti Urology Institute in Detroit. I elected to go with something commonly referred to as the Da Vinci procedure, which is performed using robotic instrumentation. Dr. Mani Menon, who heads the Institute, has done more of these robotic operations than any other surgeon in America. At last count I believe he has done over 2000 robotic operations. Quality is always important, but in this area of surgery quantity matters. There is a steep learning curve on this operation, and as someone told me "the first ones are not pretty". As my brother-in-law, the surgeon, said, he wanted someone who had done at least 400 of these operations. Well, I wanted someone who had done more than any other doctor in America, and that was Dr. Menon.
With the help of my brother-in-law, the Henry Ford Hospital scheduled me for surgery on October 24 at 7:30 am. The day before, my sister and I met in Detroit and visited Dr. Mani Menon. As soon as I walked into his office I knew that I had made the right decision. He had a wonderful smile, and a warm handshake. He exuded an air of confidence and ability. During our conversation he pointed out a large TV screen in his office where we could watch an operation in progress. He clearly loves what he does and enjoyed sharing his enthusiasm with us. I left the meeting feeling very good about my decision.
We met a half dozen other people at the Institute who checked me in and told me what to expect. They were all professional and friendly. After these meetings we headed to the hotel that would be our home for the next ten days. The next morning, I checked into the hospital at 6 am, and by 7:30 am I had been wheeled into the operating room. I was out before I knew it, and awoke a few hours later. My sister rejoined me after I had been put into a hospital room. I felt surprising good for such a major operation. Dr. Menon came by that afternoon and said that everything had gone well. By that evening, I was up walking around, albeit very slowly. The next morning I had eggs and toast for breakfast after eating Jello for lunch and dinner the day before. By that afternoon I was back at the hotel relaxing.
A week later, I returned to the hospital to have the Foley catheter removed. I was also informed that the cancer was contained in the prostate that was removed, and that the lymph nodes were clear of cancer. I was very relieved to hear this.
Now it is six weeks since surgery, and the only evidence of it is a 1.5-inch scar where the prostate was removed. There are also five other small scars (less than half an inch each) where the robotic arms and tubes were inserted. This beats a 6-8 inch scar needed for an open radical prostatectomy. My PSA is now only 0.2, which is good. In other words, I'm doing well.
The reason that I wrote this blog is to help spread the message that it is very important for all men over 50 to have a PSA and a DRE every year. If there is a family history of prostate cancer, it is a good idea to start when you are 40 years old. And as soon as the PSA starts going significantly above what it had been in years past, I would suggest you consider getting the test every six months. But PSA is not totally accurate as is evidenced in my case. My PSA has always been normal, and often better than average. Yet I still had prostate cancer. So a digital rectal exam is imperative. That is what led the doctors to suggest a biopsy for me.
The bottom line is don't wait when you notice an aberration in your PSA score or a firmness of the prostate is noted. Move expeditiously and find out what is going on. If you catch cancer early there is a very good chance you will live a full life. Not only will that be good for you, but for your kids, wives, partners, friends and every one else who you love.