MyView: How I lost my prostate
September 04, 2017
The story began three years ago.
I was seeing my physician for my physical and the associated blood work. I got my regular lecture on the need to watch my cholesterol. He also noted that my prostate-specific antigen — a protein that can signal the presence of cancer — was borderline high and that I should see a urologist. He hastily added that everything felt normal during the infamous "digital exam" so most likely there was nothing to worry about. I latched onto the "nothing to worry about" comment and ignored the urologist referral.
Over a year later, I applied for an insurance policy. The underwriters wouldn't consider my application until I got another PSA test. More annoyed than concerned, I scheduled another test. My PSA level had doubled. This time, no him-hawing. I set the appointment with a urologist.
Lesson 1: It's fine to be an optimist, but don't ignore unfavorable medical test results. If the physician recommends you see a specialist — see a specialist.
He was a nice young man who looked fairly fresh out of residency. I'll call him Dr. Young Guy. Dr. Young Guy reviewed my numbers and offered reassurance. There was a good chance all was fine, but he recommended a needle biopsy to find out for sure. By this time I had done a bit of reading on the subject and I knew a biopsy was not a pleasant experience. I asked, "Exactly how are you going to do this test?"
His explanation began, "Well, God didn't put the prostate where it is easy to get to."
With that, he described the procedure. You folks are dentists, and you are accustomed to poking needles where they don't belong. But even taking that into account, I'm going to spare you the details of a prostate biopsy. Let's just say you would never consider poking needles where this doctor intended to go.
The morning of the biopsy I was escorted into the treatment room and told to get undressed. I climbed on the exam table and covered myself with a paper sheet. I'm told that in dental school you are taught how to hide the syringe from your patients. Why create unnecessary anxiety if by sleight of hand you can keep the needle out of sight? My nurse must have skipped needle concealment class. She stood in front of me while she drew up an injection. I honestly didn't know they made syringes that big. She explained it was an antibiotic to reduce the chance of infection from the biopsy.
Lesson 2: Continue to hide syringes from your patients. It's the right thing to do.
After the needle attack, Dr. Young Guy came in and cheerfully greeted me. He explained that the front office had overlooked some paperwork that I needed to sign. While I continued to whimper from the injection, he held the clipboard and I consented to something.
Lesson 3: Don't ask your patients to sign consent forms while they are naked.
Much has been written about prostate biopsies including a fair number of horror stories. I can honestly say it was not as bad as I feared. Certainly unpleasant, but in terms of pain, not nearly as bad as Nurse Ratched's antibiotic injection. After 20 minutes of being probed, prodded and poked, I got dressed and hobbled down the hallway and out to my car. I briefly considered returning to the office, but after finding out how uncomfortable the car seat was, I decided I had earned an afternoon off.
The results of the biopsy came back a week later. The lady who called said, "There are some signs of cancer cells and you need to come back in for a consultation with the doctor." As I suspected, that was code for, "You have cancer."
One of the first people I spoke to about my diagnosis was Dr. Jim Shupe, a pediatric dentist from Fort Wayne, Indiana, who I knew had received prostate surgery the previous year. I pulled Jim aside at a social event and told him my news. The first words out of his mouth were, "Don't be afraid of the surgery."
That's significant, because I was, indeed, afraid of the surgery. There is no absolute medical protocol for prostate cancer treatment. The three most common alternatives are:
- Watch and wait. In most cases, prostate cancer is slow growing, which means some patients can wait and observe the rate at which their cancer progresses before receiving treatment. The downside, if it is the rare fast growing cancer, the condition can quickly become much more serious.
- Radiation. Most forms of prostate cancer treatment have unpleasant and inconvenient side effects. Radiation is often successful at killing the cancer, but it can damage surrounding muscle and nerves, producing negative side effects that can manifest months or years after the treatment ends.
- Surgery. It's called a radical prostatectomy. The prostate and surrounding tissue is removed. Sensitive muscles and nerves are almost always damaged, producing side effects that begin immediately, but that can improve over time.
I decided that if my choices were immediate side effects that improved over time, vs. no immediate side effects, but problems in the future, I'd opt for the former.
While a nice young man, Dr. Young Guy confessed that he had only performed the procedure a few times. Jim recommended his surgeon, Dr. Old Guy.
When I met with Dr. Old Guy and asked how many times he had performed the surgery, he replied, "I have no idea. Well over a thousand. I've assisted with that many more."
"Are you good at it," I asked.
"I'm very good," he replied.
Dr. Old Guy was my man.
I was scheduled for "laparoscopic robotic surgery." While I've found that most folks in the medical/dental field are familiar with Da Vinci Robotic Surgery, it sounded like science fiction to me. While the robot does the cutting and snipping, the surgeon is on the other side of the room manipulating controls from inside what appears to be an NFL instant replay booth. The precision of the robot is amazing. There are online photos of it removing the peel from a grape, then suturing it back into place. Of course the night before the surgery, I made the mistake of watching the Terminator movie sequel where robots become self aware and take over the world. I had nightmares of my robot going rogue during the middle of my procedure.
The next morning as I was rolled into the operating room, I asked the nurse if I could see my robot. "It's right there," she replied as she pointed.
The robot sat in the corner waiting on me. It appeared safe. It resembled an oversized Star Wars R2 unit, only with extra arms.
The anesthesiologist put a mask over my face and told me to breathe normally. The next thing I remember, they were wheeling me into my room where my wife was waiting.
Lesson 4: While not perfect, we are still blessed with the best health care in the world. If I'm going to be sick, I want to be sick in the good ol' USA.
After a two-day hospital stay, I was recouping at home. Dr. Neal Richter, an Indiana Dental Association past president and prostate cancer survivor, called me the day he heard about my diagnosis and has been my coach and cheerleader through the entire process. I still have the empathetic voicemail message he left me the day I got home from the hospital.
"Glad you are home. Now get your butt out of bed and start walking."
That's the encouraging chair-side disposition that endears Neal to his patients.
At the time of this writing, I'm nine months post-surgery and feeling great. Though I will continue to be monitored with regular PSA tests, Dr. Old Guy has declared me cancer free. In the grand scheme of things the dreaded side effects have been little more than annoyances. I am grateful for a good God, wonderful doctors, supportive Indiana Dental Association members, terrific staff and loving family.
Lesson 5: "The first wealth is health." — Ralph Waldo Emerson
This editorial, reprinted with permission, originally appeared in the spring 2017 issue of the Journal of the Indiana Dental Association. Doug Bush is the executive director of the Indiana Dental Association. September is Prostate Cancer Awareness Month.