If you’re a man over 70, he’s coming down your chimney and he’s not waiting for the first peals of Silent Night. Perhaps he already lives under your bed, hides in your closet, watches through your skylight. He’s the Prostate Monster and he wields a mean weapon, the promise of an ugly death. You don’t even know he’s there because the critter is invisible. He got Louie last year and Bernie last week and he’s coming for you if you let your guard down.
Some people don’t believe in the Prostate Monster because they can’t see him, and he just loves that. Others know he exists but just whistle in the dark, hoping he opts for someone else. Forget it--the creature has an unlimited appetite and sooner or later he’ll be rapping at your portal like the pizza delivery man. You can slide down your rain barrel and barricade your cellar door all you want, he knows how to get in. 70% of men over 70 contract prostate cancer and 10% of them die from it. If you know someone who has crashed and burned you know it wasn’t a pleasant exit…something like the train letting you out at a dive bar in Port-au-Prince on a bad day.
The President of the United States can contract prostate cancer despite the Secret Service. The Pope can get it and God can’t do anything about it. If they can get it, so can you. Several of our friends who seemed otherwise smart enough called us on various occasions to report they had prostate cancer, sometimes stage four. Maybe only 10% die, but we seem to know a lot of them. Our best pal Torrey Johnson got it and died. Ocala Tipoff Club President Augie Greiner got it and died. Bill Killeen got it but didn’t die because he knew it was coming and did something about it. Hopefully, so will you.
Getting The Finger
Clever as he is, there are two ways to unmask the Prostate Monster. The most common manner is to have blood drawn for your annual physical and have the PSA checked. Both healthy and cancerous cells of the prostate gland produce the protein known as PSA, which is particular to the prostate. The Prostate Specific Antigen test quantifies the PSA concentration in the blood, often expressed as nanograms of PSA. Prostate cancer victims usually have elevated blood levels of PSA (over 4.0), but not always. Bill Killeen’s PSA number was only 2.5, which suggested there was nothing to worry about.
The second and best means to detect prostate cancer is an annual DRE, a digital rectal exam where a gloved finger is inserted into the rectum to feel for abnormalities of the prostate--enlargements, hard areas and other irregularities that might suggest prostate cancer. This is not as much fun as a day on your surfboard so many gents choose not to participate. “I’ll have that done if and when my PSA numbers go up,” is a common reason to defer. But in Bill Killeen’s case and many others, opting out would have meant failing to discover a growing problem…maybe until too late.
Given the bad news, Bill visited Dr. Jack Paulk, then the reigning emperor of urologists in Ocala. A prostate biopsy revealed he didn’t have cancer yet but did have Prostatic Intraepithelial Neoplasia (PIN), which is like the cancer semifinals. The finals will be played soon enough. He asked Paulk what he could do to prevent the cancer from manifesting. “Well, we can’t do much,” Paulk frowned, “We usually just wait and take it out or radiate it when it turns into cancer.” Oh. That didn’t sound very ambitious.
Grasping at whatever straws were available, B.K. joined a University of Tennessee study operated by medicos at The Cascades in central Ocala, which was testing the effectiveness of a breast cancer drug called toremifene. A year later, a biopsy showed no advancement of the cancer, but shortly thereafter Bill suffered a heart attack, which Gainesville CVI cardiologist Dr. Gregory Imperi said might well have been caused by the toremifene. Killeen philosophized, “When you sign up for these studies, you’re required to fill out forms which tell you the study drug can cause blood clots and the like. But at the time, the prostate wolf is at the door and you’re not particularly concerned about the heart attack on the other side of the mountain.” Obviously, that was the end of Bill’s study participation. A third biopsy two years later showed the PIN had evolved into prostate cancer. Time for the main event.
One Man’s Tale/bill killeen
The silly men at the American Urological Association and the U.S. Protective Services Task Force have for years recommended against screening for prostate cancer in men over 70 years old “due to the likelihood of indolent prostate cancer in older men. Most men will eventually die WITH prostate cancer rather than because of it.”
Men, of course, just love to hear this. Who wants the inconvenience of an annual butt check? But what if that prostate cancer turns out to be not so indolent? What if it becomes aggressive like, say, the cancer that got Torrey Johnson and Augie Greiner and, oh yes, Joe Biden, 46th President of the USA? By the time this is published, the gnashing of teeth over Uncle Joe might well have made these people think again. Many men have an annual physical replete with CBC blood tests--how hard is it to at least add a PSA test to the list? Primary care doctors and urologists, like everyone else, enjoy being regular guys but discouraging their patients from getting a DRE is a lousy way to achieve popularity. It’s not that big a deal, folks, and even the biopsies are much less onerous than a night at a Lil Maboo rap concert. All this is prelude, of course. In my case, the Prostate Monster had entered the building. Now what?
“You have three choices,” said Dr. Paulk, “watchful waiting, surgery or radiation. Some people opt for those radioactive beads but virtually everyone who gets them comes back to me complaining about the pain. There’s also cryosurgery---don’t like that---body parts sloughing off and all.”
Nobody, including me, is crazy about any surgery, let alone this one, which can have some sobering aftereffects. Then again, who wants their intestines fried along with their misbehaving prostate? Throwing out the baby with the bathwater comes to mind. Siobhan was solidly in the surgery camp and was almost always on the money where medical issues were concerned. I decided to interview a surgeon and a radiology doc the same day at Shands, wife in hand.
