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PROSTATE CANCER SUPPORT SITE

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Mike Horridge [pictured here with his grandson] and Patty live in Texas, USA. He was 63 when he was diagnosed on March 21, 2007. His initial PSA was 3.9 ng/ml, his Gleason Score was 7 and he was staged T1c. His choice of treatment was Robotic Laparoscopic Surgery. Here is his story:

I live in San Antonio, TX, and on March 21, 2007, was diagnosed with prostate cancer. The cancer was judged to have a Gleason rating of 7 (4+3), but a T1-C stage. We discovered the cancer after my PSA tested in November, 2006, went from 3.1 ng/ml to 3.9 ng/ml in late January 2007. I had the second PSA test due to a physical required prior to cataract surgery done in early March, 2007. My General Physician, Dr. Sam Sayegh, gave me a clean bill of health for the surgery, but told me that he was sending me to a urologist, Dr. Louis Russell, due to the significant percentage increase in my PSA in less than 90 days. Dr. Russell did 9 biopsies on Monday, March 19. He called me on Wednesday to tell me they had found cancer in the upper left quadrant.

I found YANA and read just about every account, in addition to everything I could find on the internet. My spouse read everything I did and helped me with the research. She also went to each of the doctors with me, and agrees with my decision below.

I decided to interview two doctors: The first was Dr. Brad Prestidge,a oncology radiologist in San Antonio. He is noted for his experience (3,500 operations) and knowledge of radioactive "seed" technoloy. The next doctor was, Dr. Naveen Kella, also of San Antonio, who has done about 550 robotic laparoscopic prostate removals using the Da Vinci robotic technology marketed by Intuitive Surgical.

In summary, I was concerned about the stories from my friends and associates who had chosen radiology treatments and decided after meeting with Dr. Kella to go with full removal, hoping that the cancer is contained in the prostate. To test for containment, I have decided to have a "hybrid" Positron Emission Technology (PET) Scanner test prior to surgery. This test is offered by Dr. Prestidge's organization, Texas Cancer Clinic. The exam requires that I receive a shot of special radioactive isotopes that will attach themselves to each prostate cancer cell, and five days later I will receive a "CT Scan." The results will provide a color picture of locations of prostate cancer cells. Dr. Kella is aware of older tests like this, but agrees with me that even if the test is only partially accurate, it will be better than nothing prior to surgery.

We have tentatively scheduled the surgery for mid-May. I am writing this on Easter morning, April 8, and have made a commitment to lose weight, exercise more and attempt to "get ready" for the surgical procedure that will occur in about 5 weeks. I will update this entry as things develop. If you wish to review the surgery, just go to Dr. Naveen Kella's web site at Urology of San Antonio. There is also another organization in Austin, Texas, where a Dr. Fagin has done nearly 900 of these same procedures.

Good luck to us all!

 

UPDATED

May 2007

 

 

It's May 15, 2007, and the day before my surgery which shall begin at 7:00 AM at St. Luke's Baptist Hospital in San Antonio, TX. Since my initial input, much has happened. Here's a few of the highlights:

My wife and I went to the Gulf Coast of Texas on April 2 to relax and reflect for the month. I made it 2-1/2 weeks since all I kept thinking about was "I've got so much to do!" (There's a certain 'finality' to having cancer that makes completion of projects of paramount importance.) I spent the next week in tests and working physically hard on our country place which kept my mind busy and helped me to lose some weight and gain some new muscles I haven't used in 10 years.

On April 20th I was injected with a special radioactive isotope (monoclonal antibody) that has been developed to help identify prostate cancer cells in our bodies. The procedure is called a ProstaScint which was approved by the FDA in 1996. On April 25th I received two gamaray scans and a cat-scan and the images were combined via computer into a single color image that highlighted the cancer cells. The results were bad news, good news and confusing. The image results showed that the cancer is outside the prostate and is in the s. vesicules. The good news was that is seems my lymph nodes are clear. The confusion came from the fact that my biopsy had shown that the cancer was in the upper left quad of the prostate and the ProstaScint showed it on the right. No idea why this occurred but it makes the output from the scan(s) suspect.

I was able to talk to the surgeon, Dr. Navene Kella, on May 2 and just asked him the bottomline .... would he operate based on the test results and did he think he could be successful. "Successful" is defined as full removal of the cancer, not me paying my bill in a timely fashion.

