I remember very distinctly the day my doctor called and left a voicemail to call him back as soon as possible. I had just turned 51 and was feeling extremely good for my advancing age. Every year, near my birthday, I always scheduled an annual physical. The physical went well, and they took the standard blood tests. I had no reason to suspect that anything was wrong.

I was in my car when I called the doctor, expecting to be told that my cholesterol was too high … it had always been in the 220 range. (It is below 100 now—but that’s another story that I will share with anyone who wants the information.) I was more than a little shocked when he said my PSA test results had gone from 3.2 the previous year to 7.7. I had very little idea what a PSA test even measured, let alone what a 7.7 score meant. He said it had to do with my prostate and could indicate an infection or something more serious like cancer. Like most men, I knew very little about the prostate.

I was healthy: never smoked, didn’t drink, was not overweight, and had no known history of prostate cancer in my family, so it was probably just some kind of infection, I thought. However, I am naturally curious when it comes to my health, so I began to research prostate problems. After searching the net for several weeks, I knew more than I ever wanted to know about my prostate. However, much of the information was confusing if not contradictory. I asked friends what they knew, but that was an exercise in futility. The most important thing I learned was that if the worst came true, and I had cancer, it was not a death sentence.

From my research, I concluded that since I was an avid bicycle rider, the seat pressing on the prostate could have caused the increased numbers. Therefore, I decided I would stop riding for a few months and find some supplements designed to improve prostate health. The good news was that after several months, my numbers did in fact come back down below 4.0, which is the upper limit for a healthy PSA test. Nonetheless, the doctor said that while the total number came down, another indicator (PSA Free) had also declined. He told me that anything below 24 was a concerning level for PSA Free. My original number was 11 and for the second test it went down to 9. He recommended I see a urologist.

I went to several urologists before I found one I liked. The first one was cocky and resented that I brought my wife with me to talk to him. He suggested a prostate biopsy. Uck! A prostate biopsy involves a dart gunlike device being placed inside one’s rectum. Then a metal rod similar to a darning needle, with a hook on the end, is shot through the rectal wall to rip out 6 to 12 quarter inch pieces of an organ the size of a walnut (when not enlarged). For some reason, this didn’t seem like a pleasant test to me. As a result, I continued to do research until I was convinced that there was no other way. Finally, I gave in. The test pretty much met my expectations—which I won’t describe further, but it didn’t take long and wasn’t as painful as I had anticipated.

By the time the doctor called me with the test results, I had concluded that I did in fact have prostate cancer. I always figured if you expect the worst in situations like this, you won’t be disappointed when the worst does happen. I wasn’t disappointed. It was cancer and my numbers were average on the Gleason score (Gleason Score-http://www.phoenix5.org/Infolink/GleasonGrading.html). When I relayed the news to my wife, she correctly said, “Well, that’s what you expected.”

I know this will sound strange, but the news did not depress me or make me ask, “Why me?” I approached the problem as I would any business issue, with logic and as little emotion as possible. Again, I knew that prostate cancer grows very slowly and even after the discovery, there was still only a small chance that I would die from it. I investigated surgery, seed implants, and also “watchful waiting”. I have always believed that the best treatment for cancer is to cut it out. My mother and father both died of cancer, but it was discovered too late to operate. When I asked the doctor who specialized in seed implants what he would do if he had prostate cancer at my age, and his answer was surgery, I was convinced.

In May of 1999, I went into Johns Hopkins Hospital and had a radical prostatectomy. Because I believe in being prepared, prior to surgery I had treatments from an acupuncturist and counseling sessions with a psychotherapist. The acupuncture was to reduce the size of the tumor, if possible, and the therapist was to prepare me mentally for the surgery and recovery. I can never be sure if the acupuncture helped, but the therapy was incredible. I learned meditation and visualization in order to develop positive images. I saw myself in the hospital, in surgery, with everything going as planned and then a quick recovery. During surgery I took a CD player with my meditation music into the operating room to keep from hearing the doctors’ conversation (I was awake during most of the surgery). Then I used the CD player and meditation techniques while I was in the hospital for my three-day stay to “zone-out” from the ruckus that occurs in a typical hospital, and to make the time go by faster.

