Presented at Naturist Society Eastern Gathering, Lenox, Massachusetts, June, 2007

June 12, 2007

 

Prostate Cancer Symptoms, Detection, and Treatment

           HI EVERYONE, I WANT TO WELCOME YOU TO THIS DISCUSSION OF PROSTATE CANCER.

          WHY AM I READING THIS INSTEAD OF TALKING EXTEMPORANEOUSLY? THE ANSWER IS BECAUSE PROSTATE CANCER DETECTION AND TREATMENT IS A BIT COMPLEX AND FRANKLY, I DON'T WANT TO FORGET ANYTHING.

          I WANT TO BEGIN BY EXPLAINING TO YOU THAT I AM NOT A MEDICAL PROFESSIONAL. I CAN NOT SPEAK TO YOU IN TECHNICAL TERMS ABOUT EVERY ASPECT OF PROSTATE CANCER.  I AM HERE SIMPLY AS AN INDIVIDUAL WHO LATE IN 2005 WAS DIAGNOSED WITH PROSTATE CANCER AND WHO HAS DEALT WITH IT IN VARIOUS WAYS EVER SINCE.  I AM CURED; I HAD A RADICAL PROSTATECTOMY WHICH IS BASICALLY THE REMOVAL OF THE PROSTATE GLAND AND THE NEARBY LYMPH NODES AND MY PSA AT THIS POINT IS UNDETECTABLE.

          YOUR QUESTION MIGHT BE WHY AM I HERE AND WHAT'S IN THIS FOR YOU.  THE ANSWER IS I HAD NO SYMPTOMS AT ALL BEFORE I WAS DIAGNOSED WITH PROSTATE CANCER.  THE CANCER WAS FOUND AND WAS DEALT WITH BEFORE IT HAD AN OPPORTUNITY TO SPREAD ELSEWHERE.  I AM HERE CONCEIVABLY TO SAVE YOUR LIFE BY TELLING YOU SOME IMPORTANT THINGS ABOUT PROSTATE CANCER --- WHAT TO WATCH OUT FOR, HOW TO SEE IF YOU HAVE ANY "SYMPTOMS," AND WHAT YOU SHOULD DO TO TRY TO KEEP YOURSELF ALIVE.

          LET'S START THIS DISCUSSION BY MAKING A FEW THINGS CLEAR. 

          FIRST OF ALL THIS IS A DISCUSSION AND NOT A SPEECH, SO IF YOU HAVE QUESTIONS WHILE I'M PROCEEDING PLEASE ASK THEM, HOWEVER I AM GOING TO TRY TO ANSWER ALL OF YOUR QUESTIONS IN MY PREPARED REMARKS. 

          HERE IS A QUICK SUMMARY OF QUESTIONS I'M GOING TO TRY TO ANSWER THROUGH THE COURSE OF THIS TALK:

·        FIRST WHAT IS THE PROSTATE GLAND, AND WHAT IS PROSTATE CANCER. 

·        SECOND HOW DO YOU GET IT. 

·        THIRD HOW IS IT DETECTED. 

·        FOURTH WHAT ARE THE SYMPTOMS. 

·        FIFTH WHAT IS PSA AND WHY IS IT IMPORTANT. 

·        SIXTH WHAT IS A GLEASON SCORE. 

·        SEVENTH, WHAT ARE THE OPTIONS FOR SOMEONE WHO IS FOUND TO HAVE PROSTATE CANCER. 

·        AND LAST, WHAT IS LIFE LIKE AFTER YOU ARE TREATED FOR PROSTATE CANCER.

         

          LETS GO THROUGH THESE ONE AT A TIME.

          FIRST WHAT IS THE PROSTATE GLAND. THE PROSTATE GLAND SECRETES SEMEN, THE LIQUID IN WHICH SPERM IS TRANSPORTED FROM A MAN TO A WOMAN. IT IS LOCATED NEAR THE BLADDER AND IS ABOUT THE SIZE OF A WALNUT. IT HAS WHAT AMOUNT TO TWO HEMISPHERES, THE RIGHT AND THE LEFT. SOMETIMES PROSTATE CANCER IS FOUND IN ONLY ONE HEMISPHERE AND SOMETIMES IT IS FOUND IN BOTH.

