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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 of 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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