THERE WAS NO RESPONSE TO AN UPDATE REMINDER IN 2014 SO THERE IS NO UPDATE.

I wish to share my experience with you because I found reading the many experiences of others on YANANOW so beneficial, both in assisting with treatment decisions and in providing information concerning expectations. Hopefully, my story will similarly help others with prostate cancer.

The Diagnosis

I was diagnosed with prostate cancer in July 2007. While some have experienced shock when first learning that they have prostate cancer, my reaction was more of disappointment and resolve. I had previously read about the frequency of prostate cancer. Most men will have some cancer in their prostate glands by the time they are into their 70's. I had read how a number of autopsies of men in their 40's (who died of unrelated causes) had disclosed that they had prostate cancer. Additionally, my father was diagnosed with prostate cancer when he was in his 70's. So, I knew that there was a good chance that I would be diagnosed with prostate cancer at some point.

My PSA had been rising over the last several years. Two years earlier, I had taken a biopsy that was negative. This was a typical in-office biopsy with 10-15 samples taken. When my PSA level increased some more, my urologist suggested that I take a saturation biopsy. This type of biopsy is generally performed at a clinic or hospital. You are given an anaesthetic and between 30 to 40 samples are taken. The saturation biopsy indicated that I had substantial cancer cells in both lobes of my prostate. The initial pathology report graded it at a Gleason 6 (3+3). I had read that it was important to be sure of the grade of cancer before deciding on a treatment. So, I had the samples sent to the well respected, Dr. Epstein at Johns Hopkins. His office confirmed that most of the tissue indicated a Gleason 6 (3+3) grading, but that some samples were graded as a Gleason 7 (3+4).

Choices, Choices, Choices

So, I began my journey. There are so many treatment options - how was I to decide which option was right for me? Initially, you generally find out the news that you have prostate cancer from your urologist. So, he is usually the first one to inform you with your treatment options and provide you with his recommendations. In my case, I did not wait until I heard about my diagnosis. I did some preliminary research on the internet. So, when my urologist discussed some of the treatment options with me, I had some understanding of them. He strongly recommended surgery for me. When I asked him about brachytherapy (seeding), he said that my cancer was "not unsubstantial" and that surgery would be a far better choice.

I did not like my doctor's response, because my initial research had indicated that the brachytherapy was less invasive and had provided similar results. I also did not like the potential side effects of surgery - incontinence and impotence. (Later, through my research I learned of significant potential side effect of brachytherapy, as well). Additionally, I had not undergone any surgeries or been hospitalized, except as a kid for the removal of my tonsils. I was determined to do more research, consult with doctors offering other treatments, and talk to others who had undergone the various treatments before making my decision. So, back to the internet I went.

While the information found on the internet was generally beneficial, some of it was confusing. You can find every treatment option from surgery to herbal treatment of prostate cancer. There is cryosurgery, HIFU, and proton beams. It seems like the list is endless. Even the generally standard forms of treatment of prostate cancer such as surgery and radiation have variations. For example, you can have external radiation or internal radiation (brachytherapy-seeding). But there are two forms of brachytherapy - temporary seeding or permanent seeding. Even the option of surgery presents some issues. Do you choose open surgery or the newer robotic prostatectomy? You will find that each treatment option has its own proponents who claim that it is the best for you. For me, I narrowed the choices down to the permanent seeding or surgery.

Seeding or Surgery?

Next, I consulted with two radiation oncologists. One recommended the permanent seeding as the best treatment for me. He stated, in fact, that the seeding was yielding such good success that in another five years surgery would no longer be a viable treatment option. The other radiation oncologist took a more reasonable approach and indicated that if it were he, he would choose either surgery or the permanent seeding.

I spoke with a number of people who had chosen surgery. I also spoke with some who had experienced the seeding. It seemed that everybody I spoke to had a good experience with their choice of treatments and would recommend it. How was I to make my decision?

After all of my research, consultations, and discussions with prostate cancer survivors, I chose surgery. I based this on the premise that the primary issue was to rid myself of the cancer and that the side effects were secondary. In my mind, there are two important advantages that surgery has over the brachytherapy (seeding). First, with the removal of the prostate and surrounding tissue, you learn with a certain degree of certainty whether or not the cancer was confined to the prostate gland. You also get the entire prostate analyzed and graded. Sometimes it turns out that the cancer was more significant than as determined by the initial biopsy. With brachytherapy or any form of radiation, you are never going to have that knowledge.

