Prostate Cancer - Now What?

Prostate Cancer - Now What?

Prostate Cancer - Now What?

I find hope in the darkest of days, and focus in the brightest. I do not judge the universe - Dalai Lama

     
Prostate Cancer - Now What?
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They say it's better to give than to receive...

It all began about three years ago when my doctor referred me to a urologist to look into my excessive need to urinate. Several blood tests, a couple of ultrasounds, and one prostate biopsy later, I was informed that I was the one of the one-in-six men who hit the cancer sweepstakes.   

In my case, the cancer was small and localized in a narrow region in the prostate. My doctor recommended we adopt a treatment called "active surveillance" (also euphemistically known as "watchful waiting"). This was the least intrusive of all possible actions and called for me to have regular blood tests and a yearly biopsy to make sure my disease was not growing or spreading.

So life progressed for the next two and a half years.  My blood tests kept track of the PSA (prostate-specific antigen) in my bloodstream. A rise in PSA can often, but does not always, indicate the presence of cancer. My annual biopsy determined the aggressive nature of the actual cancer cells, as reflected by a number on something called the Gleason scale.

Men with prostate cancer are much like fantasy sports geeks discussing batting averages and power play percentages. They love to sit around and talk numbers and statistics. It's not unusual to hear something like, "Joe's PSA count has dropped to a 6.8 but his Gleason score has gone up a half point." A statement like this is usually accompanied by empathetic head nodding.

I was starting to believe that if I had enough prostate biopsies, I would effectively have my prostate removed piecemeal and never have to go through radical prostatectomy surgery. Unfortunately, a few months ago the numbers changed and my doctor suggested a different course of action. He looked me in the eye and said, "Let's stop farting around and get that sucker out." Or words to that effect.

As I was being wheeled into the operating room, I couldn't help but think about the matter of my mortality. What if I didn't make it? My father had died on an operating table when he was about the same age as I was now.

I tried to assess my options. I asked myself how much time is enough time. Would sticking around another ten, fifteen, maybe twenty years really make that much difference to me or the rest of the world?

There was definitely an up-side to checking out early. For one thing, I would never have to go through (and pay for) all the dental work I had been putting off for over a decade. I would never have to organize my desk or clean out the attic. Equally appealing on the "glass half full" side of dying was the thought that I would never have to miss another ferry because of some stupid trivial technicality.

Another tempting thought was the realization that I would not have to waste another breath of my life waiting for the Toronto Maple Leafs (the glory team of my youth that had now strung out over 40 futile hockey seasons) to compete for another  Stanley Cup. Upon further consideration, however, I realized that I could survive the operation and live still another hundred fruitful years without the chance of ever seeing a Leaf captain hoist the Cup anyway.

As with most choices, there was a down-side to dying. The unbearable possibility of never again seeing my wife and life partner, Jane, pretty much clinched the deal on my sticking around. To a lesser extent, I reflected on how close I was to finally getting my senior's card, and how I really wanted the satisfaction of getting discounted admission rates at the Fritz Cinema and riding the ferries for free (Mondays to Thursdays). Lastly, I felt badly about all the miles I still had left on the warranty on my brand new winter tires. That pretty much put a "nail in the coffin", so to speak, of the death option.

The operation itself went well. My surgeon, Dr. Goldenberg (we like to call him "Goldfinger"), utilized a laparoscopic technique which allowed him to sit a fair distance away from the operating table at a console much like a stainless steel PlayStation3. From this position he was able to pull levers back and forth while watching a monitor relaying images from a tiny camera inserted into my abdomen. His intricately accurate hand motions apparently controlled the several arms of the "da Vinci" robot which hovered over my prone body (picture Star War's R2-D2 with about a dozen scalpel-wielding tentacles). I wonder if he was answering emails and updating his Facebook site at the same time.

Nonetheless, about five hours later I was lying in a mental haze in the Recovery room. I was now "de-prostated". There were seven small bandaged incisions spread out across my abdomen. I was attached on one hand to an IV drip line attached to a bag at top of a metal pole. Another line ran from my drainage catheter to a urine bag positioned near the bottom of the metal pole.

For the next twenty-four hours that metal pole became my best buddy. We were inseparable and did everything together.  In a sense, I had become a one-man watershed ecosystem with my own waste water management treatment plant.

Two days after the surgery Jane and I returned to the Island. We stopped off at the local pharmacy to pick out a large package of diapers that I would use to control my residual "leakage". It was difficult to make the choice between Huggies and Pampers, but in the end we settled on the more adult oriented "Deep Ends". (Note to adult diaper manufacturers: there's a fortune to be made from diapers with the Canucks logo or the 2010 Winter Olympics symbol stamped across their bottoms.)

There has never been much pain involved with the entire experience. All the medical professionals instructed me that I had a better chance of getting back full control of my bladder if I practiced something called Kegel exercises. Women have been doing these for eons to help them with childbirth and its subsequent after effects.

For a man, a Kegel exercise consists basically of moving your testicles on the south end in a straight line through your midsection towards your Adam's apple on the north side until they touch. Fifty of these at a time is a good start.

Nobody asked me, but I'm delighted I made the choice to stick around on this planet for at least a little while longer. Now about that desk that needs organizing ...

Initially published January 6, 2010 in Gulf Islands Driftwood, Salt Spring Island, BC, Canada. Photo by Dylan Walters


Shilo Zylbergold lives on a small island somewhere in the southwest corner of British Columbia, Canada. He grows vegetables, teaches math, and is a columnist for a local paper. Send complaints to [email protected]

Shilo Zylbergold

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