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To My Husband's Prostate Cancer Story Page I
On August the 5th, 1997 my husband, Joe, returned from his appointment with the urologist, and as he walked in the door the first words out of his mouth were, "I've got it". He was referring to the diagnosis of Prostate Cancer. As it settled in, and as we realized we had some important decisions to make, we also realized that we needed more information so those decisions would be well thought out, and we would be able to seek the very best treatment that would be appropriate for him. It wasn't always easy to gather that information, and we were soon confused by the many options available. Our local urologist told us that there was no hurry, and that we should set up an appointment for three months to discuss the treatment. My husband (and this is so typical of him) went to the bookstore and bought books while I on the other hand (and, this is so typical of me) immediately traveled to the internet and began an intensive search into the treatment of Cancer of the Prostate.
The whole story begins back in 1991 when my huband's physician noted an increase in his PSA (Prostate Specific Antigen) blood test. PSA is an enzyme made by the prostate gland, and elevated amounts of PSA in the blood can signal prostate cancer. The prostate gland is a muscular, walnut shaped gland about an inch and a half long that sits directly under the bladder. Its main function is to make part of the fluid for semen. As men grow older it is normal for the prostate to become enlarged making urination more difficult and often requiring more frequent urination especially at night. This is known as Benign Prostatic Hypertrophy (BPH) and can usually be treated either with medications or sometimes may require surgery to open the urinary passageway. Infections, and inflammation can also raise PSA levels. Prior to the time of actual diagnosis of my husband's Prostate Cancer, he had a PSA test every six months, saw the urologist routinely, and whenever he thought he had an infection or inflammation. Routine physicals always included a DRE (Digital Rectal Exam) to check for abnormal growth, nodules, or any other overt changes. Other tests that were done on a fairly routine basis were sonograms and biopsies.
On January 7th of 1997, Joe had another sonogram done without a biopsy and things were deemed to be OK. In February of 1997 he was placed on Cipro (an antibiotic) for what was thought to be Inflammation of the prostate. His PSA was 8.8 at that time, and in April the PSA was down to 7.5. Then in June the PSA was back up to 8.9 and the Doctor scheduled another sonogram with a biopsy. Subsequently, it was determined that Joe had Cancer of the Prostate.
Once we started our search for information, we were amazed and confused often by conflicting information. We also learned a lot about common misconceptions regarding prostate cancer. Those misconceptions include: 1. It is a disease that only old men get. 2. It is slow growing, and non aggressive 3. It is nourished only by hormones. 4. Hormone starvation will stop the cancer from spreading. Granted, Joe was 73 at the time his cancer was diagnosed, but he was in excellent health otherwise, and we were looking for options. Joe's cancer was given a Gleason scale of 7 which is medium aggressiveness. (The gleason score is the method used by pathologists to grade the cancer, based on what the cells look like under the microcope. Well differentiated cells are given a low grade of 2,3,or 4; poorly differentiated cells are given a high grade of 8,9, or 10.) Needless to say, we didn't wait three months to seek treatment. Joe eventually had a CAT scan done to determine if cancer had spread to any surrounding organs and the report was good. So, we knew that he had cancer of the prostate, that it involved only one lobe of the prostate, that it was of medium aggressiveness, and that it hadn't yet spread to any other organs.
Armed with this information we started investigating treatment options, looking for Doctors, and started reading the statistical reports that were available. Our local urologist was more than helpful, and did set up an appintment with the both of us to discuss options long before the original three months that he had given us to think things over, and he continues to work with the Doctors in Atlanta to provide care here at home.
We had many options to consider. Our local urologist offered RP (Radical Prostatectomy) which is considered the gold standard by many Physicians. Side effects range from few to many, and include things like incontinence, impotence, not to mention blood loss and longer time under anesthesia. Of the two people we personally know who had this done, both are still incontinent at times, and one of them has a PSA level that is increasing again after six years. Some men choose Radiation therapy. Hormonal therapy is another treatment that is available. Side effects include enlarged breasts, hot flashes, and often this does not prevent the spread of the cancer. Experimental treatments include Cryosurgery (this is where they freeze the prostate thereby killing all of the cancer cells) and Brachytherapy. Brachytherapy, involves the placement of radioactive seeds into the prostate. The seeds then kill the cancer and shrink the prostate over a period of time. Radiation therapy may or may not be given with this procedure. We decided on Brachytherapy, and chose a clinic in Atlanta, Georgia to have this treatment done, and External Beam Radiation is always a part of the treatment at this particular clinic.We chose to go to Atlanta because of the track record and statistical reports we received, and because no Doctor was performing this procedure locally.
We were now ready and armed with information to make the important decision. We had decided on Radiactive Seeds or Brachytherapy followed with Radiation. My internet search was invaluable now. I was able to get Dr.'s names and telephone numbers, and as I proceeded to call the different Doctor's offices I was amazed that quite often the staff could not or would not answer questions. They didn't know what kind of seeds were used, they didn't know if the Doctor's followed the Seed Placement Procedure with radiation or not, some couldn't even tell us how many procedures the Doctor had done, and almost all of them wanted to set up an appointment for a consultation. We had already made our decision and we now needed information. There was one Doctor about 45 miles away who was just starting to do the seed placement, but had only done five of them and we were uncomfortable with this. We had one Doctor locally who was preparing to start doing this procedure and we were uncomfortable with that as well. Eventually, we made the decision to go to the Radiotherapy Clinics of Georgia, where they have been doing this treatment since 1984 so the track record was good and they answered every single question we asked over the telephone. We were impressed !
In order to keep these pages from being too long, the story will be continued on page II. Below are some links with information about the Prostate and Prostate Cancer.
One book we found that provided excellent information is the one entitled: The Prostate; A Guide For Men And The Women Who Love Them by Patrick C. Walsh, M.D., director, Department of Urology, Johns Hopkins University School of Medicine: and Janet Farrar Worthington, science writer. A quote on the front of the book reads, "If caught early enough, all prostate problems can be cured, even cancer. That is the message of this book."
Here are some links to some excellent sites where you can obtain more information: Radiotherapy Clinics of Georgia My Prostate Cancer - From a Patients Perspective
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