Monday, March 02, 2009

A Cancer Success Story

I don’t know how many of my readers will be interested in the following story about cancer survival, but perhaps it helps to explain why I am not completely distraught about the huge shrinkage in my savings due to the stock market crash. I am distraught and angry, but not losing sleep over it; plus this story is not the only time that I have learned and relearned that you, yourself, often have to plunge in and do the work required to solve a problem – no matter how technical it may be.

A Cancer Success Story

In 1985, during a routine physical exam, my family doctor found a lump on my prostate, causing him to send me to an urologist for follow-up. The urologist began giving me periodic PSA tests and monitoring the results. He also prescribed Proscar because I was also starting to suffer from the symptoms of BPH (enlarged prostate) that causes frequent urination. The urologist mentioned that the Proscar was thought to give some protection for prostate cancer, which, apparently, did not work for me.

By 1987 my PSA readings had increased to the point where my urologist decided that a biopsy was in order. At that time, prostate biopsies were conducted with a single needle under anesthesia. My initial single-needle biopsy and another one a year later proved to be negative, but in 1995 my urologist informed me that there was a new, multiple-needle biopsy procedure that was done without anesthesia – and was much more likely to pick up evidence of cancerous cells. I had this biopsy (it hurt a lot; I could have used the anesthesia), and it revealed the presence of prostate cancer.

Years before I had made a vow that if anything serious or life-threatening ever happened to me I would head for the Lahey Clinic in Burlington, Massachusetts. That’s what I did when I learned I had a ruptured disk in my back in 1984. I checked myself out of the hospital where I was and went to Lahey – with great results, so again I headed for Lahey.

I made an appointment there and came under the care of one of their urologic surgeons who told me that there were three procedures for treating prostate cancer: 1. radical prostatectomy (RP, surgical removal of the entire gland), 2. external beam radiation, and 3. the implantation of radioactive seeds. He further advised me that RP is, by far, the recommended treatment, that my prostate was too large for seed implantation, and that external beam radiation carried a risk of harm to surrounding tissue and organs. Even though RP is a rather horrendous surgery with severe side effects (incontinence and/or impotence), I was told that RP had the most extensive data to support favorable treatment outcomes, and I immediately decided on RP. The operation was scheduled for mid-December, 1995.

Besides their excellence, one of the reasons I like the Lahey Clinic is that they have everything there on campus. If your doctor decides you need a test or an MRI, for example, it can usually be done and analyzed within an hour or two. My surgeon required several tests, including a bone scan, which was one of the tests that could not be done immediately, and which was scheduled for a couple of days before my surgery. I had the bone scan on Friday, administered my last final examination to my students on Saturday morning, corrected the exams over the rest of that weekend, and turned in my grades Monday morning (recuperation from RP can take some time). That afternoon I went back to Lahey to learn the results of the bone scan.

As soon as I saw my surgeon I could tell something was wrong. He had adopted an impersonal style I had not seen before, and he told me that the bone scan had “lighted up my left hip”. His conclusion was that the tumor had spread, and he could not any longer perform the RP surgery. He told me then that I had five years to live, and that was true only if I immediately began a course of chemotherapy treatment. The treatment involved the insertion under my skin once a month at the Lahey Clinic of a capsule containing hormones. I arranged to begin the treatment right away.

My surgeon also informed me that not everyone on the staff at Lahey agreed with his conclusion that the results of the bone scan indicated that the cancer had spread – that orthopedic surgeons thought it meant something else, and if I wished to talk to them, he would arrange it. Of course I wanted to talk to them, and a meeting was arranged later that day.

The orthopedic surgeon I spoke with told me that, in his opinion, the bone scan revealed that I had a dead blood vessel (arterial necrosis) in my hip, not the spread of prostate cancer. Unfortunately there was no way to confirm his diagnosis, because a biopsy would destroy my hip, and my urologic surgeon’s opinion was the only one that would prevail under the circumstances.

I then began my mid-winter break by returning to Stonehill and researching the internet for everything I could learn about prostate cancer and about arterial necrosis. This was before the World Wide Web and browsers were generally available, so my research was a little harder to perform than it would be today. I learned three very important things: 1. there were two widely differing schools of thought as to the correct way to perform RP, 2. the results of radioactive seed implants were comparable with RP, although the available data covered a much shorter period of time (RP has much more severe side effects than the seed implants), and 3. there was a doctor associated with Beth Israel Hospital in Boston who was considered one of the world’s leading experts in arterial necrosis. I called his office, and arranged to see him, bringing with me the test results, including the bone scan, from Lahey.

This doctor examined my bone scan and told me two things: 1. the orthopedic surgeon at Lahey was not aware that there had just become available ultra-thin needles (that he had developed) that could do the procedure without harming my hip, and 2. it was irrelevant anyway because he could tell from the bone scan that my condition was not cancer, but unquestionably was a case of arterial necrosis, and he would write a letter to my surgeon so stating.

I returned to Lahey with this letter and presented it to my surgeon, who told me the following: he could not accept the letter and perform the surgery, but that he would schedule another bone scan in April (a four month interval). If the second scan showed no change in the object in my hip, he would change his mind about what it was and operate because, if it was a tumor, it would noticeably grow in four months.

In April the bone scan showed no change, and my surgeon wanted to operate, however, in the interim I had learned that the chemotherapy course I was on had a side effect of shrinking the prostate, as well as the fact that radioactive seed implants had a comparable record of success to RP. I asked to be re-evaluated for seed implant treatment. The oncologist who performed this treatment re-measured my prostate and said I now qualified for it. I decided that this was the option I wanted. The treatment was scheduled for June, because the oncologist wanted me to continue the chemotherapy two more months before the procedure was performed.

In June, 1996 the procedure was performed. Each year since then I have returned in the summer to the Lahey Clinic for a PSA test and a follow-up examination. As of this writing (2009), no evidence of the cancer’s return has been detected.

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