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04/03/2016

Prostate Cancer (PC) Thoughts, 2016 Update

Gary Minar, ‘58

            Several years ago (2003), when I went thru the prostate cancer experience, I wrote a brief piece that was placed on our USNA 1958 Website and other retiree websites. It received a lot of attention and I received many inquiries from classmates and friends about it. I encouraged them to be thorough in learning about the disease and in seeking specialist care if they had any test that indicated they were at risk. And if treatment were necessary, to thoroughly explore treatment options so that life expectancy, side effects, etc. were fully understood. We of USNA Class of 1958 were in the prime zone for it to occur due to our age. Many of my working associates at that time had some PC experience or had known men who had gone thru the PC drill, so that gave me a lot of exposure before it actually happened to me.

            This important men’s health topic should be re-emphasized because of some new thinking and internet proliferation of prostate cancer ideas. Over these past few years, there have been many studies on the topic, and some recent ones seem to address the ‘medico-economics’ aspect of dealing with the disease (save money by treatment economics). I believe that some of what is being stated is dangerous to MEN, and men our age, because they seem to say ‘don’t screen for prostate cancer after age 75 or so’. Screening means getting routine PSA tests, and following that with a specialist’s care (urologist) if the PSA shows a danger or increased risk. The next step in the prostate cancer protocol, if PSA is elevated, is a biopsy to see if cancer is really there. The biopsy would yield a Gleason Score, a direct measure of prostate cancer risk. Following that, treatment options must be explored when cancer is detected, depending on the outcome of the biopsy/Gleason Score.

            Med school sites have good PC info, and at the time I advised Johns Hopkins Urology School, where the renowned physician Dr Walsh serves (he wrote the book on prostate cancer):  

http://urology.jhu.edu/ (look for the Prostate Cancer info)

                Now I have found another site with more good info:

 http://www.brighamandwomens.org/Departments_and_Services/surgery/services/urology/prostate-cancer.aspx?sub=1    (also known as the Harvard Medical School)

It has an excellent 10-15 minute video labeled, “video of Dana-Farber/Brigham and Women’s Cancer Center’s 17th Annual Symposium on Prostate Cancer, found at the front of the web page.  That video covers what one must understand about available treatment and the risks of all.  It also discusses the surveillance (‘watchful waiting’) approaches that could give whatever cancer you have time to expand, and should only be considered with continued, diligent urologist oversight.  Surgical removal is noted as the approach that eliminates the cancer and hopefully you become cancer free for life with minimal side risks.

As a refresher, this is what I recommend for all men our age, not just USNA guys:

1.      Keep up on your routine medical visits and, if necessary, insist that a PSA test be done annually.

2.      If your PSA shows an increase of 25% or more compared to last visit, or is above 4.0, see a specialist/urologist without delay (my personal experience was from an off-schedule PSA test at a 6 month interval, due to some heart studies that were ordered, showing almost a 50% jump in my PSA up to 4.5 – ALARMING). But if you are uncertain, be sure, ask your urologist.

3.      If the PSA results indicate a suspected prostate problem, have the uro do a biopsy to learn if you do indeed have cancer. Biopsy is not fun, but very important to provide diagnostic info.

4.      If the biopsy results show cancer (Gleason Score is non-zero), study what that means and learn all you can about treatment options via your doctor/uro, web sites, 2nd opinions – question the doctors.

5.      Don’t let others suggest that you don’t need to do this or that based on what they ‘know’, learn thoroughly for yourself.

6.      Surgical removal is the surest way (as per both JHU and Harvard/Brigham-Women’s) to protect yourself for the long run. The info I read told me that radiation treatment protocols do not allow a Plan B, if the radiation treatment does not work.

7.      Surgery takes some recovery time and there are some risks, among them I & I (incontinence and/or impotence) but these are quite low for a reasonably healthy man. All treatments have risks!

8.      Whatever your choice of PC treatment, be certain that you understand what the consequences are.

Don’t believe general internet health info without doing due diligence! Read, read, read and gather all you can from trusted sources. FYI - When you Google the subject of prostate cancer treatment or diagnosis, you will find many thousands of information sources. Some could be ‘junk science’. Try this on Google for prostate cancer: The ‘diagnosis’ search word finds about XX million suggested sites, while the ‘treatment’ search word finds about 25 million! Might be best if you search ‘diagnosis and treatment’. Much of that info is OPINION, not fact. That is a lot of data, but probably the best is found at the major hospital sites, like JHU, Harvard, Sloan, etc. it was troubling to me that one of the big cancer radiation treatment sites pops up near the top – WHY?, their skilled use of search words, or buying a top-of-page site! And don’t depend on magazine articles about this matter. Use your critical thinking skills. Be diligent.

