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BRONZE

Andrew Sikes lives in Virginia USA. He was 40 when he was diagnosed on September 21, 2009. His initial PSA was 1.4 ng/ml, his Gleason Score was 6 and although he does not give his staging, it seems from his narrative that he would have been staged T1c. His choice of treatment was RALP (Robotic Assisted Laparoscopic Prostatectomy). Here is his story..

I am Andrew Sikes and I have Prostate Cancer. I'm 40, I surf, build wooden surf and Stand-up Paddleboards, sail, race mountain bikes, teach SCUBA, and work as a Fire-fighter/Paramedic. Needless to say my general health is excellent.

I received my diagnosis on Monday September 21 and am scared shitless. You probably need not guess that I've been awake most of the night...

Things started with a PSA test during my annual FD physical in March. The doctor and I decided to do a PSA screen due to my age and close family history (father had PCa). My PSA was 1.7, I was referred to a urologist and re-tested in July after a circuit of antibiotics with a result of 1.4. DRE.(s) are normal. Biopsy on September 15, results on September 21 revealed Gleason = 6 in one of 12 samples, not yet staged. Samples were sent to Johns Hopkins for re-analysis. RLRP (Robotic Laparoscopic Radical Prostatectomy) is recommended, I meet with the surgeon on Monday.

What scares me most is not the surgery, I survived emergent brain surgery for intracranial bleeding in 01/06, I can certainly survive this. I was privileged to witness a robotic nephrectomy when I was in Paramedic school, and am not unfamiliar with operating rooms. It's what happens after that I'm worried about.

I'm not sure what I expect from you, actually I really don't know what to expect from any of this. The past two days have been an emotional rollercoaster. Now I'm just trying to educate myself and accept that I have prostate cancer at 40.

Later: First, I would like to express my appreciation to all on the YANA site for sharing their stories and experiences, good and bad, and for those who contacted me with words of encouragement and advice. I especially would like to mention Terry Herbert, Bob Evansen (whose story so closely parallels mine), John S, and Mrs K**** G****** for sharing her husband's story. You have all made this experience significantly less scary, your words provide much needed solace in this time of fear and doubt. The resources here are far more informative and (more importantly) personal than any book or literature I've read since my diagnosis. Your bravery is contagious. Thanks to All of You.

Now for some good news!

I met today with Dr Scott Burgess of Hampton Roads Urology. He's an enthusiastic young Urology Surgeon (38) but has an immense amount of experience with RLRP. For the past five years, He has performed Da Vinci procedures at Riverside Regional Medical Center in Newport News and does around 300 procedures a year. His first comment was "...what's a guy like you doing with prostate cancer..?"

My 12-Core biopsy on 09/15 showed 2% Gleason-6 in only one core. To Dr Burgess, this discovery is simply a case of aim. He feels that Dr Taylor could have easily missed the one small area of cancer and returned a normal biopsy. In my case it was simply chance that my cancer was discovered.

We discussed the multitude of options I have available: RP, RLRP, Cryo, Focused Cryo (trial ongoing at Johns Hopkins now), Brachy, etc. Apparently I have the entire menu for my choosing. The most important thing I have right now is TIME. I didn't expect a surgeon to discourage me from a procedure. Dr Burgess thinks surgery isn't necessary...yet. When the time comes though, I'll have him do a Da Vinci RLRP.

For now, we're not doing anything. We'll diligently monitor my little walnut, I'll continue living my life, repeat a PSA next March with another 15-core (or more) biopsy early next Fall. There is no need for surgery at this point. Dr Burgess feels it's too early for RP because I have so little cancer and since for me, surgery would not result in a "life change" only a "lifestyle change." This also gives me a chance to donate and preserve some sperm for use when Katie and I decide to have children.

This news does not change the fact that I am 40 and have prostate cancer. I will have to treat it eventually... What this does mean is that I'm 40 and LIVING with Prostate Cancer.

 

UPDATED

November 2009

 

 

Well, I received some pretty good news yesterday. On the advice of my Urologists Drs. Taylor and Burgess from Hampton Roads Urology, I had my biopsy slides sent to the James Buchanan Brady Urological Institute of Johns Hopkins University in Baltimore, MD. [without wishing to imply I'm in the same class as these good doctors, that is my advice to every one - see Recognised Expert Pathologists.]

My slides were reviewed by Dr Jonathan I Epstein, a specialist in "...diagnosis of limited adenocarcinoma on needle biopsy..." Dr Epstein's opinion is that I DO NOT HAVE CANCER...yet. My Biopsy definitely contains abnormal cells, most likely pre-cancerous, but not yet definitively cancer. His recommendation for treatment also coincides with that of Drs Taylor and Burgess. For now, surgery is absolutely not warranted.