The end result of the surgery was that the doctor said he believed he had gotten all the cancer. Amazingly, I was in little or no pain after surgery and stopped pain medication before I left the hospital. Three weeks later, much to the doctor’s and insurance company’s chagrin, I was back to work part-time. One week after that, I was back to work on a full-time basis. (For the golfers out there, I was told I couldn’t play for six weeks. The wait almost killed me, but I was standing on the tee ready to play on the last day of the six-week period—and I played darn good.)

Although surgery worked for me, I am not necessarily recommending surgery for prostate cancer. I know many men who are very happy with seed implants. It is an individual choice, and I think every man has to make up his own mind. I do not believe there is a right or wrong treatment; it has more to do with the comfort level of the individual. Each treatment has advantages and disadvantages. What I would warn every man is not to believe the hype given by doctors and hospitals about how successful they are in preventing impotency and incontinence. Regardless of what we want to think, medicine is a business and the doctors and hospitals compete for patients. The hospitals with the best statistics for cure, potency, and continence will obviously have the most patients. Therefore, there is an incentive to interpret the statistics on successful surgeries and side effects in a favorable light. Specifically, you owe it to yourself to ask the doctor how they define potency and continence. It might not be the way you (or anyone else in this world) define it.

Another warning I would share is that many well-meaning people want you to feel sorry for yourself, because they feel sorry for you. Friends and others close to me, as well as doctors, said, “I suppose you are asking, why me?” or they said, “It is okay to cry and feel sorry for yourself.” To the first question I answered, “Why not me?” There are medical problems far worse than prostate cancer in my opinion. In response to the statement about self-pity, I said simply, “What do I have to cry about? I’m not going to die … at least not from prostate cancer.”
What is my message here? First of all, my message to men is that we need to raise our voices about prostate cancer research and the related spending. We should not be shy about this serious medical problem, because there is nothing to be embarrassed about. A stiff upper lip and machismo have no place here… prostate cancer can be a death sentence if it is ignored. Our historical silence on this subject has placed funding for prostate cancer far down the list. The lack of money for research is beyond appalling. Women, on the other hand, have stepped up and demanded that researchers and the government develop better treatments for breast cancer. And the results have been impressive. Why can’t we men do the same thing? We can!

In 1997, spending on research for every death from the following three diseases, including prostate cancer, looked something like this:

 Breast Cancer - $12,800 per death
 Prostate Cancer - $2,700 per death
 AIDS - $47,000 per death

While the numbers have changed quite a bit since 1997, I am not sure the relative position has. I recently read an article stating that in 2005, a total of $466 million was allocated for prostate cancer research. If you divide $466 million by 31,000 prostate cancer deaths, today the total is about $15,000 per death. That is a great improvement, yet the research has not yielded tremendous change. The fact is, treatments have not changed dramatically, and a cure has not been found. Therefore, men still need to speak up and be their own advocates on this important health issue. Currently 180,000 men are diagnosed with prostate cancer each year. (I would be more than happy to correspond with men about my experience with prostate cancer, or their wives, girlfriends, daughters, or sisters—since they are often the ones willing to discuss prostate cancer.)

Secondly, and just as important, for me, surviving Vietnam many years ago made me realize that every day is a gift … and there are no guarantees for tomorrow. Since I survived Vietnam and returned without physical scars, every day has been a bonus to me. There are over 58,000 men listed on the Wall in Washington D.C. who never saw a tomorrow. Developing prostate cancer only reaffirms my belief that you must live everyday as if it was your last …be positive about the future, but enjoy today. There are a number of things I want to do before I am no longer on this earth.

