DIAGNOSIS
On July 31, 1996, I was 62 years old when I was diagnosed with prostate
cancer.  In May, my doctor had me take a blood test, Prostate Specific Antigen,
(PSA), which measures the level of increased protein when prostate cancer is
present.  My PSA test had a count of 6. On July 26, Dr. Peter Carey, my urologist
performed the ultrasound/biopsy and on the 31st, he called me with the results.

He said, "I have bad news for you, your tests came back and unfortunately, you
have prostate cancer."  He advised me the cancer was localized within the prostate
and I would have two choices of treatment, surgery or external beam radiation.  He
advised me to speak with his secretary and schedule an appointment for a
consultation with him for Myrna and I , and for me to schedule a bone scan at
Mary Washington Hospital in Fredericksburg, Virginia.

As I set at my desk in my home office and after hanging up the phone, I was
devastated.  I was terrified at the thought of having cancer in my body.  I
could not understand why I had survived open heart bypass surgery in April,
and before my recovery was complete, I had been diagnosed with prostate
cancer.  I then realized, I needed to tell my wife the bad news.  I went down
stairs, Myrna met me at the bottom of the stairs, and all I can remember is, I
said, "I have prostate cancer."  Later I went back to my office, and scheduled
the appointments for the bone scan for August 16th and the consultation with
Dr. Carey for August 20th.

Sometime during the next week, I received a large package from Dr. Carey,
containing a video and articles about prostate cancer.  Myrna went to the
public library and checked out 3 books on prostate cancer, written by 3 men who
also had prostate cancer.  The information from Dr. Carey and the 3 books
helped me learn what I needed to know about my disease and treatments available to me.

I went and had the bone scan at Mary Washington Hospital on August 16th,
and on August 20th, Myrna and I went for our consultation with Dr. Carey.  He
advised me the results from the bone scan were negative, indicating the cancer
had not spread into the bones.  He informed me about my two options, nerve
sparing surgery and external beam radiation.  He advised me seed implant
radiation and cryotherapy were still in the experimental stages in 1996 and that
my HMO would probably not pay for these treatments.  He answered all of my questions,
including the prostate measurent scales.

One measurement scale, called Tumor Nodes Metastases (TNM), has a scale ranging
from T1A, the earliest stage, to T4, a tumor that often has spead into the
bladder, bones, etc.  I was scored at a T2C, localized.  Another scale, the
Gleason score measures the "grade" of the tumor, what the cells look like.
Cells with well-defined borders are generally less aggressive than those with
irregular borders.  The Gleason scale is a numerical count between 2 and 10,
with the higher numbers indicating more aggressive cancer.  Most men are a 5, 6,
or 7.  I was scored at a 6.  These 2 measurement scales are present in every
biopsy report when prostate cancer is diagnosed.  All subsequent medical
treatments are determined from these 2 measurement scales, plus PSA and one's age.

After Myrna and I got into the car, we decided to let Dr. Carey perform the
surgery at Mary Washington Hospital.  The next morning I called his secretary
and informed her that I would like for him to perform the surgery.  He called
me back later that day, and the surgery was scheduled for September 19th at
Mary Washington Hospital.  By waiting 1 month to have the surgery, this would
allow me to donate 3 pints of my blood over the next 3 weeks with the American
Red Cross and have the 4th week off to rebuild my blood supply before the
surgery.

You may be wondering why I did not seek a second opinion from another surgeon?
When I was in Dr. Carey's office on August 20th, I asked him if I had a second
opinion, would I also have a second biopsy?  He said, "No."  The second opinion 
doctor would use a copy of the original biopsy report, and since my staging
count was a T2C which means the cancer was localized within the prostate gland,
and my Gleason score was in the average range of 6, I decided a second opinion
from another doctor would be of no value to me.  Why delay my recovery?

On September 11th, I had another appointment with Dr. Carey for my
pre-operative examination.  He had me read and sign a consent statement that I
understood the possible risks from having the prostate surgery: impotence,
incontinence, bleeding, infection, death and that I understood the other
treatment option--external beam radiation therapy, which I had rejected.

I have 6 reasons why I did not consider the external beam radiation:

1)Remember earlier, I mentioned, I had read 3 books on prostate cancer, written
by 3 men who had been treated for prostate cancer.  Two of them chose surgery
and have had no sign of returned cancer.  The third one, Sylvan Meyer, had the
external beam readiation therapy and in the epilogue of his book he informed the
reader, that the prostate cancer had returned within 2 years and he was
undergoing subsequent treatment, crytotherapy.

2)A man I went to high school with was diagnosed with prostate cancer, he chose
the external beam radiation therapy and I understand the cancer had returned.

3)My Uncle Nick was also diagnosed with prostate cancer and he told me, he
chose the surgery over external beam radiation.  I understand from Nick, his
brother Vernon, and been diagnosed with advanced prostate cancer.  Vernon
subsequently died from lung cancer, and he die 2 weeks after being diagnosed
with the prostate cancer. 

4)There is another bad side effect, external beam radiation therapy can also 
burn the colon, and then the patient has an increased risk of having 
incontinence of the bowels.

5)When one has the surgery first, and if the cancer returns, then it can always
be followed up with external beam radiation.  When one has the external beam
radiation first, it is difficult to follow it up with surgery.