I will continue to monitor for changes, repeat PSA's every six months, and have a more thorough biopsy in four months. More updates then...

 

UPDATED

April 2010

 

 

I met with Dr Burgess of Hampton Roads Urology a few days ago for a follow up. My annual FD physical this year revealed a PSA again of 1.4, which shows no change since September of last year. With this in mind, Dr Burgess and I decided to continue watching. I'll have repeat PSA's every six months and diligently monitor myself for any changes or abnormalities.

To quote Dr. Burgess "...if the grand poo-bah holy high muckety-muck of prostrate cancer [referring to Dr Epstein] doesn't think intervention is necessary yet, then we have some time. There's no reason to go rushing into unneccessary surgery..." [Not too sure that Dr Epstein would be too keen on this title ....:-) ] I wholeheartedly agree and am quite comfortable with this decision.

The proverbial 'gorilla' is still sitting in the corner, but he's not quite so scary anymore. Thanks again to all here for your bravery and encouragement. I'll update in six months or so.

 

UPDATED

April 2011

 

 

Thanks as always to YANA and especially to George H. and Terry H. for reminding me to update my story. I'd had no problems of note until August of 2010 when I started having blood in my ejaculate. I first noticed only a small amount appearing infrequently and without pain or discomfort. I reported this to Dr Burgess when it first occurred. He initially told me not to worry about it, it's usually self-correcting and clears in two to three weeks. My PSA at that time was trending down to 1.2 and didn't generate any real concern.

My research taught me that it's not all that unusual for men over the age of 35 to have small amounts of blood in their ejaculate. It's usually benign and often goes unnoticed, since most ejaculations are intravaginal and can be caused by a number of benign factors including trauma or infection (I had a traumatic Foley catheter removal during a hospitalization in '06 due to an improper removal procedure by an overworked and apathetic RN). Dr Burgess said not to worry, so I waited.

In December, the amount and type (dark-brown 'old' bleeding) had increased in frequency and quantity (bright red 'new' bleeding) to close to that of just after my first needle biopsy. I also began seeing blood and clots in my urine. Pain was minimal and occurred only with ejaculation. I reported this to Dr Burgess, he asked me to come in ASAP for an exam. I scheduled an appointment for late in January but never made it.

Just after Christmas, I was having significant, sharp prostatic pain and bright red bleeding with urination and ejaculation. When I reported this new development, Dr Burgess decided to forgo the office visit and instead scheduled a 20-core needle biopsy and cyctoscopy.

The procedure went better than expected. I reported, scared and anxious, to Riverside Doctor's Surgery Center in Williamsburg on a Thursday afternoon early in February. I was greeted by a very nice and friendly staff, eager to answer questions and help me relax (a little pre-op Midazolam had some influence as well). Since I was under general anesthesia, Dr Burgess was able to take his time and pay attention to his 'aim' as he passed an endoscope through my urethra and into my bladder, then took 18 tissue samples from my prostate. He was relaxed and comfortable, I was unconscious and didn't care. It was a significantly better experience than the first 12-core biopsy that was done with local anasthetic in Dr Taylor's office a few years earlier. Post-op discomfort was minimal, I bled a bit more and for a longer time but had generally less discomfort compared to the aforementioned 12-core biopsy.

I received my results from Dr Burgess a few weeks later during our follow-up office visit. The results were essentially unchanged: Less than 5% pre-cancerous/abnormal cells in 1 of 18 cores, graded at Gleason-6. Based on this result, I chose not to have the slides re-examined by another pathologist. My bleeding was caused by idiopathic urethral polyps, which are benign and will require intervention only if they begin to cause urinary problems. The treatment is to usually scrape them out with a large-bore endoscope and can be done in the office. I'm in no hurry to have anything else in my urethra for now. That too, can wait.

So now, to draw this long update to a short statement, everything's going well. No changes, no new develpments, no new plans other than to closely observe for changes and repeat PSA's at six-months. I feel blessed and fortunate for this littel bit of luck. To again quote Dr Burgess "...eventually you'll have to [poop] or get off the pot, but don't need to do anything more than what we're doing now..."

Thanks again to all at YANA. Your bravery is truly contagious. My hope is to be able pass that on to someone else in need by sharing my story.

Bye for now, surf's up and I'm heading to the beach... .

Andrew's e-mail address is: asikes@williamsburgva.gov