Not long ago, I read about a survey that asked people over 75 years old what they regretted in their lives. Surprisingly, there was little regret about things they had done. The regret was about the things they didn’t do. Like many people, I was putting off many of the things I wanted to do until I reached retirement (60 for me) and had “free” time. Prostate cancer convinced me not to wait. First of all, I re-dedicated myself to my family and my job … my credo is work hard, but enjoy as much free time with my family and friends as possible. I bought that house in Florida that I had been putting off (for someplace to go when it is too cold to play golf in Maryland). I started a number of hobbies I had an interest in: photography, travel, target shooting, and writing a book, to name a few. Now, more than ever, there are not enough hours in the day.

I hope my telling of my experiences with prostate cancer has helped someone facing the dreaded “C” word.

“Dance like nobody's watching; love like you've never been hurt. Sing like nobody's listening; live like it's heaven on earth.”

- Mark Twain

“Time is the coin of your life. It is the only coin you have, and only you can determine how it will be spent. Be careful lest you let other people spend it for you.”

- Carl Sandburg

“Yesterday is a dream, tomorrow but a vision. But today well lived makes every yesterday a dream of happiness, and every tomorrow a vision of hope. Look well, therefore to this day.”

- Sanskrit Proverb

Below is an interesting article copied from www.menstuff.org. Unfortunately, you will find it difficult to find honest articles like this on the net.

The Truth on Prostate Treatment

Menstuff® has compiled the following information on prostate treatments.

Men Seek the Truth on Prostate Treatments

At a robust 56, he faced surgery for prostate cancer, terrified that it would leave him impotent. He made the rounds, visiting top urologists at Harvard hospitals. He chose a surgeon who told him that 80 percent of his patients end up able to have sex without the help of devices.

Last week, unable to get an erection and suffering from incontinence, he went to a support group at Beth Israel Deaconess Medical Center, where he learned that the vast majority of the group have significant trouble with sexual function, even years after surgery or radiation treatment. It turns out that the 80 percent success rate may be more hope than reality, achieved only by a few highly practiced surgeons on selected patients. One large-scale study of prostate cancer survivors found that, 18 months after treatment, 60 percent could not get an erection firm enough for intercourse. As a result, many men, including some in the Beth Israel support group, feel they were misled about the sexual side effects of their treatment.

''Why can't we get good solid information?'' said the Boston man at Beth Israel, who, at four months after surgery, still hopes for improvement and did not want his name used for fear of alienating his doctor. ''If people knew the truth, if there was more - I hate to use the word honesty - but I think people could deal with this disease a little bit better.''

Doctors agree that there is a broad gap between the more optimistic potency rates widely quoted in surgeons' books and Web sites - especially those of celebrity specialists like Johns Hopkins Hospital 's Dr. Patrick C. Walsh - and the more typical experience. Published studies report post-surgical rates of impotence ranging from less than 15 percent to more than 80 percent, depending on the patients' ages and conditions and the experience of the surgeon.

Radiation treatment offers a somewhat lower risk of impotence, but, because long-term survival is not so good, doctors usually recommend surgery for younger patients, the ones most likely to be sexually active.

However, doctors say they tell patients up front about the risks and trade-offs. They also say that support groups overstate the degree of dissatisfaction because they tend to attract more men who are having problems.
But some doctors, as well as many patients, believe the prostate cancer survivors have a point: Surgeons sometimes downplay the chances of impotence as they focus on curing cancer. They sometimes quote potency rates for celebrity surgeons who do nothing but remove prostates, rather than their own rates, said Dr. Jeffrey Steinberg, acting chief of surgery at Cambridge Health Alliance, who advises the support group. Or they don't emphasize that the best numbers come from groups of younger, healthier patients.

The result, said group leader Stan Klein, is that with 180,000 men diagnosed and 55,000 undergoing prostate-removal surgery each year, thousands of survivors are glad to be alive, but painfully disappointed with their sexual function.