Secondly, in the event that it is determined that the cancer has not been confined or you have a subsequent occurrence, you still have the option of external radiation as a secondary treatment. If you have the seeding and it turns out that the cancer has returned, surgery is a much more difficult procedure due to the effect of the radiation from the seeding on the tissue with less beneficial results. Further, external radiation is not generally recommended for failed brachytherapy due to the amount of radiation already in your system.

What type of surgery is for me? There is the traditional open surgery approach as recommended by Dr. Patrick Walsh of Johns Hopkins Medical Institutions (See his book, "Guide To Surviving Prostate Cancer") and the newer robotic laparoscopic approach. Dr. Walsh and others believe that only the open surgery gives the surgeon the ability to feel the tissue to help determine which tissue is cancerous. The surgeons who advocate the robotic procedure respond that the robotic surgery results in less blood loss, less time in the hospital, and a quicker recovery. They also contend that the surgical area is better illuminated, the 3D images from the camera are better, and robotics offers other advantages.

One of the few consistent statements in all of my readings was that the experience of the surgeon is the most important point in any prostate surgery. Ultimately, I went to a urologist who switched from the open procedure to robotics about two years ago. His name is Dr. Kaplinsky, and I was very impressed with him.

The Surgery

On October 25th I had my prostate gland removed with a robotic prostatectomy. The procedure lasted only two hours, and I was advised that everything went very smoothly. However, in the Recovery Room I noticed that I had another problem - I could not see. I was advised that sometimes a patient has dry eyes as a result of your eyes being taped during surgery. I was provided with drops to ease this issue. Unfortunately, the problem persisted and eventually an ophthalmologist diagnosed that I had a scratched cornea.

It's funny that I felt no pain, only slight tenderness from the surgery, but that I was unable to open my eyes for over a day due to the scratched cornea. One never knows what to expect from surgery. My hospital roommate had unexpected kidney complications from a reaction to the pain killer after his prostate surgery. On the other hand, I never experienced severe gas pains, perineum pain, or other side effects from the surgery that I had read about.

While the nurse's aid only wanted me to sit in a chair on the evening of the surgery, I convinced her to take me for a walk (with eyes closed). Other than the eye issue, I felt pretty well for having just had surgery. I was discharged the following day after the removal of the drain tube. I was sent home after instructions on using the Foley catheter and switching from the large bag to the leg bag. We made an appointment to have the catheter removed on 11/1 (one week after surgery).

The next days were uneventful. I continued to feel surprisingly well. I went for two walks each day. The only issues were my eyes (still, but getting better) and the catheter, which is more of an annoyance than painful. Finally, on 11/1 the catheter was removed. While I was anxious about the removal and lack of control afterwards, the process was not too painful and I have more control than I anticipated. More importantly, I received good results from the pathology report. It appears that the cancer was confined to the prostate. In four weeks I will get the results from the post surgery PSA test which will help confirm whether or not all the cancer was removed.

Although I do not have complete control of my urinary functioning and have the urge to frequently urinate, I do not have any pain urinating. I am currently wearing diapers which are more comfortable to me than the pads that I tried. However, I hope to regain control soon as I practice my Kegels. My urologist also prescribed Levitra to start next week for what he terms "penile rehabilitation." We'll see how that works soon.

I feel a little stronger day by day. I already went into my desk job work for 2 hours on Wednesday and hope to return part time next week. After this experience, I feel that I have a new lease on life and express my love to my wife and kids on a daily basis. Who knows what the future will bring, but for now life is good!

Conclusion

I apologize that this became so wordy. I think the most important part of the process is that each one of you take the time to decide what is the right treatment option for you. It took me two months to make my decision. Once you make your decision, go forward with high expectations knowing that this disease can be cured and with the hope that the future will be bright. It is also important to have good support. My wife was a great partner, advisor, and nurse. We experienced every aspect of this entire journey together. Best of luck to all of you!

I just had my second follow-up visit with my urologist after my robotic prostatectomy in October. After 4 months, my PSA is down to 0.1 and my continence is almost back to normal. I no longer wear a pad except when doing strenuous physical activity. I am back to all my usual activities. I am now going to the health club 3 times a week and back to playing tennis on a weekly basis.