          ACCORDING TO THE PROSTATE CANCER FOUNDATION, PROSTATE CANCER OCCURS WHEN THE CELLS OF THE PROSTATE BEGIN TO GROW UNCONTROLLABLY.  NOBODY KNOWS PRECISELY WHAT MAKES THAT HAPPEN, BUT SCIENTISTS ARE HARD AT WORK TRYING TO FIND OUT. ABOUT 218,000 MEN THIS YEAR WILL BE DIAGNOSED WITH PROSTATE CANCER. WHEN CAUGHT AND TREATED EARLY, PROSTATE CANCER HAS A CURE RATE OF OVER 90%. BUT WHEN IT IS NOT CAUGHT EARLY, AND WHEN IT IS NOT TREATED, PROSTATE CANCER CAN SPREAD TO OTHER AREAS AND IT CAN BE FATAL.

            WHAT ARE THE SYMPTOMS?  FOR ME, THERE WEREN'T ANY, NONE AT ALL.  FOR SOME PEOPLE THERE ARE CHANGES IN BLADDER HABITS OR DIFFICULTIES OR PAIN WHEN HAVING SEX. 

          MY PROSTATE CANCER WAS DISCOVERED DURING A ROUTINE ANNUAL PHYSICAL EXAM. ALL MEN OVER THE AGE OF ABOUT 45, OR PERHAPS YOUNGER, SHOULD HAVE THEIR PSA MEASURED BY THEIR DOCTOR DURING THEIR ANNUAL ROUTINE PHYSICAL.  PSA IS AN ACRONYM FOR PROSTATE SPECIFIC ANTIGEN WHICH IS A MARKER OF PROSTATE PROBLEMS. IF YOUR PSA SHOWS AN UPWARD TREND OVER A PERIOD OF THREE OR FOUR YEARS OR IF IT GOES ABOVE 3.0 THOSE ARE BOTH INDICATORS THAT YOU MAY HAVE A PROBLEM.  IT CAN BE A SIMPLE PROBLEM, SUCH AS PROSTATITIS, OR INFLAMMATION OF THE PROSTATE. OR IT MAY BE SOMETHING POTENTIALLY MORE SERIOUS. IN ANY CASE, IF EITHER OF THOSE THINGS OCCUR, YOUR DOCTOR MAY RECOMMEND AN ULTRASOUND OR A BIOPSY, WHICH I'LL TALK ABOUT MOMENTARILY. 

          THE PSA TEST IS A SIMPLE ROUTINE BLOOD TEST LIKE ANY OTHER BLOOD TEST; THE NEEDLE GOES IN YOUR ARM AND NOT ANYWHERE ELSE.  ANOTHER TEST THAT'S DONE FOR PROSTATE CANCER IS THE DIGITAL RECTAL EXAM. THIS EXAM IS VALUABLE IN TERMS OF SEEING IF THERE ARE ANY ABNORMALITIES SUCH AS SWELLING OF THE PROSTATE GRAND.  THE PROSTATE GLAND CAN BE FELT THROUGH THE RECTUM.

          IF YOUR DOCTOR FINDS AN ELEVATED PSA OR A REASON FOR CONCERN ABOUT THE SIZE OF YOUR PROSTATE BASED UPON HIS DIGITAL RECTAL EXAM, HE OR SHE MAY RECOMMEND AN ULTRASOUND. IF THEY DO, I SUGGEST YOU SEE ANOTHER UROLOGIST:  TOP UROLOGISTS TODAY NO LONGER USE ULTRASOUNDS ALONE BECAUSE OF THEIR NOTORIOUS INACCURACY.

          USUALLY THE NEXT STEP IN DIAGNOSIS, IF APPROPRIATE, IS A BIOPSY.  THE BIOPSY IS TAKEN BY INSERTING A PROBE INTO THE RECTUM AND THEN WITHDRAWING SMALL PROSTATE SAMPLES OR "CORES" THROUGH THE WALL OF THE RECTUM. DOCTORS USUALLY TAKE SIX "CORES" FROM EACH OF THE TWO HEMISPHERES IN THE PROSTATE GLAND.

