Just My Luck – Chapter 9 – Part 3
“Now, let’s focus on your prostate.”
Day 1 + 3 Weeks + 3 Months + 1 Week + 1 Week + 1 Week
Dr. S. had visual aids that he’d obviously used many times in situations like mine. After all, the odds of contracting prostate cancer are not very slim.
He prefaced his discussion with a pithy statement that was probably spoken thousands of times, but was new to me, “More men die with prostate cancer than from it.” There was some real comfort in those words.
As implicit from the phrase, Dr. S. said that actively doing nothing was actually one treatment option to consider. In effect we could leave the cancer alone and monitor whether its inevitable growth would be at an acceptably slow rate.
Immediately I considered actively doing nothing both moronic and oxymoronic.
He went on to describe basically three active and aggressive treatment options available (at that time).
- Radiation treatment was a well proven regimen that bombarded the cancerous portion of the gland with radioactive particles, literally burning the cancer out. The object here was to slow or stop the spread of the disease. There was some danger of irradiating some non-cancerous areas, but that was relatively small since their equipment was capable of near pinpoint accuracy. There was also the danger that the treatment could fail to reach all of the cancerous tissue, again a small chance but a real one nonetheless. Lastly, more than one treatment session would be required and I would likely feel sick after each one.
- Radiation seeds were a more recent treatment option. Irradiated seeds would be strategically implanted in the cancerous area to continuously slow the disease. The seeds released the radiation slowly and so was a less radical treatment. I had visions of glowing in the dark, which Dr. S. quickly dispelled.
- The third option was the most aggressive: a prostatectomy, the surgical removal of the entire prostate gland. This was the most complete option, but it had some serious drawbacks to consider.
Anticipating what I was about to ask, Dr. S. added, “You can’t try radiation and, if it doesn’t work to your satisfaction, proceed to a prostatectomy. The irradiated tissue can’t be cut as readily or accurately as we’d need. Except for choosing to do nothing, once you begin a course of treatment, you have to stick with it.”
He explained that my age, which at the time was in the mid-50s, was near the borderline of advisability of radiation. Slowing the growth was suggested for some men over 60 on the ‘die with it not from it’ premise. If it’s probably not going to kill you before something else does, just slow the cancer down. Men in their 70s or more might consider the wait and see route, depending on how far advanced that cancer already was.
Younger men might do well to consider the prostatectomy to remove the disease completely from the body. But even they would have to work through some serious considerations. The prostate plays a key role in the reproductive system. It produces the semen that nourishes and transports sperm cells. The potential of naturally fathering another child drops to zero absent the prostate gland.
According to Dr.S., considering my age at the time, a good case could be made for any of the treatments a He suggested that I might want to take a week or two to think about the choices and talk it over with Doris.
I told Dr. S. that I needed no time to think it over. From the day he called me with the news of the biopsy, I had no question or hesitation about the treatment I wanted. “Get that cancer out of me as soon as possible.”
I’d already had a vasectomy over a decade earlier, so my new fatherhood days were long behind me. The do nothing option seemed too risky, especially considering my cancer had achieved Stage 3 without detection. I had no idea how rapidly it may have grown and how quickly it might reach the point of no return. Radiation treatments were interesting and probably okay, but after a week of testing and worry over whether it had spread, I didn’t want to give the cancer any opportunity to spread in the future.
I simply wanted to be cancer free.
“Before you make your final decision, there are a couple of other risks you need to consider,” he said. “First, as with any surgery, there is always a risk that something may go wrong when you’re opened up. The risk of infections is typically at the top of that list. In your individual case, the cancer area is very near some critical nerves that, if damaged, could leave you with some unattractive results. There are no guarantees that any of these can be avoided, though we will take every precaution we can.
One of the nerves is crucial to bladder control, the other, if damaged, could leave you unable to have an erection.”
These were risks I’d never heard about. Both caught my attention. “How likely are these nerves to be damaged?” I asked.
“Well,” he said, “the worst of the two, loss of bladder control, is less likely but a daunting possibility. You really don’t want to live the rest of your life wet. When we do a prostatectomy we have to cut the line from your bladder that passes urine through the prostate to your penis. When the prostate gland is removed, we put some tubing in to re-connect the bladder to the penis and insert what’s called a Foley Catheter to connect your penis channel to a large external bag to collect your urine.
“Immediately after the surgery you will be unable to control the flow of urine from your bladder to the collection bag. It will fill gradually and it will need to be emptied a few times a day. After a couple of weeks we will remove the catheter and if all has gone according to plan you will be able to urinate as usual. If the system was inadvertently damaged, you may need to wear that bag for the rest of your life.”
“And the second one, no more erections?” I asked.
“Unfortunately,” he replied, “I’d put that more closer to a 50/50 chance in your case. I’ll be cutting away cancerous tissue quite close to the critical nerve. Bear that in mind when you make your decision.”
“My decision is still made,” I replied with no hesitation. “Get that cancer out of me.”
Day 1 + 3 Weeks + 3 Months + 1 Week + 1 Week + 1 Week+ 2 Weeks
My operation took place within a week of my birthday over 10 years ago now. I have been cancer free ever since.
An Unlikely Gathering of Moving Parts
Looking back at my over 20-week cancer saga, I see another improbable series of lucky Buster Keaton-like breaks that probably saved my life (e.g., bought me more time):
- If a change in Aon’s employee benefits program hadn’t created a need for me to have a simple administrative form signed by my primary care physician, I would have blithely continued living without a medical practitioner in that role until some other pressing need might surface. Meanwhile, my already stage 3 of 5 prostate cancer would have continued to secretly grow in me. By the time I might otherwise have been diagnosed, it might have been too late to deny the Grim Reaper his harvest.
- If Dr. R. hadn’t decided to give up his primary care practice when he did, I would have brought him the form I needed signed and he’d have signed it. Case closed. No question he would have suggested I think about having a check up soon, but left in my court to schedule the physical, it wouldn’t have been soon.
- If Dr. R. and my Pulmonary Department Head friend hadn’t both recommended Dr. A. as my primary care physician, odds are I would have one of the “nine out of ten doctors” who would not have seen a need to ask for a second opinion about a minor coarse spot on my prostate gland.
- Likewise, if Dr. A. had not been taking new patients at the time, again I might not have found another “one out of ten.”
I won’t include on my “if” list that it was crucial that Dr. A. insisted on my having a physical as a new patient of hers, and it was crucial that Dr. S. biopsied my prostate gland. These were best practices, not lucky decisions.
Lastly, I was greatly relieved that I didn’t lose my bladder control.
Just My Luck.
©2016 James Ash