In May 1994, I learned the value of PSA testing from a Scientific American article  and from conversations with friends; and at age 56 I was diagnosed with Prostate Cancer. PSA 9.5, Gleason 7, post-biopsy staging B2. CAT and bone scans were clean then, as was an MRI a year later. The most realistic estimate, accounting for habitual understaging, that the tumor was organ-confined was 70%. I was confident of this estimate.
I accepted all of the following as options for therapy.
I rejected all of the following as therapy options for the reasons given.
I elected combined hormonal therapy for a finite period -- option 3 -- to begin in September 1994 and to proceed until some indefinite date in the future (it turned out to be August 1995). All three urologists with whom I was speaking went along with this choice, none enthusiastically. My reasoning was that Combined Hormonal Therapy could do no harm (it would halt the tumor's progress); and that it could help (it might shrink the tumor).
In August 1995, I underwent a radical retropubic Prostatectomy.
CHT SIDE EFFECTS
The obvious side effects of Combined Hormonal Therapy were these:
Almost immediately after beginning CHT, my PSA fell to 0.2 or below and stayed there. A digital rectal exam in early 1995 revealed that the tumor seemed no longer palpable and that the gland was smaller than before. With respect to PSA values, one can believe that "PSA becomes an unreliable indicator of disease status after initiating preoperative androgen deprivation therapy." ; .
After the RP (Radical Prostatectomy), the surgeon confirmed that the gland was very small indeed; and that this had helped to make it easy to save one sphincter, more of the urethra than expected, and the nerves on one side. He could feel the tumor on removing the gland, but thought that the margins would be negative.
The pathologist reported that the gland had atrophied; that no tumor was evident in the gland; and that the margins were negative.
VERBATIM PATHOLOGY REPORT
A,B,C,D. RIGHT AND LEFT LYMPH NODES: LYMPH NODES NEGATIVE FOR TUMOR.
E. PROSTATE: PROSTATE ATROPHY CONSISTENT WITH ESTROGEN THERAPY. NO RESIDUAL TUMOR SEEN.
*** Signed Copy on File ***
[first pathologist's name]
Clinical History: Prostate CA
Intra-Operative Consultation: No Tumor seen in left and right nodes.
[second pathologist's name]
Gross Description: Received in formalin in five parts.
Specimen A labeled "right nodes nfs" consists of multiple yellow-tan adipose tissue measuring 5.5 x 4.5 x 3.5 cm. in aggregate and serially dissected to reveal multiple lymph nodes. Entirely submitted in A1-2.
Specimen B labeled "right nodes fs" consists of three irregular yellow-tan rubbery tissue fragments measuring 2.1 x 1.9 x 1.1 cm. in aggregate. Entirely submitted in B1.
Specimen C labeled "left nodes fs" consists of three yellow- tan irregular rubbery tissue fragments measuring 2.5 x 2.1 x 0.9 cm. in aggregate. Entirely submitted in C1.
Specimen D labeled "left node nfs" consists of multiple irregular yellow-tan adipose tissue measuring 3.5 x 3.1 x 2.1 cm. in aggregate. The specimen is serially dissected to reveal multiple lymph nodes entirely submitted in D1-2.
Specimen E labeled "prostate" consists of one previously inked and cut prostate measuring 4.1 x 3.7 x 1.9 cm. and weighing 12 grams. The right side of the prostate has been previously inked in red and the left side has been inked in green. The specimen is serially sectioned to reveal multiple white-gray ill demarcated nodules in the left and right lobes with the largest measuring 1.1 cm. in diameter. The right seminal vesicle measures 2.1 x 1.1 x 0.9 cm. The left side measures 2.4 x 1.1 x 0.8 cm. Section codes; E1, apex resection margin; E2, bladder neck resection margin; E3-7, right lobe of prostate; E8-13, left lobe of prostate, entirely submitted.
The biggest conclusion, and the most surprising, is that, given the hindsight provided by the pathology report, perhaps no operation was necessary as shown by the state of the gland. However, I would not have been comfortable without some kind of mechanical intervention, even had I known about the state of the gland. I would probably have chosen the RP regardless even of knowledge certain about the tumor.
So, for me in this particular set of circumstances, a year of CHT helped to:
LONG-TERM PSA LEVELS, EVENTS, MORBIDITIES, AND OTHER EFFECTS
|PSA Levels at Months After RP|
Events, Morbidities, and Other Effects
I was nearly 58 at RP time and reasonably healthy, though far from fit. They make you walk the day after the RP. I walked all I could -- 3 or 4 times a day. That really helped, I think. Very important for me. So I was comfortable walking when I was discharged. I was driving some two weeks after the RP; the doc said it was OK to drive three weeks after the RP.
I work for myself so really had to work. But I didn't want to go to work with an embedded catheter; I waited the nearly three weeks (postRP) for the catheter to come out. I thought I could go back to work then.
It wasn't so. I actually did show up at work, but couldn't do much. I really hadn't the stamina to do anything. And I couldn't stay awake (well, no surprises here). The incontinence didn't bother me (pads took care of that) and my gut was pretty comfortable (I wore sweatpants to the office). But I just couldn't get and keep going. It really was eight weeks before I was anywhere near normal, and I felt the effects of the RP (diminishingly) for six months. I had to sleep 10 or 12 hours each day. It was a bitch.
I do not know what I could have done to change things. There might be something one can do to restore his stamina quickly, but I've no idea what. Long-Term Effects