August 12

Part 4

The journey begins

Okay, now to summarize. I got the hernia fixed, and I can walk around. Got a scar from the belly button down to as far as it can go (relevant later). PSA is bouncing from 11 to 13 but is relatively stable (not great but not horrendous, either). Gleason score is either 8 or 9 (out of a possible 10) depending on which pathologist is reading it. Not good. PSA could have been much worse (some guys run over 100 or more). Low PSA and low Gleason are the best possible combination. I don’t quite have either. I chose a radical prostatectomy (RP) as my first option. All I was thinking is, “get this thing out of me.”

Perhaps it wasn’t the best choice, but I will never know. I took my best shot at the time.

An aside

I need to explain that I work for a multinational health textbook publishing company. We have an outstanding insurance plan. In addition, I am accustomed to dealing with the health professions on an informal, questioning basis. It’s what I get paid for, so I carry that attitude over into my relationships with my new doctors. This will pay off big, later.

Once more, into the brink . . .

Surgery is December 18, 2002. Not too difficult. Recovering from hernia surgery was actually harder. Need to learn to pee all over again (the prostate surrounds and is attached to the urinary tract, so some tubes inside have to be reconnected, and they are kind of traumatized). Very sore stomach area, even though the urologic surgeon used essentially the same incision area as did the hernia repair surgeon.

Post-surgery, the report is that apparently the cancer had not spread and that they got all of it. I am thankful to the point of tears and assume a complete cure and a long life ahead of me. Follow-up CT/PET scans show no metastases to the lymph nodes or liver.

Bone scan is negative.

My surgeon is my hero.


Less than a year later, PSA rises from 0.4 (I should have known I had a potential problem then—PSA should have stayed around <0.01, or undetectable) to 2.4. Cancer is back.

FYI: I have come to think that the cancer’s return is due to micrometastases in the area adjacent to the prostate. Perhaps if I had had radiation therapy right after surgery, the prostate cancer may not have returned. However, it isn’t useful to dwell on this possibility; it doesn’t reflect reality. This is the thing about prostate cancer: right now, there seem be almost infinite possibilities. It is not, in medical jargon, a “well-understood” disease.

I talk to my surgeon; he talks about statistics. I talk about research, and he mumbles something about “throw-away journals.” I ask him for an educated prognosis, and he gives me 10 years, max. Uh-oh.

Like hell. I need another doctor. I’ve worked with these guys for a long time helping them publish their research. I know they are not gods. And this guy isn’t even taking the time to stay abreast of the latest research. There is a final straw in our relationship; more on that later.

Click here for Part 5.