1. A trusting partnership between doctor and patient that facilitates informed consent is a goal for many proactive patients. Such a partnership requires an understanding of all the factors that lead to a treatment recommendation. In light of the precious little in the way of guidance from clinical trials with respect to best empiric treatment, which is based on medical journal articles, epidemiology and economics, physician's decisions need to be based on personal experience, clinical insights, and medical training.

Posted at 12:13PM on Jun 7th 2007 by Gregory D. Pawelski

2. Discovering I had prostate cancer at the age of 47 was almost an accident and certainly not something that in any way I expected. I had no symptoms - none whatsoever. In layman's terms, everything seemed to work fine. So the discovery of prostate cancer was quite accidental. It seems I had gone to my doctor simply requesting a pill (propecia - a drug to reduce hair loss). She required I have a blood test, as this drug would have an effect on my PSA. Frankly, all that was greek to me...as I didn't know what PSA was and had never had it checked. I hated needles - had always said I was allergic to them - hence I avoided being stuck as much as I could. But on this day in November 2004 I decided to take the plunge - have my blood checked - and get the prescription.


Two days later I got a call while out of town saying that all the lab work was fine except that my PSA was a bit elevated - it was 4.58 and for someone my age that was high. My doctor referred me to a Urologist. The appointment was set.


Of course I had some concern, but after all, all the plumbing seem to work fine and I had no symptoms, so surely there was no problem. The Urologist's exam was routine - in fact he said he thought I had nothing to worry about as he felt nothing abnormal. But, to be on the safe side he schedule a biopsy. Being fearful of needles (and a biopsy is the ultimate needle) I asked if it would hurt. His response, "Most men don't really feel a thing." That was a lie! Looking back, I would have asked for good drugs as that was the most painful experience I can recall.


Several days following the biopsy I received the results. Prostate Cancer! I had a Gleason score of 6 and 30% of one side of my prostate was cancerous. My heart sank as I received the news. How could I, a 47 year old healthy male, with no other medical issues have prostate cancer? And, how amazing that it was caught by a simple test that my well versed female doctor required. Looking back, her diligence saved my life.


What next?


My local doctor wanted to schedule surgery immediately. He said I had four options: (1) Radical prostotectemy (traditional surgery); (2) Radiation; (3) Hormone therapy and/or (4) Watch and wait. Again, he recommended surgery. My immediate question was how many of the surgeries that he was suggesting did he do weekly or monthly. The number was low. In the back of my mind I thought, "Hum, maybe I need someone who isn't so surgery happy and who does this delicate removal frequently." I was like learning to play golf - I would prefer to learn from someone who plays daily than learn from a weekend hacker. Maybe that analogy seems harsh, but after all the decision made would have lasting and profound effects.


Following the meeting with the Urologist, and after telling my family (who thought I was joking), I spent some time in research. First thing I found - based on my diagnosis - I had time to consider carefully my options. Not that nothing should be done, but I didn't have to rush into any hasty decisions. Prostate cancer generally is slow in it's progression. CAUTION - do not use my experience as a crutch to avoid treatment (I witnessed my father-in-law die from complications from prostate cancer), rather, seek competent medical help in making your treatment decisions.


Options Considered:


Watch and wait. Well for several months I did just that. I researched - changed my diet - considered the possibility that I could reverse what existed and even reduce the cancer. I began a regiment of daily intake of cottage cheese and flax seed oil. For a short time I actually saw a decrease in my PSA; however, that was short lived. What I did learn was that diet was important - not only for general well being - but an effective tool in promoting a cancer free body. This was valuable time in that it gave me the opportunity to consider all my options.

Radiation Therapy. Not really an option for me. While I talked with a man in his late 60's to early 70's who had outstanding results using focused radiation (proton therapy I think it was called), the reality is - once you opt for radiation and the tissue is destroyed, if prostate cancer returns, it cannot be surgically removed. Hence the best advice I received was, in my case, this would not be a practical option. By the way information on proton treatment can be found at http://www.protons.com/ or at http://www.llu.edu/. The people I talked with who had used this treatment were extremely pleased with the level of care they received and the overall outcome.

High Intensity Focused Ultrasound (HIFU). In my search for the right treatment, I spent much time in considering this alternative. There were three practical objectives I wished to accomplish with whatever treatment I selected: (1) Cancer elimination, (2) Minimal issues with incontinence (preferably none) and (3) minimal issues with erectile function (again, preferably none). Based on my Gleason score and prostate cancer diagnosis, it seemed that this treatment would be viable. For research information visit http://www.ushifu.com/. As part of my consideration I met with Dr. George Suarez, Medical Director for USHifu. He reviewed my medical background and was kind in taking the time to discuss with me my options using this new prostate cancer treatment. Dr. Suarez took the time to explain all my options and how, if I elected, HIFU could be effective while meeting my three objectives. My only resistance was, at the time, it was not an option yet approved by the FDA in the United States, hence I would have to seek the treatment outside the scope of my medical insurance outside of the country. While I gave this serious consideration, I ultimately decided to go another route.

Radical Prostatectomy. All of the possibilities above, brought me back to the original suggestion - SURGERY. The issue I had was what kind and who would perform it. Since I had the time to research I discovered (through the wonder of the Internet) this, then, new procedure called a robotic-assisted radical prostatectomy. Hum...seemed that needed more study. Of course, at the time, Johns Hopkins Brady Urological Institute was recognized as one of the best in the world for prostate cancer research and study. After careful consideration I contacted Johns Hopkins inquiring about this seemingly new procedure - using the daVinci Surgical System. www.urology.jhu.edu/MIS/daVinci/

The folks at Johns Hopkins could not have been more caring and helpful as I sought all my treatment options. Of course, they reviewed my file carefully and spent all the time I wanted and needed to evaluate my options. Dr. Li-Ming Su was my surgeon and my hat is off to him and his skill and patience. In the end, one thing was clear - all other options being equal - surgical removal was still the "gold standard" in the fight against prostate cancer. Likewise, it appeared that this robotic assisted laparoscopic radical prostatectomy would meet my three objectives.

The surgery went fine - of course I don't remember a thing - so all I can base it on what the Doctor's report. Initially the report indicated that the cancer was contained in the prostate and the removal should yield me "cancer free." Of course this was to be confirmed later from lab reports. The first several days following surgery were not pleasant, but tolerable. Within three days, I boarded a plane and flew home to North Carolina - travel was not a big issue. The most discomforting thing following surgery was the catheter - which remained in for three weeks.

Outcome. Within four weeks following surgery I boarded a plane to Dallas, TX to begin a new job. My energy level was back and I had minimal incontinence isses with subsided within another three weeks. Within seven weeks of surgery incontinence was not an issue. Erecticle function returned within three months (with the aid of medication) and returned to full function (without medication) within twelve months.

Now it's been two years since surgery and all three objective have been achieved. Life is normal. I am cancer free. My sincere thanks to all who were there for me as I sought out the treatment that was right for me. I would not have the opportunity to function as a motivational speaker today if it were not for the skill and help of the fine folks at Johns Hopkins. While printing such personal items for all to read may seem (to some) out there! I feel that, perhaps, others who find themselves diagnosed with prostate cancer may learn from my experience. If you find this helpful, but still need to talk - please visit my web site: http://www.chuckgallagher.com/ and contact me through that portal. I'll be happy to talk with you via e-mail or phone.

Posted at 2:58PM on Jul 6th 2007 by Chuck Gallagher