Happy New Years

prostate-cancerLet me wrap this up with an end of year summary of my experience with prostate cancer.  I could have written more after that last blog but really, I don’t think about this much anymore.  That might sound odd but it’s true.  Eight months after my prostatectomy, my recovery is complete enough that I am no longer preoccupied with thoughts of cancer or measuring my recovery progress.  Only one relative asked me about it over the holidays and I was fine with that.  I’m done bringing it up.

I should relate my experience with the penis pump.  I asked my Urologist for one because I wasn’t satisfied with my erections.  I began to obtain erections fairly quickly after surgery.  They grew more robust with each passing month.  I only took the 30 day sample of 5 mg Cialis and never asked for refills because I believe my extreme running has my blood flowing strong.  My issue with erections has been two-fold.  I had not been able to obtain a boner without a helping hand.  As in physical stimulation.  And it would not remain hard during intercourse.  Talk about frustrating.  I got over my initial immature concerns with the pump and determined to try it in an effort to avoid prescription medication.  I’m not totally against meds but I do feel they should be a last resort.  Also, I never noticed any benefit from the 5 mg sample of Cialis.

I found the pump to be a bit of a process.  It’s fairly simple if only using the vacuum to create an erection.  But much more complicated if you apply the ring to clamp the blood flow.  And good God is that ring ever uncomfortable.  I could never imagine actually having sex with that rubber band around my shaft.  Maybe if I was into S&M, but I’m not.  It works fine though to spring a stiffy.  My Urologist suggested therapy to me during our last visit when I related my requirement for physical stimulation.  I declined.  I can’t see myself in therapy.  And I really do improve measurably each month.  In fact, I woke up with a boner on Christmas Day.  Talk about a Merry Christmas.  This was a first since surgery and a very welcome gift.

I wouldn’t say I’m 100%.  I’ll never be 100% again.  I aged from this, both physically and emotionally.  It still bugs me not to ejaculate during orgasm.  That takes some getting used to.  But I do orgasm.  There are worse things.  Overall, my quality of life is fully back and probably better than most men my age.  In my first race after the surgery, I ran a PR 3:31 marathon.  One minute shy of qualifying for Boston.  After ten years sporting a buzz cut, I’ve purposely grown my hair long.  My bangs are down to my nose.  I’m not stupid, I know I’m compensating for having lost my prostate to cancer.  But after all this, it feels good to know that at 52 my hair still grows like a weed.

At the end of the day, I feel very fortunate.  I am 100% cancer free.  I don’t consider myself at all unlucky to have prostate cancer fifteen years below the average age.  My youth made surgery an option and enabled me to recover much quicker than average.  I won’t have to worry about prostate maladies when I’m 65.  I’m good.  I’ve been able to advise a couple of men after they read my blog, and several more have thanked me for chronicling my story.  Happy to share.

Fitness & Health

Cialis film-coated tab 5 mgI met with my Urologist today for a post-surgical progress report. My PSA levels are fine. At .3 ng/mL, they could be lower.  It will probably never be zero because of how these tests work. I’ll have these reviewed quarterly for the next two years. I’m good on urinary continence, and of course have started my physical therapy for that. I have three more PT visits over the next two weeks on that topic.

My incisions are also healing well.  In fact, I escaped my prostatectomy without any infections period.  Feeling good about that.  The next focus area is erectile dysfunction.  Sonofagun, if I’m not ahead of the curve in that area too.  I am having erections already.  They have not been sustainable for actual sex, but they are a start.  Dr. Webster offered me a choice of Cialis or the erectile vacuum pump, or both.  I declined the vacuum pump.  I’d rather my kids find my collection of vibrators in the house than that.  I did research the pump online and am just not comfortable with it.  At least, I’d rather try the Cialis first.  Remind me to clear my browser search history.  He gave me a 30-day supply of low-dose, 5 mg samples.

We talked further about my running and his belief that even for my age, Dr. Webster believes I am recovering stronger than his typical patient.  I think the standard idiom is “health & fitness” but I reversed it for my blog title because Dr. Webster made the point that he credits my fitness being largely responsible for my rate of recovery – for my health.  He described how the effect of good blood flow and other healthy body conditions lead to a stronger recovery.  This made me feel pretty good.

