When I got the word that I had prostate cancer, making me one of the 186,000 American men who are projected to be diagnosed with the disease this year, the urologist gave me one of those bad news-good news lines.
“The bad news is that you have cancer,” he said, “but the good news is that you have options.”
Options, I thought. In my terrified state, I began to feel like the hapless gas station owner in the movie “No Country for Old Men.” There’s a scene where Javier Bardem, in his Oscar-winning portrayal of the killer, comes up to the gas station counter, pulls out a quarter, and, as he flips the coin, says to the owner in a very menacing voice, “Call it.” You quickly understand that the wrong call could be the owner’s last call. And now, it was my turn to “call it.”
My urologist recommended surgery, noting that he and his fellow urologists are trained as surgeons and have a certain bias toward that option. He told me about the other options, including radiation therapy; cryotherapy — freezing the prostate; brachytherapy — implanting radioactive “seeds” in the prostate; and hormone therapy to slow the growth of the cancer.
Tackling cancer like a reporterAnd so I began doing my homework, trying to figure out the best treatment for me. I talked to several doctors and spent hours researching the subject on the Internet. I began to learn about the side effects, the percentages of men who become incontinent or impotent after being treated for prostate cancer.
I also started talking to prostate cancer survivors, among them, a former Polaroid Corporation executive named Bob Marckini. He wrote a book called “You Can Beat Prostate Cancer” that has become a hit on Amazon.com. Because of that, Marckini says he fields about 100 e-mails a day from guys like me.
“What’s the most common question?” I asked him.
“Is this a death sentence?” he replied. “What is my chance of being cured? Will I be impotent? Will I lose bladder control?”
He asked me about the details of my case and I told him they’d caught the cancer early. My primary care physician had detected it during a routine physical that included a PSA test. (PSA stands for prostate specific antigen, an indication of tumor activity. It’s a simple blood test.)
My PSA score was 4.8 and it had jumped from its previous level of 2.8. Doctors are now saying anything over 2.5 bears watching and that a change like mine is a major red flag. My doctor sent me to the urologist for a biopsy, and that revealed the cancer.
It was then that I learned about another number, the Gleason score, a rating of the aggressiveness of the tumor. It was a 7, putting it at the high end of moderately aggressive. Fortunately, in my case, both the doctors and Bob Marckini said my prognosis was pretty good.
“George, you’re going to die some day,” Marckini said. “But probably not from prostate cancer.”
He was treated at the Loma Linda University Medical Center in Southern California, one of a handful of hospitals in this country that offers proton beam therapy for prostate cancer. He wrote glowingly in his book about Loma Linda, but encouraged me to speak to prostate cancer survivors who had undergone other forms of treatment at other places.
I started acting as if this were a news assignment, interviewing cancer survivors and seeking out contrasting points of view. And I kept thinking about that scene in the movie:
Ultimately, I decided I’d go for outpatient proton therapy at Loma Linda. The doctors there explained that they feel protons are superior to conventional radiation because the positively charged particles can be channeled to deposit the bulk of their energy right on the tumor.
“It helps to protect the healthy tissues more so than standard radiation does,” said Dr. David Bush, who became my doctor at Loma Linda. (No, he’s not related to George W.)
If you’re a guy worried about your male components, limiting “collateral damage” is an important consideration, a major selling point for the advocates of proton therapy. Unfortunately, Loma Linda and the other proton treatment centers now have growing waiting lists. (It took me four months from the time I applied for a consultation until I was accepted as a patient.) For patients who don’t want to wait to get rid of their prostate cancer, that could tilt the decision to other forms of treatment.
There is a lively debate in radiation medicine circles about whether standard radiotherapy for prostate cancer has caught up to proton therapy in terms of precision targeting and whether the added cost of proton treatment is justified. But, beyond the questions of technology, the thing that persuaded me to go to Loma Linda was the nurturing atmosphere there.
‘I’m going to live until I die’The medical center’s mission statement is “to make man whole,” a philosophy derived from the religious beliefs of the Seventh-day Adventists who run the place. There’s a culture here of caring and compassion — staff members here all call patients by name, not treating them with the indifference that sadly permeates many hospitals.
I never imagined I’d be in a room full of fellow cancer patients, laughing our heads off, but that’s what I found at the weekly support group meetings run by Lynn Martell, an ordained minister who acts as patient counselor and has an endless supply of corny jokes. He himself is battling a rare form of lymphoma and serves as a role model for the patients.
“I’m going to live until I die,” he said at one of the meetings. “And I’m going to do what I’m telling everybody else to do, to enjoy life to the fullest.”
He encouraged me and the other patients to exercise regularly, explaining that one of the side effects of the therapy can be fatigue and that physical activity can counteract that. Loma Linda offers patients free memberships to the state-of-the-art fitness center on campus, so I began hitting the gym four or so times a week.
I also started going up and down the steps that run from the bottom to the top of Santa Monica Canyon, where I live, and I even enrolled in water aerobics classes. I got so immersed in the activities at Loma Linda that I ended up spending four nights a week at a nearby hotel, commuting home on Fridays and returning on Mondays.
At Loma Linda, they joke about taking a “radiation vacation,” and indeed, many of my fellow patients took advantage of their time there to go golfing, cycling and sightseeing. This was especially true of the guys who came from places where the sun doesn’t shine as often as it does in Southern California.
In the end, I sailed through my 9 ½ weeks of proton therapy with few side effects, other than an occasional burning sensation when I had to urinate, something that went away after the treatments ended. Today, I feel great and my 40” waistline is shrinking as I work on eating less and exercising more.
A new look on lifeSo, what have I learned from this experience? The first piece of advice I’d give to guys over 45 is to get their prostate glands checked annually. That includes the PSA blood test and a digital rectal exam, where the doctor feels for lumps on the prostate. This is no time for false modesty. Early detection can keep you from dying.
If you’re diagnosed with prostate cancer, remember that no two cases are identical and that you need to do your own research, talking to people versed in the various forms of treatment that are out there. That includes physicians and prostate cancer survivors. (We’ve included a list of useful Web links to the right.)
It sounds trite, but I emerged from my treatment with a whole new outlook on life. I am blessed with the love of a wonderful woman, Cecilia Alvear, a breast cancer survivor who has been cancer-free for the past 14 years. I’m hoping to follow her example as I await my first follow-up test in October. Whenever my morale flagged during this whole journey, she was always there to prop me up in a calm, levelheaded fashion.
I’m also blessed with two lovely daughters, Sarah and Katie, both engaged to be married. I will be there to walk both of them down the aisle, and someday, God willing, I’ll be granddad to their kids.
On my last day of treatment, the affable crew that ran my proton gantry had me write D-O-N-E in Magic Marker on the polyurethane liner of the custom-fitted pod that held me immobile while my cancer was being zapped. I’m now free to write something else: the next chapter of my life.