New Medical

I attended another meeting of my prostate cancer support group early in January 2001. At this meeting five men who had undergone different therapeutic procedures shared their experiences with us.

The presentations, which provoked many questions from the rest of the group, were uniformly straightforward and candid. A good deal of practical, personal information was passed on and the men who spoke seemed to energize the group and free it from the insularity I had noted in earlier meetings.

There was a good deal of cross talk following each presentation. Several men made outrageous puns about lingering incontinence, and there was a general sense of brotherhood throughout the room. My impression was that everyone in the group had confronted the same demon, negotiated a truce with it and moved on with life. Everyone, that is, except for two men who recently had been diagnosed with prostate cancer but had not yet chosen their therapies. Needless to say, these two men followed the dialogue in the room with sharply focused attention.

We heard first from James and Joseph, both about 60 years old. who had been treated with a combination of hormone therapy and radiation.

James recorded a PSA of 20 and was diagnosed with prostate cancer after a needle biopsy. His tumor was assigned a Gleason score of 5. He received initial hormone therapy with two drugs, Lupron and Casidex, to halt the growth of the tumor and help shrink his enlarged prostate. Next, James underwent a course of external beam radiation followed by a radioactive seed implant. While he noticed some fatigue and loss of muscle mass during the hormone therapy, James tolerated the radiation and seed implant quite well, reporting only minor problems with incontinence, which quickly went away. Today, some six months after his treatment, James has a PSA of less than 2.0 and has returned to his normal routines.

Joseph was diagnosed with prostate cancer following a PSA test result of 7.9. His tumor was assigned a Gleason Score of 8.0 and he also chose a combined course of hormone therapy, external beam radiation and radioactive seed implant. Joseph experienced moderate fatigue during the hormone therapy and radiation treatment and has experienced frequent and uncomfortable nighttime urination in the seven months since his seed implant.

To alleviate his discomfort, Joseph's doctors prescribed two medications. As Joseph wryly noted, "the first pill made me urinate orange, the second one makes me urinate blue. I'm waiting for the day when I get back to plain old yellow."

Paul and Robert, both 59 years old, chose surgery - radical prostatectomy - to deal with their cancers. As both men put it: "I just wanted to get rid of it, once I knew I had it."

In 1995, Paul had a PSA of 4.3, but a biopsy was negative for cancer. He entered a period of watchful waiting, which culminated in 1999 when his PSA rose suddenly to 11. His tumor was assigned a Gleason score of 6.0 and he had surgery 90 days ago. He experienced some swelling of his scrotum and penis following surgery, but this disappeared after a week. He wore a catheter for several weeks, but resumed normal activity quickly following surgery. Paul enjoys exercise and he walks about four miles, five to six days each week. He resumed this regimen while wearing the catheter and found the device only "mildly annoying" during his walks. He took mild painkillers for a week (Tylenol) to deal with the discomfort of the catheter, but soon found ways to accommodate it. He has learned to manage the mild incontinence that still remains with him, but has otherwise resumed his normal life. His PSA is .04.

Robert discovered his cancer during a routine processing- out physical examination at the time of his retirement from the federal government. A PSA test administered during that examination showed Robert's PSA at 5.8. A subsequent biopsy and pathology report assigned a Gleason score of 7 to his tumor. Robert had his surgery in May 2000 and was discharged from the hospital six days later. He wore a catheter briefly and found it uncomfortable and sometimes painful - particularly when resting on his back as he slept. Robert found that his reclining chair helped alleviate the pain and discomfort of the catheter and he found that by using the chair in place of his bed, he could get a good night's sleep, free of pain. Interestingly, pathology studies of his tumor following surgery caused his doctors to downgrade the Gleason score of his cancer from 7 to 5. Today, Robert's PSA is .03. He still struggles to manage his lingering incontinence but said that he is doing much better now than during the months immediately following his surgery.