He then tempered my enthusiasm to ensure I didn’t push myself too hard.  He suggested I keep my runs at 3 miles for the next month.  That was actually my game plan so we’re on the same page.  I’m not in a hurry to get back into racing shape.  I just want to show progress.  And I have some events I hope to be ready for.  I’m confident I will be without over doing anything.  I expect to report next on how this Cialis works out.

Diagnosis

gloved handThis story begins with the blood work a gentleman is obliged to undertake when he reaches fifty years of age.  I pushed the boundary a tad by waiting until I was fifty-one.  I had been waiting for the general acceptance of a blood test that would replace the dreaded colonoscopy.  About the same time however the efficacy of a promising blood test was brought into question by the medical establishment.  I would soon learn there are far worse “oscopies” to fear.

I visited Dr. Tusek (he has an office in my neighborhood) on August 20th, 2013 for my first blood work, along with my first digital rectal exam.  Another thing I had been hoping to avoid with the advent of some new medical breakthrough.  I now understand the tactile benefits of the finger probe.  The surface of the prostate should be smooth to the touch.  A seasoned doctor can easily feel small bumps which indicate cancer.  I checked out fine and scheduled my colonoscopy.  I completed that procedure, with great results, before returning to Dr. Tusek to review my blood test results.  Drinking the prep solution the day before the colonoscopy truly is the worse component to that experience.  Especially considering they drug you with something that erases your memory of the event.

I walked away from my review of the two dozen or so serum and protein test results thinking my biggest concern was a vitamin D deficiency.  Dr. Tusek’s recommendation for 10,000 IUs seemed excessive considering you can’t buy Vitamin D over the counter in capsules larger than 5000 IUs.  He was also concerned about my PSA results.  I scored a 4.1.  The acceptable range is 0.0 to 4.0.  Dr. Tusek explained to me I could schedule a prostate biopsy, but that such biopsies aren’t trivial and this particular measure of proteins in my blood could be skewed by a long run I did the day before.  I scheduled a do-over for December and didn’t think much of it.  Oh, and my testosterone results were on the high end of the established range.  Booya!

I took the second test on December 20th, and reviewed the results with Dr. Tusek on January 7th, 2014.  This PSA reading was 4.4.  Not only is this higher than my initial score but it indicates an undesirable rate of change – PSA Velocity.  I scheduled a consultative visit with my Urologist for January 10th – Friday of the same week.  Dr. Webster, of Alpine Urology in Longmont, used this session to set my expectations for the biopsy.  Oh, and his nurse collected a urine sample.  You will never leave the office of a bonafide Urologist without also leaving behind a urine sample.  Even if you are only there to pay a bill.  Dr. Webster was thorough, meaning yet another digital rectal exam.  He also completely advised me of the potential side effects to biopsies and why some men don’t risk the procedure.  I scheduled my prostate biopsy for the following week on January 17th.

I’ve written on some of these earlier events in my running blog.  This link will filter those stories under the “medical files” category.  Suffice it to say, the biopsy is not painful, but it is extremely uncomfortable.  I couldn’t run the next day but did snowshoe on Sunday.  The blood in my urine cleared up by the next day.  As far as I know I might still have blood in my semen.  I’m told it takes about twenty ejaculations to fully clear.

I reviewed the biopsy results with Dr. Webster on January 23rd, wherein I learned I have an early-stage, slow-growth cancer.  Of the twelve biopsies, two show carcinoma and two are suspicious.  The two carcinomas are clinical stage T1c which implies early stage, and both have a Gleason score of 6 which indicates slow growth.  Dr. Webster reviewed my treatment options which include active monitoring, radiation and surgery.  Some sort of cryo-freezing procedure is technically an option too but he didn’t support it.

Active monitoring is an option with the Gleason score of 6.  But it would require quarterly digital rectal exams and annual biopsies.  I can’t live like that and did not consider it a viable course of action for myself.  There are two forms of radiation treatment.  They have formal names but I’m not a doctor.  One is internal with beads or seeds.  I’ve also heard the term pellets.  These radioactive seeds are inserted into the cancerous prostate tissue and left there to rot.  The other form of radiation treatment is external and administered with a death ray gun.  This requires five or six weeks of daily therapies.  Like I have that kind of time.  The final option is of course surgery to remove the prostate.  A prostatectomy.

