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One farmer's experience with prostate cancer
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."
Dr. Critz sounded like the kind of independent-thinking physician I had been searching for. I sent all my medical records to RCOG, and within days Dr. Critz himself phoned me: "I've studied your pathology report, CT scan and all other records. We've had excellent outcomes with even more difficult cases than yours."
We studied data on the RCOG website (www.prostrcision.com) and visited with several of this clinic's previous patients. By early July, Jill and I concluded that treatment at RCOG offered the best statistical prospects for cure -- with the fewest potential complications.
Every aspect of my treatment there, from seed implant July 28, to 35 linear beam treatments completed October 11 has confirmed that decision. Three months after the implant, my PSA had plunged from 24 to 10.4. Six months later in January 2006, it dropped again by half, to 5. As it does for every patient. RCOG will track my PSA every six months until I'm in Heaven and out of their range. With this trend, I expect that the PSA indicator of cancer's presence will drop to 0.2 nanograms per liter in about 18 months. That's the declining curve established by thousands of other treated men.
RCOG's most recent "cure rate" data shows that over almost 9,000 cases treated with seed implant and precision radiation in the past 25 years, 81% have a PSA of 0.2 or less after 10 years. That's the same "cancer-free" standard used to judge the success of radical prostatectomy.
RCOG has given the name "ProstRcision" to their unique combination of implanting Iodine-125 radioactive seeds followed with precision external irradiation starting two to three weeks after the implant -- while the internal seeds are active. Here are the benefits I experienced at the clinic:
The transperineal implant is minor outpatient surgery, using needles and ultrasound imagery for guidance. Most men leave the hospital after recovering from light anesthesia. The following day, they check in at the RCOG clinic for removal of the catheter they've worn overnight. Typically their main discomfort is having to keep the catheter overnight.
The implanted seeds, including gold marker seeds, provide precision markers for focusing of linear beam irradiation. They can be seen on simple X-rays and more comprehensive CT scans. Specialized computer programs create a three-dimensional model of each man’s prostate. This program masks the Intensity Modulated Radiation Therapy (IMRT) beam so it focuses within a few millimeters of the tissue intended for treatment. This spares rectal tissue and other non-target organs. Seeds are placed at least five millimeters from the urethra, which passes through the prostate gland. Cells impacted by both internal and external radiation are disrupted the most. Over several months, the inability of cells to reproduce leads to gradual fading away of the prostate gland and seminal vesicles. Fortunately, most nerves well outside the prostate are spared, so about 70% of men maintain their pre-treatment erectile capability. The urinary restriction typical of prostate cases gradually fades over a few months. You can virtually compare your progress with the charts established by nearly 9,000 men treated at RCOG over 25 years.
The atmosphere of the staff and patients was upbeat and enthusiastic at the Decatur RCOG clinic where I was treated. Radiology therapists are cheerful, almost affectionate, with the dozens of men they treat daily. It was the first time I've ever gotten a goodbye hug from a nurse, plus an invitation, "Y'all come back to the annual reunion, heah? I'll be disappointed if I don't see you." The waiting room is more like a mens' club, where the guys share their clinical stories. Few men I talked with had any really bothersome side effects from treatments.
Patients benefit from a wide array of supportive activities. RCOG's main clinic in Decatur has a separate building dedicated to patient education, including regular lectures by the doctors and an excellent nutritionist, Brodie Haddock. RCOG recognizes the importance of nutrition, and Jill and I are following a primarily plant-based diet of whole, fresh foods to further reduce odds of recurrence. We've learned that diet (especially animal protein) is an important factor in eight out of ten cases of cancer. I especially recommend the book, The China Study, by T. Colin Campbell and his son, Thomas M. Campbell II.
Also at RCOG, patients are encouraged to enjoy social get-togethers organized by former patients such as Margaret and Bill Frisbee and Eleanor Barnett. In effect, the clinic's patients are their "mission field."
The clinic also has a full-time professional, Anita Luebben, who facilitates a prostate support group and helps patients with individual issues like insurance and housing. Patients are encouraged to make new friends and participate in regular tours of the Atlanta area. The friendships are so enduring that hundreds of patients return every year for an annual reunion. The 2005 reunion included a reception at the home of Dr. Critz.
RCOG was also instrumental in providing an excellent, free place to stay nearby in Atlanta for men and their spouses with limited financial resources for the six or seven week stay in Atlanta during external beam irradiation. Men come to RCOG from all U.S. states and 40 countries around the world. Naturally, many are from Georgia, so RCOG has established several satellite clinics throughout the state so more patients can drive from home daily for the 30 or 35 external beam treatments.
Dr. Critz told me I was one of the "toughest 5%" of the seed implant cases he has dealt with. The cancer nodules had distorted the gland, pushing the urethra off to one side. I needed 118 seeds, which are about the size of those little sugar sprinkles you use to decorate cupcakes. When I told Dr. Critz that my local urologists had recommended Lupron and external radiation, Dr. Critz told me, "You'd have been better off doing nothing than take that course. I've never seen a case like yours cured by external radiation alone." RCOG does not recommend testosterone blockers. If men come to the clinic with previous hormone use, RCOG has found that these men don't have higher cancer cure rates -- but they do have an increase in negative side effects.
Since returning home from RCOG, my energy level is rising. I've had minimal follow-on symptoms. Even the minor urinary restriction from my biggie-sized gland is gradually receding. I've been pushing up terraces with the bulldozer, cutting firewood and cleaning up behind the barn, finally.
Jill and I have been blessed. And we've already been able to share our experience with four other men just diagnosed with prostate cancer. Our prayers are with those guys, and for any man and his wife who face such a need for treatment.
Other installments in the series on prostate cancer:
Like many farmers, I have to be dragged almost semi-conscious before I'll go "see a doctor. "