Prostate Cancer – A Lesson to Learn
Some years ago I had a visitor from Israel. A friend. He told me he had prostate cancer and had traveled to the Mayo Clinic for an operation.
“How was it discovered?” I asked.
“My PSA test results were growing and my doctor told me it was a sign that I might have prostate cancer. The biopsy confirmed his suspicion.”
So I started taking the PSA test and, whoa, my numbers were growing from test to test too.
So I went to an urologist. “What to do?” I asked.
“Oh do not worry,” he said. “You are too old. Prostate cancer grows very slowly. You will die from old age before it causes damage.”
Hmmm. I was not at peace with his answer. My son’s music teacher just died from prostate cancer. He was older than me.
Back to the urologist. Please do a biopsy. I was firm.
He repeated his earlier assertion: I should not worry because of my age. He shows me an article from the Wall Street Journal which says that people over sixty should NOT even do a PSA test. It was not necessary.
Hmm. I am still worried. My client from Greece, my age, is going through chemotherapy for prostate cancer.
I called him. “How come you are undergoing chemotherapy? My urologist claims old people die of old age, not of prostate cancer.“
“Do not listen to him,” he began to shout, “take the prostate out.”
Back to the urologist. I request surgery to take the prostate out.
“I can’t do it,“ he says. It is against the law to perform surgery unless there is proof of need. And since we have not found cancer, he all but shrugs his shoulders.
“Then I insist you do a biopsy,” I say. “Let us see if I have it or not.”
He was still trying to convince me not to go forward. “In a biopsy, we take at random twelve pieces from your prostate. Since they are random, we might miss the cancer cell by a millimeter. The biopsy is not very reliable.” On the other hand, he informs me, there is a possibility of infection. It happens one in a hundred thousand. It is a concern.
I insist. I will take my chances.
He does a biopsy. Finds nothing, but I get the infection. Pain galore and I can’t pee.
I had to be admitted to the hospital. A week of drugs fed via tubes into my veins.
The PSA keeps jumping.
I decide to change doctors. I go to UCLA’s department of urology which specializes in the treatment of cancer.
They do the biopsy and find nothing again.
And again I get an infection. Again I go to the hospital. More drugs into my veins.
I open the WSJ. Dick Pratt, another client, this time from Australia, has died. I call his wife to express my condolences.
“What did he die of?” I ask.
How can that be? He was my age. But I am damned if I will undergo another biopsy. I have had enough pain.
Time passes. Maybe a year.
I visit the True North Residential Health Center in Santa Rosa, this time to lose weight. The doctor performs a general check-up. I tell him about the jumping PSA and the ill-fated biopsies.
“You should go to the University of California San Francisco. They have a new technology. Only four years old. They perform a Doppler biopsy which has a higher probability of finding the cancer.”
A Doppler biopsy is a computer aided biopsy. It is a heat-seeking device, thus not a random biopsy.
I am scared. It might mean another infection. Another hospital stay.
My wife insists I do it. She is worried.
Wives always win, no?
So, I go. And they find the cancer. It was close to the rim of the prostate. And they do another test of the cancerous cell, called the W test, which tests how aggressive the cancer has become.
In most people it is relatively passive. So they die of old age. In my case, and the case of the music teacher, my Greek and Australian clients, it was aggressive and needed removal of the prostate before it spread.
Not all people have a non-aggressive cancer. Some do, so for them to wait for old age to die is wrong. But we do not know if it is aggressive or not till it is found. And only then should the decision be made to operate or not rather than to presume it is ok and automatically not operate.
In my case, there was a chance the cancer might spread across the rim into my lymphatic system and then move all over my body; in which case it meant good-bye life.
They offered to do the surgery right away.
I decided I wanted to investigate the best place to go under the knife.
Some friends told me that John Hopkins was the leader. Or Mayo Clinic in Rochester, Minnesota.
I called everyone I knew who had prostate cancer and asked for his opinion. Monroe Price, my good friend, suggested I call a young MD who had just graduated from medical school, a friend of his son. He knows the latest in technology, he advised me.
“Should I go to Mayo or John Hopkins?” I asked him.
“No, no, no!!” He started screaming on the phone. “They are the leaders with the old technology and because of that they resist new technology. They will perform radical surgery which is outdated. There is a high chance of incontinence. You cannot control your urine discharge and will have to wear old age diapers. And lose your erections.”
“Go to UC Irvine. See Dr. Ahlering who performs surgery with a new technology called robotics. It is computer aided. Very new technology.”
I did. Wheeled in at 7 am and out by noon. Walked by 5 pm and went home next morning without taking even a Tylenol for pain. No incontinence.
But the cancer DID spread. I lost a year getting bad advice.
Moral of the story:
Men: take periodic PSA tests.
If it is jumping or just high, find a hospital with a Doppler capability to do a biopsy.
Find what the W test score is. If it is low, go donate money to some just cause, thank God, and go home. If it is high, investigate the best technology for you. Whom should you consult? Two doctors. The old and experienced one and the young and up to date on technology one.
The technology is advancing so fast that not all doctors know what is going on. Some are stuck with what they learned at medical school years and years ago. You need to know the experience of the old one nevertheless, but find what the latest technology is from a young doctor.
I hope this will save some lives.
Ichak Kalderon Adizes