          THE DISCOMFORT YOU ENCOUNTER IN HAVING THE BIOPSY VARIES ACCORDING TO THE COMPETENCE OF THE DOCTOR WHO EXECUTES IT. THE DOCTOR I ORIGINALLY HAD WAS NOT PARTICULARLY COMPETENT AND IT FELT LIKE HE SHOVED SIX MOUSETRAPS UP MY REAR END AND THEN SET THEM OFF ONE BY ONE. HE ALSO ONLY TOOK SIX CORES INSTEAD OF THE USUAL 12. THE SURGEON WHO I LATER SELECTED TO PERFORM MY RADICAL PROSTATECTOMY REACTED WITH SURPRISE WHEN I TOLD HIM ABOUT MY BIOPSY. HE SAID THAT USUALLY SOME KIND OF LOCAL ANESTHETIC IS USED TO MINIMIZE PAIN.

          A WEEK AFTER MY BIOPSY, I FOUND THE RESULTS WERE POSITIVE ON BOTH SIDES.  IT WAS AT THAT POINT THAT I MADE CONTACT WITH DR. WILLIAM DEWOLF AT BETH ISRAEL DEACONESS MEDICAL CENTER IN BOSTON.

          AFTER LOOKING AT MY BIOPSY SLIDES, DR. DEWOLF SAID MY CASE DID NOT LEND ITSELF TO WATCHFUL WAITING. "WATCHFUL WAITING" IS A TERM YOU MAY HEAR AGAIN.  IN SOME CASES, PROSTATE CANCER MAY PRESENT ITSELF IN LIMITED AREAS AND BE VERY SLOW GROWING.  THE GLEASON SCORE, BASED UPON BIOPSY SLIDES, REFLECTS WHETHER YOUR PROSTATE CANCER IS FAST-GROWING, OR HIGH-GRADE, OR WHETHER IT IS SLOW GROWING, OR LOW-GRADE. 

          IN MY CASE, SOME OF THE AREAS BIOPSIED WERE GROWING QUICKLY, AND DR. DEWOLF TOLD ME THAT FOR ME, "WATCHFUL WAITING" WAS NOT AN OPTION.

          DR. DEWOLF AND OTHERS MADE ME AWARE THAT THERE ARE SEVERAL OPTIONS FOR TREATING PROSTATE CANCER OTHER THAN SIMPLY WATCHFUL WAITING, UNDER WHICH YOU KEEP AN EYE ON SLOW GROWING PROSTATE CANCER TO SEE WHETHER IT IS A SERIOUS THREAT TO WHETHER IT IS JUST FOR ALL PRACTICAL PURPOSES SITTING THERE AND DOING NOT MUCH OF ANYTHING.

          THE THREE TREATMENT CHOICES ARE:

1.     A RADICAL PROSTATECTOMY, WHICH REMOVES THE ENTIRE PROSTATE GLAND AND THE TWO LYMPH NODES CLOSEST TO IT;

2.    EBRT OR "EXTERNAL BEAM RADIATION THERAPY," WHICH IS USED TO KILL THE CANCEROUS PART OF THE PROSTATE GLAND; AND

3.    "BRACHYTHERAPY" OR RADIOACTIVE SEEDS, WHICH ARE IMPLANTED INTO THE PROSTATE GLAND TO KILL NEARBY CANCEROUS CELLS.

         

          DR. DEWOLF WANTED TO REFER ME TO A RADIATION ONCOLOGIST SO I COULD GET MORE INFORMATION ABOUT THE RADIATION OPTIONS BEFORE MAKING A CHOICE AMONG ALL OPTIONS.  HE HAD TOLD ME ABOUT THE SURGICAL OPTION AND ITS AFTER EFFECTS.  I CANCELED A MEETING WITH THE RADIATION ONCOLOGIST, HOWEVER, HAVING QUICKLY MADE THE DECISION THAT I DID NOT WANT TO TAKE WHAT I CONSIDERED A GAMBLE IN RADIATION TREATMENT.  RATHER, I DECIDED, AND MY WIFE AGREED, THAT I SHOULD HAVE THE SURGEON GO IN THERE AND TAKE OUT THE CANCEROUS PROSTATE GLAND AND THE NEARBY LYMPH NODES AND THOROUGHLY TEST THE LYMPH NODES FOR CANCER. WERE THE LYMPH NODES FOUND TO BE CANCEROUS, OTHER ANTICANCER THERAPY IN ADDITION TO THE RADICAL PROSTATECTOMY MIGHT HAVE BEEN REQUIRED.  I WAS NOT SATISFIED THAT RADIATION WAS AS CERTAIN A CURE AS I FELT SURGERY WOULD BE. AGAIN, THIS WAS MY OPINION AND MY DECISION, AND YOUR DECISION MAY BE QUITE DIFFERENT.