We got very lucky with the surgeon. Dr. Li Ming Su, despite his Asian moniker, grew up in Gainesville and had just moved back to town after performing over 250 prostate surgeries on the newish da Vinci robot at Johns-Hopkins. He was personable, charismatic and had little doubt about his abilities. “The first thing you need to know,” he said heavily, “is that you will no longer be able to father children.” I asked him if that was the bad news or the good news. Siobhan said the bad news was still coming. “Second, no matter how good sex is for you right now, it will be less so in the future. The intensity will be diminished---for some people, not too much, for others a lot.” After dropping that bomb, Su sat back in his big chair, waiting to see if I ran out of the room. “But still better than a poke in the eye with a sharp stick, right?” I asked.
“It will depend on how many of the nerves we can save,” said the doc. “Sometimes, we do very well. The third thing you should know is that everybody who has this issue has some degree of temporary incontinence. It can last for a couple of months to a few years.”
“When do we get to the good part?” I asked Siobhan.
Dr. Su went on to say that all operatees need a catheter for a week or so. No heavy lifting was allowed. For some vague reason, they also didn’t want anybody driving while the catheter was in place. Otherwise, have a blast everyone. You did get the unexpected bonus of not having to go to the restroom at halftime, since you had one strapped to your leg. Oh, and you got the additional gift of a batch of free Viagra, which you could possibly use in two months if you were lucky. “If things don’t work out for some reason you can still have radiation,” added Dr. Su, “whereas if you have radiation and it doesn’t work you cannot repeat it.” Why is that, I asked Siobhan. “Nuked guts,” said she. Oh, right, said I.
Finally, I was offered a visit with a woman downstairs who had an apparatus she hooked up to your penis for enlargement and hardening purposes and she’d be happy to give me a free demonstration. “Let’s go down on the stairway instead of the elevator,” I whispered to Siobhan, “so we don’t run into that woman.”
The Nuclear Option
After the meeting with Dr. Su, it was time to chat with the radiology doc about the alternative eraser. I didn’t catch his name, so let’s just call him Doctor Strangelove. Dr. S. didn’t believe in guilding the lily, he let you have it with both barrels as soon as you walked in the door. “First off,” he frowned, the treatment will be daily, except for weekends, and it will last for 8 1/2 weeks.” Holy shit! “Second, there is the possibility of intestinal perforation from the radiation.” Siobhan, give me a Quaalude, please.
“But here’s the GOOD news!” he almost smiled. “To prevent damage to the intestines, when you come in we insert a balloon into your rectum. The balloon is then inflated to provide separation from the intestines and better protect them.” That’s me you see running from the room in blind panic. “Siobhan, is this guy trying to sell me something or is he getting paid off by the surgery department?”
Dr. Strangelove got up and offered his hand as we started to leave. “I hope you decide to take advantage of what we have to offer,” said he, smiling. I smiled back weakly and told him we’d think about it, then wobbled to the door.
“I think I’m leaning slightly to having the surgery,” I told Siobhan. “No shit,” said she.
Whatever Happened to Mack The Knife?
The da Vinci Surgical System is a robotic critter designed to facilitate complex surgery using a minimally invasive approach and avoiding the bloody mess which used to be prostate surgery. The system is controlled by a surgeon from a console, typically in the same room as the patient. It features a patient-side cart and four interactive robotic arms controlled from the console. Three of the arms are for tools that hold objects, act as a scalpel, scissors, bovie or unipolar or bipolar electrocautery instruments. The fourth arm is for an endoscopic camera with two lenses that gives the surgeon full stereoscopic vision from the console. The surgeon sits at the console and looks through two eyeholes at a 3-D image of the procedure, meanwhile maneuvering the arms with two foot pedals and two hand controllers. The da Vinci System scales, filters and translates the surgeon’s hand movements into more precise micro-movements of the instruments which operate through several small incisions in the body. Eventually, the prostate is removed through a slit just below the navel, leaving little permanent evidence of the passage but several small holes in the body from the playful cavorting of the robotic arms. Years later, these divots will be barely evident.
Optimist that I am, I went into the surgery thinking of it as almost an outpatient procedure. It is not that. I lay around groggy from the anesthesia for hours, listening to my uncouth roommate bestow his unique notion of romantic solicitation on the nurses. “You almost cut off your leg with a mower, Robert, how impressed should we be with your skills?” asked one of them.
Dr. Su didn’t care much for dispensing pain pills to his customers. “Among other things, they constipate you,” he said, but sometimes constipation is better than pain. Nonetheless, I left the hospital the next day and sallied over to a horse sale in Ocala. The catheter was taken out a week later but reinserted a few days later after terrible bladder spasms following urination. It was removed again at 14 days after surgery with no further discomfort.
Incontinence turned out to be short term. You’re not thinking too much about sex for awhile after surgery, but for us that was only about a two-month fast, which Dr. Su assured me was remarkably good fortune. Anyone with this surgery will be using Viagra pills for awhile and perhaps forever (they’re chummy and helpful little fellas when you get to know them). Sexual spontaneity disappears from your dance card for quite awhile and grousing in the goodie gets to be like a planned trip to Walmart, but you adapt. My prostate cancer turned out to be encapsulated and subsequent PSA tests kept turning out 0.004, so they were eventually abandoned. All in all, better than agonal weeks in the hospital and a screaming death.
One thing still bothers me, though. Had I known that some day I would be writing these Flying Pie columns I would have definitely sacrificed my dignity and gone to visit that woman in the bowels of Shands Cancer Center with the penis blow-up machine. I mean, think of the possibilities! What if it doesn’t shut off? What if it doesn’t work for you and the woman looks at you with scorn and disgust? What if your penis gets irreversibly bent and you have to start dating gymnasts and acrobats? Maybe it’s not too late. Maybe she takes appointments from serious journalists walking the penile enhancement beat. Probably not.
That’s all, folks….
