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Guestwords: The Fight of My Life

Wed, 05/31/2023 - 14:47

The word “cancer” delivered as a diagnosis must be one of the scariest words in the language. It not only causes one to face one’s mortality, which may be imminent, but it also portends the possibility of long, drawn-out treatments and considerable pain.

I had suspected that I might have prostate cancer before I was diagnosed. My prostate-specific antigen, or P.S.A., scores had been creeping up over a period of 19 months. My urologist ordered a 4K score, which measures the likelihood of aggressive prostate cancer. My score was a low 5 percent, so nothing more was done. Eighteen months later, however, my 4K score shot up to 23 percent. My urologist performed a digital rectal exam, then ordered a magnetic resonance imaging test with contrast. It revealed a PI-RAD score (more on that later) of 5, which meant that my prostate contained a significant cancer.

The next step was a biopsy. The results indicated that one quadrant of my prostate had a Gleason score of 7, which meant the presence of cancer, in this case an intermediate cancer. It abutted the wall of the prostate, but had not pierced the wall. The other three sections of my prostate each had a Gleason score of 6, which was nothing to be alarmed about. The present cancer had to be treated, however.

Before I chose a method of treatment, I investigated not only various options, but also the nature of the disease.

Cancer cells in the prostate, like cancer cells in other organs, often grow uncontrollably. However, because my prostate cancer, like 90 percent of all such cancers, was detected early, it was treatable, with the likelihood of a positive outcome. In fact, the five-year survival rate for men with treatable and early-detected cancers is 99 percent. That was reassuring. 

Not so fast, though. I next discovered that for some men prostate cancer is the second-leading cause of cancer deaths in the United States. Ninety-four men die each day from it.

I also discovered that prostate cancer is the most diagnosed cancer in men, especially as one gets into one’s 50s, 60s, and 70s. In 2021, more than 248,000 cases were diagnosed. That amounts to one out of eight men. Approximately 60 percent of prostate cancers are diagnosed in men over the age of 65. And if it weren’t for P.S.A. tests, many of those cancers would go undetected, for elevated P.S.A. readings invariably lead to biopsies, when the cancer is discovered.

It is important to note, however, that P.S.A.s are not a perfect screening test to determine the presence of cancer. Elevated levels may mean the presence of an infection or a simple enlargement of the prostate. As a urologist said to me, “P.S.A. screening, if done correctly, has reduced the death rate from prostate cancer for men with aggressive cancers that were diagnosed early, before the cancer has spread.” Men like me have been effectively treated, their cancers either cured or managed.

I learned that age, prostate size, previous P.S.A. scores, certain drugs that may artificially lower those scores (such as Proscar and Propecia), infections, and some herbal supplements (such as saw palmetto) may all affect one’s P.S.A. score. And even some men with a low score may have prostate cancer that may not be found until after it has metastasized. Because the P.S.A. test is not definitive (as it wasn’t for me), it is essential that it be followed up with an M.R.I. (as it was for me). If the results of that indicate the likelihood of cancer, then a biopsy is the next step.

The results of an M.R.I. scan are measures known as PI-RADS (for prostate imaging-reporting data system). The scores range from 1 to 5. The lowest number means that there is a low likelihood of a significant cancer being present. If the score is 5, it means that there is a high likelihood. That was my diagnosis. I swallowed hard when I heard it.

My next encounter with hospital testing meant getting a biopsy. As I anxiously awaited my Gleason score, I imagined the worst outcome. Would my cancer metastasize? Would I die? Would I have to have treatments that would leave me incontinent and impotent?

I attempted to meditate away my concerns, but found that a tranquilizer worked just fine. I waited.

A nurse practitioner called me with the results: I had a Gleason score indicating an intermediate cancer with a likely favorable outcome. The cancer was contained within the prostate gland while abutting one wall. My urologist said I was an excellent candidate for external beam radiation. But what kind of external beam radiation?

I chose stereotactic body radiation therapy, which requires only five treatments and has fewer side effects than the other choices. It involved the insertion of a soft rubbery dissolvable object between the rectum and prostate to avoid radiation damage to the rectum.

I chose this form of therapy not only because it was the most effective, but also because the alternative treatments such as cryotherapy (freezing the prostate), proton beam therapy (similar to X-rays), and high-intensity ultrasound all had side effects that no rational person would want to endure, and the cure rates were ambiguous at best. 

There were two hospitals that could administer the high-intensity external beam radiation treatment. One was Memorial Sloan Kettering Cancer Center, where gold pellets would be inserted into my prostate. The other was Weill Cornell Medical Center, where I met with a radiation oncologist. He explained how the center uses a unique M.R.I. machine that delivers high-intensity radiation beams directly into the prostate in real time. In other words, he would see the treatment as it occurs, which no other hospital in New York City could do.

The doctor’s manner, knowledge, and empathy left me feeling assured that his M.R.I. machine would offer the best, least traumatic outcome.

I apprehensively approached my first treatment, changed into a hospital gown, and was escorted to the machine. I was given a pair of earphones and a choice of music to accompany my treatment. I chose “Kind of Blue” by Miles Davis, and that would be the music that accompanied each of my treatments, each of which took from 20 to 40 minutes.

In addition to my favorite jazz album, I was able to watch a screen that offered serenely relaxing images of nature scenes. I went for five treatments every other day spread over a period of 10 days.

Prior to treatment I was given finasteride to shrink my prostate and tamsulosin to increase my urine flow. Three months after the treatments concluded I returned for my first follow-up visit: My P.S.A. had dropped significantly. The doctor was pleased with the results and scheduled me for a return visit three months later. At that visit, I learned my P.S.A. had dropped even more. For the next three years, I will be evaluated every three months. During years four and five, I will be evaluated every six months. Thereafter, I hope to be considered cured with few if any side effects.

While the word “cancer” can set off alarm bells, one of the lessons I learned from my own cancer diagnosis is that research and knowledge will dispel many negative myths. A lack of knowledge invites a terrible fear of the unknown. And one way of defeating one’s ignorance is to ask as many questions as necessary. For my oncologist, my urologist, and his nurse practitioner I never felt that I had exhausted their patience by asking questions. I came to understand my cancer and the effects and side effects of my treatment.

Since the completion of my treatment, I believe that I have made all the right choices.

Jeffrey Sussman is the author of 17 nonfiction books, the most recent of which is “Sin City Gangsters.” He lives part time in East Hampton.


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