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Part 1:
Early Warning
My life had been relatively free from medical complications during
the preceding 65 years. There was never any evidence of prostate or
other cancer in my family. I was now considered to be in perfect
health. Perhaps this was so because there was no reliable
test procedure to confirm its existence during a period prior to the
death of my relatives from other causes. So, it was in March 1992,
prior to a trip to Europe that I went for a physical at the office of
a general medical practitioner.
The test results came back from the lab and hidden among a full
page of data was the one entry "PSA = 7.5". This was of no special
concern since I was advised that a PSA of 7.0 for someone of my age might be normal if not slightly on
the high side. Certainly not high enough to warrant further
investigation. So my life went on without concern for the potential prostate
cancer and I left for Europe.
I was headed for an adventure in South East Asia in the fall of
1994 and decided on another physical exam to confirm that my health
would not prove to be a problem in the third world countries I would
be visiting.
This time I had the "physical" examination done by another medical
group and the long print out of blood chemistry revealed a PSA of
8.0. On the advice of the doctor at that facility, I went to a
urologist who was a gentlemen in his late sixties and who had the
equipment and experience to further offer an opinion on my condition.
After the completion of an in-office biopsy and ultrasound the
doctor offered the opinion that "I had a few cancer cells" in my
prostate. The word "cancer" struck me like a blow! However since it
is not unusual for men past 60 to have a few cancer cells in the
prostate I was not unduly alarmed. The doctor suggested possible
treatment with general radiation of the prostate region for a period
of about eight sessions.
A second option was to do nothing and to continue "watchful
waiting". As time would prove, this suggested treatment would have
been totally incorrect. First, a period of 8 sessions would have
never been adequate to kill the cancer cells and secondly, the
general radiation would have produced serious and unmentioned side
effects.
The negative aspects of GENERAL radiation were never mentioned by
the doctor. I opted for more "watchful waiting". Prostate cancer is a
very slow growing malignancy, in older men, and there is no need for
panic. However, the time should be spent carefully studying the
problems and the available options.
Having again opted for "watchful waiting" I also decided to use
this period to conduct an intensive study into the subject of
prostate cancer including details related to the disease itself, the
surgical operation, all of the known forms of treatment along with
their positive and negative aspects, "white papers" from a
comprehensive cancer center, many comprehensive literary
presentations on the subject, and articles in various periodicals
written by men who had undergone various forms of treatment. My
thirst for knowledge continued for more than two years. I slaked that
thirst with increased knowledge, from many sources, which I knew
would prove necessary to save my life.
My study revealed that a correct decision at the outset was vital.
Corrective measures (salvage therapy) to attempt to produce a cure
after an abortive first attempt are usually unsuccessful and fraught
with undesirable side effects. Clearly, it is of the utmost
importance that the cancer patient understand as much of the
physiology of the disease as he can absorb and then understand all of
the positive and negative aspects of possible methods of treatment.
It is absolutely critical that the patient give the objective of
"cure" his very best shot - up front!!!! It must be understood that
Urologists are Surgeons and will usually opt for surgery.
Radiologists on the other hand will opt for radiology. Both of
these professional disciplines should be consulted in the decision
making process but the patient must make the final decision. Before a
final commitment is made: read everything available on prostate
cancer and treatment - consult more than one doctor in more than one
discipline - ask questions - contact patients who have had similar
treatment at hospitals you are considering. Above all - the
inconvenience of obtaining treatment is totally inconsequential when
compared to the effectiveness of the treatment itself. The
inconvenience of going for treatment will long be forgotten but the
cure will save your life!!!.
In August 1996 I was preparing for a trip to Africa. It was now
two years after cancer cells were first identified in my biopsy
specimen. During all of that time I felt fine and no adverse affect
of the cancer cells which were obviously multiplying in my prostate.
It is important to understand the ramifications involved in
"watchful waiting". There are two aspects to this decision: (1)
Psychological. Some men will find it impossible to accept the fact
that they have cancer cells growing inside of them and then do not
select the option of extended "watchful waiting". (2) Medical. Most
of the time prostate cancer is a very slow growing tumor. However, in
certain cases the spread of the disease can suddenly become
exponential in nature. During any period of "watchful waiting" it is
imperative that the PSA be constantly monitored on a schedule set
forth by the Urologist or Radiologist.
To insure that there was no potentially explosive medical problem
which might become troublesome in the African bush, I returned for a
physical to the same facility which had conducted the testing in
1994. This time the PSA test result was my main concern and I was
admittedly startled when I found it indicated a value of 14.7.
Clearly something was going on to have the PSA increase 45.5% in
only two years. The rate at which the PSA increases is called
"Velocity" by the urologists and a velocity as high as mine was
definitely an indication that something had to be done.
Considering the recommendation I had received from the urologist
in 1994 I decided to find another doctor and perhaps one who was much
younger and who would be in tune with the latest treatment methods
for prostate cancer. This time I visited a medical group of five
urologists who were younger and who had considerable combined
experience in the field of prostate cancer. I was assigned one of the
newest members of the team. This turned out to be fortuitous for me.
The doctor, though a Urologist, was not a prisoner of the old
"standard procedure"- surgery.
Additional testing was done including another biopsy. This time my
cancer was quantified more exactly. The most important numbers used
to identify prostate cancer are Gleason Number and the TNM System
number. The Gleason number indicates how well defined the cells are.
The higher the number the more amorphous and plate like (less
defined) the cells are and the worse the problem. The Gleason scale
runs from 2 to 10. The lower the score the less (or non existent) is
the problem. Scores above 7 are areas for concern. Scores as high as
10 indicate serious conditions. The TNM System is used to define the
size of the tumor. This scale runs from "T" through
T1-T1a-T1b-T1c-T2-T2a-T2b-T2c-T3-T4-N+-M+. By the time the cancer
indicates a TNM scale of T3/T4 or higher conditions are very serious.
N+ and M+ conditions are much more difficult to treat.
Here we come to an important distinction: The PSA number must be
viewed with other numbers to realize its full potential. The
important numbers are the Gleason and TNM scales, and PSA. As the
Gleason Number increases, the indication of increased metastic
potential for the cancer cells is suggested.
There are other factors which can contribute to high PSA readings
and they have nothing to do with cancer. It is VITAL that the cancer
be fully identified under the above screening systems before further
judgements can be rendered regarding treatment.
In much the same way that individuals are fully identified by a
surname, middle name, and family name, prostate cancer is fully
identified by its first name (PSA), middle name (Gleason Score) and
Family Name (TNM). A prostate cancer patient should know these
numbers as well as he knows his own name. They truly describe his
condition.
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| This information is provided for educational purposes only and does not replace or amend professional medical advice. Unless otherwise stated and credited, the content of Phoenix5 (P5) is by and the opinion of and copyright © 2000 Robert Vaughn Young. All Rights Reserved. P5 is at <http://www.phoenix5.org>. P5's policy regarding privacy and right to reprint are at <www.phoenix5.org/infopolicy>.
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