The only area of some concern is my impotence. My urologist prescribed Cialis 3 times a week. Although the Cialis does seem to have some effect, I have not been able to achieve sexual intercourse. Also, my insurance will only cover 6 pills a month with no exceptions. Once again, the insurance industry is interfering with the doctor-patient relationship and the patient's course of treatment.

Otherwise, I am feeling well, and I am happy with my progress. My urologist does not want to see me for another 6 months. I hope to enjoy the spring and summer without any other doctor visits. Good luck to all!

Hi everyone:

My last update was in March 2008. Since then, I had a PSA test taken in August. To my dismay and surprise (because I was feeling great) my PSA had risen from 0.1 to 0.4. Did this mean my cancer recurred or spread? My wife and I were quite concerned. My head was racing - do I need to prepare for radiation or other treatments? My urologist, on the other hand, was most cautious. He said that we should get 1 or 2 additional PSA tests before considering other treatment. I wanted to take another PSA test right away, but he insisted that we wait 3 months to retest.

So, I waited until several weeks ago to take my next PSA test. I was anxious and began considering my schedule for future radiation treatment. This time the PSA was back at 0.1. What a relief! My urologist could not give me a good explanation for this fluctuation. I believe either the PSA test may not be that accurate or that scientists do not completely understand its results. In any event, I am a happy camper again. I know that we are never totally "out of the woods" and will be anxious when waiting for the results of my next PSA test (in 3 months), but I learned it is not that unusual for the PSA results to go up and down.

I hope that this experience helps others of you who may have a sudden jump in PSA. It is best to stay calm and see if it is repeated in future tests and represents a trend or is merely a bump in the road.

Happy holidays and smooth roads to all!

Mitch C.

Currently, there is not much more to report.

My last PSA test result indicated that the PSA has risen to 0.3. My ED is still there, and I'm still considering using a vacuum pump for that issue. (I am a procrastinator and slow to make decisions).

Physically, I feel fine, and I'm looking forward to several planned vacations with my family this year. Of course, I still wish to participate in your worthwhile program. I have "mentored" a number of others who have contacted me after reading my story. Additionally, I have particpated in the annual march against prostate cancer in Chicago for the last several years.

My intent is to update my story after my next doctor's appointment in May to see if my PSA continues to rise or bounces back down. Thank you for your kind thoughts, and I extend my best wishes to all of our brothers.

[In response to a reminder, Mitch said:]

I am meeting with my urologist in May (and testing my PSA right before). I hope to provide an update after that appointment.

Thanks for the reminder. Mitch

I'm sorry that I have not updated my story for a while. The months and years seem to fly by. This week I had an appointment with my urologist. He reminded me that we were approaching the five year anniversary of my surgery (October 2007). Over the last 3 years, my PSA has been very steady - between .18 and .2. My urologist is ready to switch me from 6 month visits to annual appointments, which seems to be the protocol after 5 years if there are no additional problems.

Being somewhat insecure, I suggested another appointment this year and then go to annual visits if all is well. I still suffer from E.D. After years of procrastination, I am about ready to try a vacuum pump. I don't think I would like the shots. My wife has been very supportive of my impotence issues. Aside from the E.D., everything is great. I still drink my pomegranite juice every morning and do my kegels twice a day. So for all of you just starting on this venture, there is hope. By the way, my daughter is getting married this year.

Life is good! Good luck to all, Mitch C

Hello all,

It has been another year since my last update. My prostate surgery was nearly 6 years ago. Thankfully, everything is about the same. I am on annual appointments with my urologist now. My latest PSA was .27. This is a little higher than usual for me, but I have learned not to be overly concerned with small increases. I have been as high as .3 and .4 in this post surgery period. I am still drinking pomegranite juice, but every other day now. Has it helped or is it just psychological?

My ED has not improved. Although I keep thinking about trying a vacuum pump, I have not purchased one as yet. What can I say? I am such a procrastinator. My wife has been very understanding, and we still engage in sexual activities. That's about it from these parts. Oh, my daughter did get married and has a great husband. Life is good!

Best wishes to everyone!

Mitch's e-mail address is: lawmitch2 AT yahoo.com (replace "AT" with "@")

NOTE: Mitch has not updated his story for more than 15 months, so you may not receive any response from him.