Prostate Cancer Journal

Prostate Cancer Journal - 2

From Menletter January 2004

By Tim Baehr

In December of 2003 I was diagnosed with prostate cancer. Routine screening and yearly physicals have probably caught it in time to be completely curable. After much research and thinking, I decided on surgery as the most definitive way to put an end to the cancer and get on with my life. You can read the first part of this journal at http://menletter.org/cancerjournal1.htm.

Disclaimer

I want to paraphrase the disclaimer in the first installment of this journal: My experiences are mine; yours may be quite different. Don't rely on my reports of pain, comfort, hospital experience, etc., as predictions of how things may turn out for you. I will say that in all my research (and there's more stuff in books and Web sites than I could even get to), men have had widely varying experiences with prostate cancer and their treatments. But all of them got through the experience and are happy to be alive and healthier again.

Waiting

Sometime in December I was given the surgery date: Thursday, January 22, at 7:30 a.m. I was to show up for pre-op at 5:30.

Diagnosis: prostate cancer. Procedure: radical prostatectomy, in which the surgeon will remove the prostate gland, seminal vesicles, and lymph nodes while dissecting (separating out) the vascular and nerve bundle (at least on one side) that control erections. The incision will be through the lower abdomen, about four to six inches long. The operation is of some delicacy and should take about three hours. The prostate forms a tunnel for the urethra. Once the prostate has been cut out, the surgeon must reattach the urethra to the bladder with tiny, water-tight stitches.

The aftermath will be a week or two with a catheter draining the bladder while the urethra heals. After the catheter comes out, there will probably be some urine leakage (incontinence) for anywhere from a few weeks to two years. Depending on the success of the nerve-sparing, erections should come back with a little chemical boost from Viagra or one of its successors.

This is all the clinical stuff, and I'm very familiar with it and the statistics surrounding it (5 to 30 percent chance of cancer recurring in five years, 2 percent chance of permanent incontinence, and so on). I know all the technical terms like biochemical failure (if the PSA number rises quickly over a year), metastasis (spreading of cancer to other parts of the body), and so on. My feeling about any of the statistics is that they're not destiny; they're not even predictive. I am one man, one being, waiting to see what part of the statistics I will fall into.

The holidays

Beyond the clinical stuff, I have to get through the holidays. This Christmas and New Year's, my youngest son, almost 18, is home from college, and my stepson, 25, is home on a break from a consulting job in Indianapolis. My wife's Aunt Eva, 94, will be with us for the week after Christmas.

I seem to be OK with the waiting. There are lots of things over the holidays to divert the mind: putting up the tree and lighting it, decorating the house and tree, wrapping presents, cooking, eating, listening to music. Under my company's use-it-or-lose-it vacation policy, I've finagled time off from December 24 through January 4.

The weeks don't exactly fly by, but they flow, smoothly. The holidays are filled with warmth and connectedness. I don't know how much of this has to do with my impending surgery. Both boys have become more mature over the past year. Eva has conquered her fear of traveling. Ann has gained some perspective on balancing the desire for a "perfect" Christmas against the reality that we simply can't do everything.

We celebrate my 60th birthday quietly on the 29th, just family.

The only concrete hint of mortality is the violent stomach bug that Max and I get on New Year's Eve. Max spends the day in the bathroom, worshiping at the porcelain altar; I spend it in bed, having already spent my insides and feeling weak. I check in on Max every half hour or so.

Doubts

Max bounces back and is soon gadding about with his friends again. I find the bug more of an insult and a concern. One fear I have about the cancer and the surgery is that they will leave me feeling old and weak. The stomach bug and the birthday with its big round number give me a physical and psychological taste of this. I pass the beginning days of the new year feeling OK physically but mentally feeling somehow already disabled. A certain sense of vitality is draining from me. I've begun to anticipate the violence that is about to be done to my body.

Doubts have wormed their way into me, boring into my equanimity. What if the diagnosis is wrong? Under what set of circumstances could the PSA tests, biopsy, and MRI be mistaken? Am I really a borderline case that could be treated less aggressively than by surgery? Could there be a conspiracy, or just an eager surgeon's blindness, driving me toward the operating room? Do the medical people really know what they're doing?