          BEFORE I CONTINUE WITH A BIT MORE ABOUT THE SURGERY DOES ANYONE HAVE ANY QUESTIONS?

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          FOR THE SURGERY I WENT TO BETH ISRAEL DEACONNESS MEDICAL CENTER IN BOSTON EARLY ON A MONDAY MORNING AND WAS RELEASED THE FOLLOWING THURSDAY AFTERNOON.  THE SURGERY REQUIRED AN INCISION THAT WENT FROM JUST UNDER MY NAVEL TO MY PUBIC BONE.  AFTER THE SURGERY, I WAS AMAZED THAT I HAD VIRTUALLY NO PAIN, AND IN FACT I NEVER HAD ANY SIGNIFICANT PAIN IN THE WAKE OF THE SURGERY.  MOVING FROM A LAYING DOWN TO A SITTING UP POSITION WAS UNCOMFORTABLE FOR A FEW DAYS BUT NOT PAINFUL.

          THE SINGLE WORST THING ABOUT PROSTATE SURGERY FROM MY PERSPECTIVE WAS THE CATHETER THAT I HAD TO WEAR FOR 10 DAYS FROM THE DATE OF THE SURGERY.

          NOW LET'S TALK ABOUT AFTER-EFFECTS. PROSTATE SURGERY DISRUPTS THREE THINGS. 

          FIRST, IT DISRUPTS THE MOVEMENT OF URINE THROUGH THE URETHRA, SINCE THE URETHRA NORMALLY GOES THROUGH THE PROSTATE GLAND.  IN A RADICAL PROSTATECTOMY, THE UROLOGIST HAS TO RECONSTRUCT THE URETHRA AND IN SO DOING REMOVES ONE OF TWO SPHINCTER-TYPE MUSCLES MEN HAVE TO HOLD BACK THE FLOW OF URINE.  IF YOU'VE EVER BEEN TO A CONCERT OR A PROFESSIONAL SPORTS EVENT, YOU KNOW THAT MANY MORE WOMEN ARE LINED UP AT THE LADIES ROOM THAN MEN ARE AT THE MEN'S ROOM.  THE REASON FOR THIS IS THAT WOMEN HAVE ONLY ONE SPHINCTER AND MEN NORMALLY HAVE TWO WHICH MAKES THEM ABLE TO "HOLD IT" A LOT LONGER THAN MOST WOMEN. 

          AFTER PROSTATE SURGERY, HOWEVER, YOUR URETHRA IS RECONSTRUCTED WHICH MEANS THE HOLDING MECHANISM IS WEAKER AND THEREFORE YOU HAVE TO LEARN HOW TO CONTROL THE FLOW OF URINE AGAIN, AND THAT LEARNING PROCESS CONTINUES FOR A FEW MONTHS AFTER SURGERY. DURING THAT PERIOD YOU WILL WEAR DEPENDS BUT AFTER THAT, ALL YOU'RE LIKELY TO NEED IS WHAT'S CALLED A "GUARD" TO ABSORB THE FEW DROPS THAT MIGHT HAPPEN IN CASE YOU SNEEZE OR LAUGH. DR. DEWOLF TOLD ME IT WOULD TAKE SIX WEEKS TO SIX MONTHS FOR ME TO BUILD UP THE PELVIC FLOOR MUSCLE WHICH PROSTATE CANCER SURGERY SURVIVORS USE TO CONTROL THE FLOW OF URINE.  IN ACTUALITY IT TOOK ABOUT FOUR MONTHS AND, AS YOU SEE, I'M HERE TODAY AND HAPPY TO BE PARTICIPATING RATHER NORMALLY IN THIS EVENT.

          SECOND, AND OF GREAT IMPORTANCE TO MANY MEN, THE NERVES THAT CONTROL YOUR ABILITY TO HAVE AN ERECTION ARE NORMALLY DRAPED ON THE OUTSIDE OF THE PROSTATE GLAND.  DR. DEWOLF TOLD ME BEFORE THE SURGERY THAT THOSE NERVES ARE EITHER DRAPED LOOSELY OVER THE PROSTATE OR THEY ARE MORE TIGHTLY ADHERED TO IT. 