Dr. Webster ended the session by suggesting I seek a second opinion.  He also made it clear, as a surgeon, he advises surgery.  We met again for another consultative visit on February 7th, after I had some time to think about my options.  This did not give me time though for a second opinion so I refrained from making a commitment to surgery.  He retaliated by giving me my 3rd digital rectal exam.  I got in some good questions though to further establish my expectations on post surgery recovery.  I was more knowledgeable after having talked to two others with prostate cancer, along with my father-in-law who is a retired medical doctor.

Talking to others made me considerably more informed.  I spoke to an older friend who had external radiation therapy.  The cancer disappeared for five years and then returned much more aggressive.  He now needs hormone therapy which is essentially chemo.  I learned from him, and also the doctor from whom I eventually get a second opinion, that certain initial treatments can rule out specific subsequent treatments.  I further learned of the experience of another friend, now deceased, who had the internal radiation.  He had good results but died soon after from a heart ailment.  The best discussion was from a total stranger, a friend of a friend, who underwent the prostatectomy.  He is my age and in similar health as a serious recreational, masters class athlete.  He was clearly disappointed that he still has Erectile Dysfunction a full year later – for which he is attending physical therapy.  He was able to return to exercise after three months.  I’m so very grateful to this guy, whom I totally cold-called, for sharing his experience with me.  If anyone has questions for me, this blog takes comments anonymously.

I finally received my second opinion on February 28th, 2014 by Dr. Ronald Rodriguez from the UT Health & Sciences Center in San Antonio, Texas.  I mentioned my father-in-law is a retired endocrinologist.  He suggested this urology oncology center.  I didn’t know what I needed exactly in terms of a second opinion.  I had no reason to doubt my original diagnosis and was fairly comfortable already with my decision to elect surgery.  This is due diligence though. Talking to Dr. Rodriguez was simply amazing.  He gave me so much more information than I’d learned to date from all the online discovery and interviews of previous cancer patients.  He told me of interesting correlations.  Most importantly, he re-evaluated my biopsies.  He ordered them from the lab that performed them – AmeriPath.  He determined one of my suspicious biopsies was in fact another T1c carcinoma with a Gleason score of 6.  And that one of my carcinomas was actually a Gleason score of 7.  Apparently cancer scoring is a subjective art.

Dr. Rodriguez explained how this changes my treatment options.  Active monitoring is no longer an option with Gleason 7.  And I forget why but he advised against external radiation.  Plus he advised against internal radiation suggesting certain techniques would not work well for one of my carcinomas based on its location.  Essentially he confirmed my choice for surgery.  He did downplay the apparent advantages of robotic surgery.  He explained how manual surgery provides a tactile edge over the robotic visual superiority in terms of completely removing hard to reach cancers that are growing into other areas.  In his words, robotics have a higher rate of positive margin.  But robotics lower the bar allowing more surgeons to perform more operations beyond the confines of the larger medical facilities.  He suggested my surgeon should have performed a minimum of 50 robotic surgeries, but also supported my preference to use my Urologist over some hired gun.  The benefit being able to maintain an ongoing dialog with my surgeon since he is also my Urologist.  As I got up to leave he conducted my fourth digital rectal exam, with a hernia inspection for good measure.

I then scheduled my prostatectomy for April 2nd.  I hate to admit this but I took my work schedule into consideration.  I have a project with a key date for deliverables due at the end of March.  My surgery will be proceeded by a cystoscopy (AKA medieval penis torture) on March 21.  Looking forward to that.

Prostate Biopsy

Reblogging this post at this site since it is really part of the story.

A Runner's Story

Michelangelo's David  with clipping path Forgive the title.  I want to be clear up front on the following content.  I held off blogging about this until I talked to my mom to give her a heads up.  Since she reads this blog, I have to be fucking careful about what I write.  A blood analysis last fall indicated an elevated PSA level .  I elected to take a second reading a few months later rather than proceed directly to a prostate biopsy.  Do-overs are standard policy in my book.  Unfortunately the second test didn’t work out in my favor.

In case you’re interested because you expect a prostate biopsy in the future, the following is my experience.  I can tell you this is not some cavalier test.  Without even taking medication, simply having the procedure has potential side effects.  I find the risks acceptable, major inconveniences though for sure.  I can see not every guy…

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