Dr. Val FarmerDr.Val
Rural Mental Health & Family Relationships

Dr. Farmer Shares His Experience With Prostate Cancer

July 29, 2005

(This article was written in June of 1997 as I was recovering from prostate cancer surgery. Eight years later I am happy to report I am cancer free. The information on PSA exams and insurance may be dated.)

I recently had an encounter with strangers wielding sharp knives and I was glad for it. Here is what happened.

The urologist was suspicious. He had detected something during a routine digital rectal examination (DRE). He ordered a prostatic specific antigen test (PSA), which is a cancer screening test from a blood sample โ€“ and scheduled an ultrasound and biopsy of the prostate gland.

The PSA was normal. I later found out this state-of- the-art test for detection of prostate cancer still misses about 20 percent of the cancer cases. A combination of yearly PSA and a DRE are both necessary components for early detection of prostate cancer .

With appropriate dread I went through with the ultrasound and biopsy. I will spare you the unpleasant details other than to say it is very personal and invasive - a DRE in spades.

The doctor called with the results - "inconclusive" - the biopsy was being sent to Mayo Clinic in Rochester, Minn. Now this was getting a little dicey. It started to dawn on me, I might really have cancer.

Then came a phone call at work. My test was positive. I was scheduled to have a bone scan and then my wife and I were to meet with the doctor to discuss treatment options.

With that phone call, my and my wife's world was turned upside down. There were wrenching days and nights of personal soul searching and emotional turmoil. Some priorities faded in importance and others loomed to the surface.

One of those priorities was gaining a quick education about prostate cancer and the treatment options. Surgery, radiation and radiation seed implants, chemotherapy or do nothing and monitor the growth of the disease.

The do-nothing approach has to do with the idea that prostate cancer in older men in their 70s and 80s may be slow growing and not interfere with normal life expectancy or quality of life.

Cancers graded two through five are considered slow growing. Grades six and seven are considered moderate and grades eight and nine are fast growing.

My "young" age and the aggressiveness of the cancer - Gleason grade six - suggested that doing nothing could result an early and painful death.

Next comes the bone scan. If cancer is outside of the prostate, then surgery is out of the question and the prognosis becomes much more guarded and sinister. Because of difficulties, the radiology technicians had to repeat some procedures and then called in another person who ordered an additional view. All this was nerve wracking and led to some more sleepless nights before we were able to hear from the doctor with the results.

The bone scan was negative. Sighs of relief came from our souls. Next we discussed surgery and radiation options. This is a debatable area of medicine and our doctor suggested we take the time to investigate both before we made a decision.

We did so, and in our case, we opted for the surgery because of my age and the grade of cancer,

Who will be the surgeon? Both the Mayo Clinic and the surgeon we ultimately chose were highly complimentary of the urologist and pathologist who found a very elusive cancer.

We sought out a surgeon based on a โ€˜word of mouth " recommendation. We met with him, felt comfortable with him and scheduled a radical pubic prostatectomy.

My hospital stay was a remarkably short two and a half days. This was followed by 10 days of recuperation and bed rest.

The surgeon did his job and I am doing mine in recovery. Surgery results indicated that all of of the cancer was contained within the prostate that had been removed. I now have an 85 to 90 percent chance of remaining cancer free. Regular PSA exams over the next five years will determine if I am truly free of cancer.

Why am I telling you this story? An estimated 334,500 American men will learn they have prostate cancer this year and 41,800 will die from it. Early detection is a life and death issue.

Men in your 50s, go in for your annual physical! I am as squeamish as the next man about rectal exams. I got lucky. Pay special attention to prostate cancer. It is real. It is a silent killer that doesn't present many symptoms. When the symptoms appear, it may be dangerously late.

A colleague of mine asked for a PSA during his annual visit. He was told that his insurance wouldn't cover it. He had to argue to get the test ordered and he was willing to pay for it. We both wondered if the dictates of managed care medicine will negate the medical breakthroughs that can now save lives.

I am grateful for a careful and thorough urologist who was able to detect an early prostate cancer and for the miracles of modern medicine that followed. I had a brother-in-law die an extremely painful and preventable death because of late detection of prostate cancer.

This column doesn't pretend to talk about the pain and struggle couples go through a prostate cancer discovered late. That is someone else's story to tell.