Joseph
Krak and Kelly live in the United States in Georgia. He was 57
when he was diagnosed in October, 2004. His initial PSA was 3.1 ng/ml, his Gleason
Score was 3+4=7 and he was staged T2a. His choice of treatment was RRP (Surgery).
Here is his story:
One year earlier I had gone for my routine, annual PSA draw and DRE follow-up.
In October, 2004, I returned a week later, after the draw for the PSA. My urologist
was cautious, but optimistic (as I was already on Flomax for prostate issues).
So, as usual, we proceeded to the DRE portion of the annual examination.
I
guess things became a blur after he said the ominous words to me, "Sit down, Joe."
I
had been thankfully pulling up my pants, smiling, glad to have it over with and
prepared to leave his office, officially cancer-free for another year.
I
sat down and he began.
He explained to me that he had felt a palpable mass
on the prostate. He pulled out his Pharamaceutical-company-provided model of the
prostate and showed me the areas of the detection and then explained to me the
Gleason grading system. He staged the detectable mass as a T2a. He explained to
me that, at this point, and with a PSA as low as mine, that the decision to have
a biopsy or not was entirely mine. He also explained that probabilities were that
2 out of 3 men with statistics such as mine would be resolved as having BPH or
some other non-cancerous outcome.
I know my luck, however, and opted for
biopsy. Thankfully my insurance was sufficient, and the urologist was a customer
at my restaurant and I had the biopsy performed while sedated. Our relationship
also resulted in much decision making along the way by the urologist motivated
by a real concern for me as a person rather than a client.
Numbed by my
urologist's words, "Sit down." the day he discovered my cancer, I took my wife
with me for the results of the biopsy.
That day reminded me of every time
I had lain in bed as a small child and contemplated "death" after having fully
digested the new-found concept. I had the same warm, nauseous feeling in my stomach
when he explained the results listed on the paper I held in my hand:
13 core
samples. All had cancer, most had 70-85% cancerous cells, perineural invasion,
but no evidence of escape from the prostatic capsule.
I was devastated!
I knew nothing of this disease, save the fact that I was awakened in the middle
of the night a couple years earlier by the flashing lights of the ambulance which
carried away the deceased body of my neighbor. I learned later that he had died
of prostate cancer. I didn't know what it was. I didn't want to know what it was.
I was convinced I would never have to deal with it!
Reality, though, had
come home to roost! I had it. I had Prostate Cancer. Furthermore, if I listened
through the queasiness and panic I was feeling to what the urologist was saying,
I needed to do something, and I needed to do it sooner rather than later.
We
had another couple meetings before I made a decision. He was honest and fair in
presenting all my options for treatment. He expressed more than once his concern
that, since I was in excellent physical condition and had done my part in taking
care of myself all my life that he would recommend an option which would have
the least effect on my quality of life, but would also offer the greatest opportunity
to extend that life as long as possible given my family history of octogenarians
and centenarions.
He recommended RRP, explaining the other options available.
He spent a lot of time with me detailing the various procedures, their outcomes,
and their side effects. He pulled no punches and he came highly qualified having
performed over 300 RRP's in residency. He also went so far as to present my case
to his professors and colleagues as he considered my cancer (which presented itself
in less than a year and which also indicated its aggressiveness in the low PSA
it presented) a departure from the norm.
He also explained to me that Protate
was one of the slower growing cancers, though, mine was an anomaly and he recommended
treatment sooner, rather than later.
On December 7, 2004, I underwent RRP.
I chose this treatment because I had, since diagnosis, been online with various
support groups and I had researched until my fingers could no longer type. All
signs and suggestions pointed to the fact that my young age (57) suggested RRP
as best among treatment modalities. My urologist recommended it, after having
first explained the concept of "nerve sparing" and Robotic Laparascopic Prostatectomy.
He stated simply that in RRP he would actually be able to "feel" tumorous tissue.
I
was fortunate to own an established restaurant at the time. I had a good health
insurance and was able to take the entire two months after surgery that I required
for recovery. I was, however, not prepared for the post-surgical biopsy: Gleason
4+5=9, especially since the urologist staged it as not involving the lymph nodes
and not having escaped the prostaic capsule.
I was a miracle! I had almost
the highest Gleason score I could have and yet the cancer had not detectably escaped
the prostatic capsule, had not involved the lymph nodes, and, had not metastasized.
The
key word here is "detectably." It was explained to me that metastases could present
themselves much later from the escape of even a few cancerous cells, which would
not present themselves as detectable at the time of escape. Having been a member
of enough support groups to understand the concept and what remedies were available
to me, I decided to consult an oncologist (again, known to me as a patron of my
restaurant, a friend, and regarded in the medical community as on the "cutting
edge" in treatment modalities).
It must also be stated that my urologist
met with my wife after surgery. She swears he had a tear in his eye (he is only
41) as he told her that he just "had a feeling" while performing the surgery and
the evaluation and, based upon that feeling, decided against "nerve-sparing" and
removed nerve bundles on both sides of the prostate as well. Thus, erections were
not part of my decision making in choosing further treatment modalities.
The
oncologist explained that he already had two other patients presenting even more
severe Gleason grades whom he had been treating based upon newer treatment modalities.
Though there was no protocol for these modalities, he was having significant success
with them with these two patients. As he explained the modalities, I recalled
having seen comments and scientific articles about them from the support groups
I was on.
I chose his recommendations and began a regimen which included
first chemotherapy, followed by Lupron therapy for one year and 72Gy EBRT (External
Beam Radciation Treatment).
I have remained undetectable since the RRP
and rolled the dice on the Oncologist's recommendations for additional therapy.
Though my urologist assured me that he had removed all the detectable cancer,
I truly wish to fulfill the family legacy of centenarians!
Joseph's
e-mail address is: fanniesbake@etcmail.com