''It's devastating,'' he said. ''We've had them coming in with tears in their eyes.''

''I understand the frustration and anger on the part of many of those patients,'' Steinberg said, adding that doctors have to be extra rigorous in preparing patients for side effects, since men sometimes hear only what they want to hear when doctors predict their sexual future.

''It's important for surgeons to tell patients what their experience is in their own practice, how many they've done, what age range they've done'' he said. About 50 percent of his own patients are potent a year after surgery, he said, with better results in younger patients.

Klein, cancer-free nine years after surgery, is on a mission to paint what he calls a more realistic picture. His goal is not to discourage treatment: ''With almost 32,000 men dying each year, we don't want men to say, `I'll take my chances.'''

Rather, he said, realizing that impotence is more likely than not will prepare men better to cope with the problem and seek treatment - Viagra, injections, vaccum pumps and penile implants - that usually brings ''an almost normal sex life.''

Dr. Irwin Goldstein, director of the Institute of Sexual Medicine at Boston University School of Medicine, had this advice for prostate patients, whether they opt for surgery or radiation: Doctors exaggerate their ability to save your erections. Expect to be impotent. But worry only about surviving. Then, call the sexual dysfunction specialists.

''If a man owns a penis,'' he said, ''we can make them have an erection.'' Prostate cancer victims face a particularly difficult choice since the treatment options force them to decide between a greater risk of death or a greater risk of impotence. Unlike most cancers, their disease can be treated effectively with two very different techniques, surgery and radiation. While radiation causes less impotence and incontinence, surgery has better survival rates beyond 10 years. And radiation patients sometimes develop sexual side effects well after the treatment.

And for doctors, measuring safety and effectiveness of surgery is always contentious, since so much depends on individual skill and patient selection. There is some mistrust between surgeons and the epidemiologists and others who measure their outcomes. The debate over prostate surgery has even tapped into the rivalry between Boston's hospitals and Johns Hopkins of Baltimore - home of Walsh, the surgeon who helped raise expectations so high.

In 1981, Walsh published a paper describing the nerves that run close to the prostate and help control erections. He developed the technique of removing the walnut-sized gland without cutting either of the nerves, called bilateral nerve-sparing.

His most famous study, quoted frequently on his Web site, was published in 2000. Of 62 relatively young, healthy patients he operated on, 86 percent could have sex spontaneously after a year and 93 percent were completely continent. He and five other top surgeons also reported 90 percent potency on 50 patients under age 60.

Those numbers, touted in Walsh's best-selling book, raised the bar for prostate surgeons - unrealistically, say other surgeons. ''He's a very good surgeon and he's honest, but he's very selective'' in choosing patients, said Dr. Jerome Richie, chief of urology at Brigham and Women's Hospital, who says his own potency rate is 85 percent for patients in their 40s, 60 percent for those in their 60s.

In a larger study of 1,291 patients, about half over 65, University of Washington epidemiologist Janet Stanford found that 18 months after surgery, 60 percent of men reported having no erections or erections that were not adequate for sex. Even among those under 60, just 40 percent had erections adequate for intercourse.

Since not everyone can go to a top specialist, it's important for all surgeons to measure and report their own outcomes, said Dr. James Talcott, of Massachusetts General Hospital's Center for Outcomes Research. But he believes most don't - partly because the expectations are so high that real numbers would be damaging.

Talcott studied 49 patients who had surgeries at Boston teaching hospitals. He found that most were impotent, including 15 of 19 patients who had bilateral nerve-sparing surgery. He said his results were more realistic because the patients had a wider mix of ages and were asked about their conditions by independent researchers, not doctors.

Source: Anne Barnard, Boston Globe

Links:

www.menstuff.org
www.prostatecancerfoundation.org
www.prostate.com
www.pcacoalition.org
www.cancer.gov