          THERE ARE TWO OPTIONS REGARDING THESE NERVES IN A RADICAL PROSTATECTOMY. ONE OF THOSE OPTIONS IS TO HAVE NERVE SPARING SURGERY, WHICH ATTEMPTS TO SPARE THE NERVES THAT ALLOW YOU TO HAVE AN ERECTION.  THE OTHER ALTERNATIVE, WHICH IS FREQUENTLY ACCEPTED BY MEN IN THEIR 70S, IS TO HAVE NON-NERVE SPARING SURGERY.  THAT TYPE OF SURGERY REMOVES THE POSSIBILITY THAT THE MAN WILL BE ABLE TO HAVE AN ERECTION AFTER SURGERY, AND AGAIN, THAT OPTION IS USUALLY TAKEN BY MEN WHO ARE SIGNIFICANTLY OLDER. 

          IF YOU CHOOSE NERVE SPARING SURGERY, YOUR ABILITY TO HAVE AN ERECTION GENERALLY RETURNS WITHIN ONE TO TWO YEARS, THOUGH IN SOME CASES THE TIME CAN BE LONGER AND IN A FEW CASES IT MAY NOT HAPPEN AT ALL.  AGAIN, IN THE VAST MAJORITY OF CASES, YOU CAN HAVE AN ERECTION WITHIN ONE TO TWO YEARS.  VIAGRA HELPS ONCE NERVES HAVE HEALED.

          THIRD, REMEMBER THAT THE PROSTATE GLAND IS THE GLAND THAT SECRETES THE SUBSTANCE (SEMEN) WHICH TRANSPORTS SPERM. IF YOU INTEND TO HAVE MORE CHILDREN AFTER PROSTATE CANCER SURGERY, YOU SHOULD TALK TO YOUR UROLOGIST ABOUT POSSIBLY DONATING SPERM TO A SPERM BANK. WHEN YOU BECOME SEXUALLY ACTIVE AGAIN A YEAR OR TWO AFTER SURGERY, YOU WILL NOT HAVE ANY EJACULATE SINCE YOU WILL NOT HAVE A PROSTATE GLAND. 

          I'VE TALKED A LOT HERE ABOUT MEDICAL TERMS AND ABOUT DETECTION AND ABOUT TREATMENT AND AFTEREFFECTS.  THE SINGLE MOST IMPORTANT THING I CAN SAY TO YOU IS THE SAME THING THAT OTHER PROSTATE CANCER SURVIVORS SAY EVERY DAY AND THAT IS GET TESTED.  HAVE AN ANNUAL PHYSICAL.  MOST IMPORTANT, MAKE SURE THAT YOUR PSA IS MEASURED AND THAT IF IT IS ELEVATED OVER THREE OR IS SHOWING A YEAR-TO-YEAR PROGRESSION AND IS ABOVE THREE,  THEN SEE A COMPETENT UROLOGIST. IT IS CLEARLY YOUR CHOICE ABOUT WHETHER YOU HAVE RADIATION THERAPY, SEEDS, OR A RADICAL PROSTATECTOMY IF YOU TEST POSITIVE FOR PROSTATE CANCER. 

          I CAN'T SPEAK FOR PEOPLE WHO HAVE HAD RADIATION THERAPY OR SEEDS --- I CAN ONLY SPEAK FROM MY OWN PERSPECTIVE AND THAT IS THAT I HAVE NO REGRETS ABOUT HAVING HAD PROSTATE CANCER SURGERY.  I REITERATE: IT IS CRUCIAL FOR EVERYONE AGE 45 OR OVER TO GET TESTED --- HAVE AN ANNUAL PHYSICAL AND MAKE SURE YOUR PSA IS MEASURED AND THAT YOU ACT UPON THAT MEASUREMENT IF REQUIRED. 

          I DO HAVE SOME LITERATURE HERE AND WOULD BE HAPPY TO GIVE YOU THAT AND I WOULD ALSO BE VERY HAPPY TO ANSWER ANY AND ALL OF YOUR QUESTIONS. I'D ALSO LIKE TO THANK DR. WILLIAM DEWOLF FOR SUPPLYING THE LITERATURE YOU SEE HERE TODAY & FOR CHECKING WHAT I'VE SAID, AND THE NATURIST SOCIETY FOR ALLOWING ME TO SPEAK WITH YOU. THANK YOU.