I read some more from the books on prostate cancer, one from my doctor and one we ordered on-line. Bad idea to read them at bedtime! For a couple nights, sleep becomes a stranger.

Inside me I know that these doubts are both irrational and natural. I review the facts to dispel them: PSA numbers that were trending upward. A "free" PSA ratio that was too low for comfort. Biopsy results that were rated "moderately aggressive." An MRI that showed cancer spreading to the edge of the prostate on one side.

Somewhere along the way to January 22, I realize that I am taking particular notice of -- and getting pleasure from -- the normal functioning of my plumbing. Taking a leak or waking up with a spontaneous erection are like visiting old friends who are about to go off on sabbatical. We've had many good times together. I hope we'll meet again.

Pre-Admission

On January 16, my wife and I visit the pre-admission test service at Brigham and Women's hospital. The extensive literature that the hospital sent me told me that the appointment would last about three hours and would include blood work, an interview with a nurse-practitioner, and a visit with an anesthesiologist. Before going to the appointment, I had filled out an extensive questionnaire on-line regarding my current medications, smoking and drinking habits, other possible health problems, and concerns about anesthesia. I was curious to find out if anyone would have read my electronic submission before I arrived for my appointment.

Total time at the service: five hours. Total face-time with medical personnel: less than an hour. It turns out that the staff was short-handed because of severe winter weather; in addition, there were many unscheduled "emergent" cases coming through.

We had been there about an hour before I was called. A nurse took my pulse and blood pressure, hooked me up to an EKG, and drew blood for blood tests. Back to the waiting room. We half-watched soaps on the ubiquitous waiting-room TV, talked with each other, read. Time crawled by.

Round two: long interview with a nurse practitioner. Egad, she had actually read my on-line questionnaire. She asked many of the same questions anyway, to confirm. We talked about what the surgery would be like, how long I would be in the hospital (about one or two days too few, thanks to managed care), and so on. We explored room options: the euphemistically named semi-private (two to a room is more like "barely private"), a new urology floor with all singles, and the Pavilion -- a special floor with hotel-like accommodations, a concierge, gourmet food, high tea every afternoon, flat-screen cable TV, Internet hookups, and even extra beds for family members. Some of the Pavilion rooms can be connected into suites. We can imagine this whole floor being cordoned off for occupancy by a VIP patient and his or her bodyguards, press flaks, relatives, and so on. At $250 a night (insurance won't cover it at all), the smallest of the rooms is tempting. I'll probably be either in too much pain or too gorked to appreciate it, but Ann and any other visitors will certainly be more comfortable.

We put in a request for a single in the urology floor. But apparently we'll be able to switch over to the Pavilion at the last minute.

More waiting. Time drags. I ask the desk clerk if maybe I've fallen off the list. By now, we've been there about four hours.

Finally, I'm called for the last time. The anesthesiologist is not the one who will be in the operating room with me. Her job today is to do a rough screening to be sure I can tip my head back far enough to get a breathing tube in, check other aspects of my health to be sure I can tolerate general anesthesia, and allay any fears.

I do have two concerns.

One concern is that there is apparently less bleeding with a local anesthesia, making the surgery easier. The anesthesiologist, who has worked with Dr. Steele, assures me that she's never seen him using anything but general. Also, this hospital has standardized on general; local anesthesia is an option, but not common for this operation.

The other concern is that the tracheal tube may scrape up the back of my throat, causing canker sores (to which I've always been very susceptible). A severe case of canker sores in my throat could seriously compromise my recovery. We discuss options and agree that the tracheal tube will be lubricated and inserted under guidance of fiber optics. The anesthesiologist e-mails scheduling to make sure the fiber-optic equipment will be in the operating room on the day of the surgery.

We're done, just in time to go home and make dinner.

It's less than a week until the surgery.

Next: The surgery and the aftermath, at http://menletter.org/cancerjournal3.htm