Sadly, I met a lady (widow) recently whose husband was a high level Naval aviator in a command position. He had the tests and symptoms of prostate cancer. He chose radiation seeds as treatment. That did not work, and he had little recourse except hormone therapy to keep his disease at bay temporarily. He had a very bad last few years.

Think smart – it’s your life. (This info that I give is not intended to replace any medical advice and/or processes that you may have received!)

It may appear that I am indorsing surgery for the prostate cancer solution, and that is true. I believe that is the right answer. Other options should be thoroughly understood and studied before you decide what treatment to consider.

Thanks

Gary Minar (805) 245-0296, gary.minar@1958.usna.com

 

 

Addendum to Gary Minar’s Report  Re Prostate Cancer’
(From Bob Sauer)

9 June 2006

In Jan 2006 Roy Clason, my 23rd Company roommate for 4 years informed me that he had an elevated PSA of 3.9 when last taken. Roy’s family doctor was concerned of the rise from 2.5 to 3.9 in a year. The rate of rise begged for further testing. A biopsy was performed to reveal what was happening down there. Roy received word in 2 days that he did have cancer of the prostate with a Gleason score of 6. He selected to have it removed surgically via the radical surgery treatment option on 24 Feb 2006. (Gary Minar’s Report that is on our Class of 58 website and several telecons provided Roy with the info he needed to select the option. I (Bob Sauer) had my annual check on 14 March 2006. I was called on 15 March 06 by my doctor. He stated everything was fine except for an elevated PSA of 7.5. He set up an appointment with the Urologist. I had a biopsy performed on 4 April 2006. On 13 April the Urologist said he had bad news and good news. The bad news was I had non aggressive cancer with a Gleason score of 6. The good news was it was caught early and is probably totally within the prostate.

I drove the 20 miles to the clinic for the biopsy and drove home immediately after the biopsy. Don’t plan on any driving trips until eight weeks after the biopsy. We had planned 2 trips, one, the end of April and, two, a graduation the end of May. I just couldn’t sit that long because it takes about 2 months for the prostate to get back to normal. I did not expect the biopsy recovery to linger like it did but as advertised the biopsy procedure caused me to take special precautions and limit my travel. I would not have been able to make the drive because. Realizing this, I canceled the trips and proceeded with my plan to move forward as rapidly as possible to get rid of the ‘hummer’ before it could grow any more.

I completed an appointment on 20 April with the Radiation doctor and ruled the option out rapidly when I could find little or no info about the results from this option. Radiation seeds and Radiation Beam options, if not successful, require Salvage Surgery with really increased risks. If one is not in good health this might be an option. I was physically fit for any option available.

I saw the Surgeon on 9 May 06. He performs both the Laparoscopic and Robot Assisted Radical Prostatectomy (http://www.davinciprostatectomy.com/) and the traditional surgical prostatectomy. I was very biased to the new method until this appointment. (Note: Gary & Roy did not consider this option because of the long distance to the facility.) Every thing done in the traditional has to be done in the Laparoscopic option with the only difference being a 3.5 inch incision vs. a 5.0 inch for the traditional. As he talked I was gradually releasing my biased grip to the Laparoscopic option. I questioned how soon he could get me in for the two options. The Laparoscopic option could not be performed until at least 2 months after the biopsy while the traditional could be within 7 – 14 days after the 9 May appointment. Two days later I was scheduled for the traditional surgical prostatectomy on 18 May 2006. Forty hours later I was released to go home. On 31 May the staples and catheter were removed. My follow up appointments are for a PSA every 3 months for one year. (FYI, Roy completed his first follow up with a PSA of 0.0 on 31 May 06.)

My nephew’s father-in-law had the traditional surgical prostatectomy in April 06. He provided a website (http://www.mskcc.org/mskcc/html/44.cfm) and a book ‘Dr. Peter Scardino's Prostate Book’ that was written in 2005. Dr. Scardino is the Chairman of the Department of Urology at Sloan-Kettering Cancer Center. I obtained a copy from our library and found it very informative and thorough on all aspects of Prostate problems and information from Pre Operation through Post Operation.

In summary, both Roy, Gary and I chose the radical removal surgery treatment option.  As stated, the option has provided an excellent outcome, but the emphasis for 58'ers remains - seeking frequent PSA checks and getting professional consultation from a urologist if the PSA outcome is threatening.  Further, gather good objective data about treatment before taking any treatment decision.

Gary Minar’s Report on the Class of 58 website was an invaluable source for both Roy & I. We thank him for taking the time to document and share the detailed information as needed from the patients view.

Gary, Roy and I hope that this addendum along with Gary’s Report can assist you, should the need arise.

 

/s/ Bob Sauer ‘58

/s/ Roy Clason ‘58

/s/ Gary Minar ‘58