6)All the cure statistics published in 1996 indicated that surgery would
offer me the best chance for a full recovery.

TREATMENT
At 6:30 AM, on September 19, 1996, I checked into Mary Washington Hospital to
have the surgery.  The first thing Dr. Carey did when he opened me up was
remove specimens from the lymph nodes from around the diseased prostate for a
biopsy.  They waited until the results were returned from the pathology
department, which indicated the cancer was localized within the prostate and
had not spread to any of the surrounding areas.  Then he finished removing 
the prostate.  I understand if cancer had been found in the lymph nodes,
he would not have removed the prostate.  He would just sewn me up, and I
would have then become a candidate for some other form of treatment.

Once my prostate had been surgicaly removed, it was sent to the hospital's
pathogy department for a post-operative biopsy.  This microscopic examination
revealed the tumor was organ confined, the urethral, bladder, and seminal 
vesicles were negative.  The Gleason score was even downgraded from 6 to 5.
I did not need any subsequent post-operative beam radiation and/or hormonal
treatments.  Hopefully, this means, "THEY GOT IT ALL."  This biopsy is not 
available when one chooses external beam radiation, seed implants, or
cryotherapy, and the patient will always wonder, "DID THEY GET IT ALL?"

RECOVERY
I did not have any problems while I was a patient in the hospital.  I had 22
metal staples for stitches, and a catheter inserted into my bladder.  I was
only in the hospital 5 days and went home on Monday, September 23rd.  I began 
to feel great once the 22 metal staples were removed on October 1st and the
catheter removed on October 8th.  I went back to work in my home office on
October 2nd.  If I felt tired or weary, I went back to bed and took a nap.
By the end of the 4th week, I was back to work full time, and walking 2
miles each day.

However, there is always the chance a stray cancer cell was missed and still
lurking around in the margins.  I must have the PSA performed every 6 months
for the rest of my life.  Dr. Carey told me if the PSA count reaches 0.4 or
above, then the cancer has returned.  Then I will become a candidate for some
other form of treatment.  All of my post-operative PSA tests still equal 0.1.

I am not going to give my opinion on which treatment one must choose to remove
prostate cancer.  I selected the retropubic prostate surgery(an incision
through the abdomen) over the perineal surgery(an incision between the scrotum
and the anus).  Unlike retropubic surgery, the perineal surgery will not
allow the lymph node biopsy to be performed or the opportunity to save the
nerve bundles(causes impotence). 

There are some great books about prostate cancer in the public libraries and 
book stores.  I first read "Man To Man, Surviving Prostate cancer" by Michael
Korda.  Now if you read this book, Korda may very well give you a good scare.
He had a very difficult time in the hospital, and at home in recuperation.
He had more than his fair share of problems.  He and I both had the retropubic
surgery, but I did not have 1/10th the problems he had.

I then read "Prostate Cancer, Making Survival Decisions" by Sylvan Meyer and
Semour C. Nash, MD, F.A.C.S.  Meyer is the author who had external beam
radiation treatment in 1990, and found out the cancer had returned in 1992.
Dr. Nash provides a lot of technical facts and statistical information,
everything one would need to know or would like to know about prostate cancer,
and possible treatments available.

There is another book I have subsequently read and highly recommend,
Prostate & Cancer" by Sheldon Marks, MD in a very patient-friendly format.

Another choice one can make is to participate in a prostate cancer support
group.  The doctors or hospitals will probably know who to contact.  I have
attended these meetings at the Cancer Center of Virginia in Fredericksburg
since 1997.  Here I have met other men who have had or still have prostate
cancer from different economic, social, and professional backgrounds.  Each one
of these men has gladly exchanged their cancer history, the type of treatment
they selected and why, with everyone else, and who the good urologists are.
Dr. Carey is very highly spoken of.
 
RISK FACTORS
The cause of prostate cancer is not known.  There are 3 principle factors that
increase a man's risk for having the disease:
1) AGE-The risk for developing prostate cancer in one's lifetime increases with
age.  However, since the introduction of the PSA test, more men are being
diagnosed at much earlier ages.
2)RACE-African Ameriican men have the highest risk of developing this disease.
3)FAMILY HISTORY-There is a strong evidence to suggest a genetic link to the
development of prostate cancer.  Any man with a relative with prostate cancer
on either his mother or father's side of the family is at an increased risk
for this malignancy, which accounts for about 1 in every 10 cases of the 
disease. 

SUMMARY
Every year more than 200,000 American men are told they have prostate cancer
and 50,000 of these men will die needlessly from this disease.  One in 5
American men will develop prostate cancer in their lifetime.  Most men are
only vaguely aware of this disease, its treatments and its consequences.  Unlike
women, who usually talk freely among themselves about intimate health problems,
such as breast cancer, most men would rather not talk about prostate cancer, and
shy away from exchanging information about any of their physical disorders, let
alone problems involving the prostate gland, which could possibly affect their
urinary flow, and mess up their sex life.

I have recovered fully from the prostate surgery performed in 1996, and I am now
retired, and living a fine quality of life.  All the bad side effects resulting
from the prostate surgery are gone.

Thank God, I am still dodging that bullet!

Tom Ainsworth
retired97@verizon.net