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One farmer's experience with prostate cancer

Agriculture.com Staff 01/26/2006 @ 12:05pm

Like many farmers, I have to be dragged almost semi-conscious before I'll go "see a doctor. "

My wife Jill gently reminded me for more than five years that I had promised to get a physical exam. My denial: "I'm never sick."

When I finally did get a physical exam in April 2005 at age 69, the PSA test came back a shocking 24.4 nanograms per liter -- six times the upper boundary for a normal prostate. A local urologist performed a needle biopsy, snagging 16 tissue cores from my prostate. His verdict: "You have prostate cancer."

Compounding that, my prostate gland had swelled to more than twice normal size -- 53 cubic centimeters -- with 40% of that volume composed of cancer nodules. The only relieving news: The cancer was a slow-growing type, rated at a 6 on the Gleason scale, not a more aggressive 7 or 8.

The urologist said this late T2 stage case was "not a candidate for a radical prostatectomy" because cancer cells had probably spread to nearby tissue a few millimeters outside the prostate capsule. He recommended hormones and radiation to "manage" my cancer. He did not say "cure."

My wife Jill and I launched two months of intensive library and Internet research into prostate cancer and alternative treatments, filling two file drawers with data. We ordered books, and spent $300 for the 466-page "Moss Report on Prostate Cancer," a compilation of almost every known treatment for the affliction.

I learned that you can surgically remove the prostate, ream it out, freeze it, fry it with ultrasound, radiate it with external beam electron radiation or internal radioactive seeds, and deprive it of testosterone with drugs like Lupron and Viadur. Then there are dozens of "alternative" treatments, none with established track records.

I consulted two additional urologists, including one at Mayo Clinic in Rochester. Both recommended Lupron for at least four months "to shrink the gland 30%" and then external beam radiation. "You might be on Lupron the rest of your life," cautioned one of these urologists.

The urologists chuckled at the "side effects" of hormone therapy. "You'll have hot flashes, but don't expect sympathy from your wife." But as we studied the long-term impacts of testosterone blockers, we resolved to avoid hormone treatment.

At first, proton radiation at Loma Linda in California looked promising. But we could find no convincing data on outcomes of that therapy.

That narrowed our choices to two:

High-intensity focused ultrasound (HIFU), which virtually cooks all prostate cells in a two-hour treatment. This isn't allowed in the U.S., but is available in Canada, Mexico and most of Europe. The $23,000 cost wouldn't be covered by insurance. The HIFU physicians at Toronto in Canada and Cancun in Mexico were very supportive, but both advised me that my prostate gland was too large for the focal length of their instrument. That left the second option.

Implanting with radioactive seeds, then applying simultaneous, precise Intensity Modulated Radiation Therapy at the Radiotheraphy Clinics of Georgia (RCOG), founded by Dr. Frank Critz. The Mayo Clinic urologist had cautioned me: "Dr. Critz stirs up a lot of controversy in the profession. He's not in the mainstream."

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