Dr. Kella does not normally recommend the ProstaScint to his patients, because it has had a history of not being entirely accurate. Some of this is due to the fact that the output of the ProstaScint used to be black and white which made it difficult to differentiate cancer cells from other cells. Changes now allow a color output that helps the radiologist to "see" the cancer more clearly. He seemed confident about my situation and we decided to proceed foward with the surgery. If he does not get all the cancer, our follow-on strategy after the removal of the prostate and s. vesicules is: radiation, hormonal therapy or chemotherapy, not necessarily in that order. He did not recommend seeds after surgery.

The reason for this update is to let you know what has happened since my diagnosis and that my head is spinning right now; not, from fear of surgery, but from concern about the unknown outcome tomorrow. My over-prostate-cancer-educated head is saying things like: What will it mean if I wake up at 8:30 in recovery? Will it mean the cancer had spread too much to operate? What is Dr. Kella going to tell my wife, family and friends after surgery? How will that change our lives? etc. etc. When you are used to "being in charge," the unknowns are the scary things of life.

More after surgery. Good luck to all.

Mike

UPDATED

June 2007

 

June 2, 2007 - Update - Post Surgery:

We met with Dr. Kella on May 25th to obtain the post-op pathology reports. After 5 to 10 mundane questions about using the hot tub, when can I play golf again, and how much weight can I really lift after two weeks, I asked him for the results. My preamble to him was, "Dr. Kella, I would like the results of the pathology report, and your answer will have a direct affect on whether you are placed on our Christmas card list, or not."

The results were excellent. According to pathology the cancer was Gleason 3+4 not 4+3 and was totally contained in the prostate. It was positioned very close to the capsule (the outside of the prostate ... I think that was the right word) of the prostate and we were very fortunate to have found it as early as we did. The tumor type was an invasive prostatic adenocarcinoma. Tumor grade was Gleason score - 7 = 3+4, and poorly differentiated. Tumor extent overall: 4%. Right lobe = 2% Left Lobe = 2%. There was NO invasion in the seminal vesicles. No detectable involvement in the lymphovascular areas sampled after surgery, and no indication of any cancer in the surgical material (extra "steak" carved) taken around the prostate. Left and right pelvic nodes were negative for malignancy. HOOORAH!

So, now my nasty prostate is in a jar on a shelf and we can all look at and laugh at it. Now our hope is that none of those itsy bitsy microscopic cancer cells don't show up in the future. I am feeling excellent now.

Personal comments:

1. The ProstaScint test was dead wrong about cancer outside the prostate. That only part of the report that agreed with the actual results was that there was no cancer in the lymph nodes. As you can see from my last update, it had indicated cancer outside the prostate. Dr. Kella was kind when I questioned the time, effort and cost of the test when he stated, "It would appear they got a false positive." That's his classy way of saying the results were worthless. Maybe they will improve that technology in the future, but based on the test’s results as compared to actual results, I thought it was a waste of time. Never mind the worry the “false positive” created prior to surgery thinking the cancer was outside the prostate.

2. The post operative care I received at St. Luke's Baptist Hospital in San Antonio was some of the finest medical care I have ever had. Dr. Kella's classy approach to pulling my wife and son out of the post-op waiting room into a private conference room and updating them on the results of my surgery rather than going through all the details in front of friends and strangers, speaks volumes about how doctors should treat families as well as their patients. There are some major changes coming in medicine today and I hope each and everyone of your experience the next philosophy of treating the family and patient in medical situations.

3. The worst part of the surgery was the catheter. I have never had one before and didn't like it one bit. I was amazed how quickly you urinate with no prostate between your bladder and penis. You feel like you have to go, and you better get ready to go. I also have begun to understand why those “bladder spasm” pills are helpful after surgery. They allow you to control the urge to urinate.

4. It's 17 days after surgery and about the only incontinence I am experiencing is when I sneeze or cough. I am having no problem holding my urine, but have found it wise to not to try to hold it too long. Am wearing the pads just as insurance, but am having no problems at night or during the day, except as noted.

5. I have started taking Levitra twice a week to wake up the urge again. Actually felt like I had an erection with the catheter in. That was an interesting experience.

In summary, I am grateful to about everyone in the world right now. (Please, no one ask me to send a donation to their favorite family member.) I won’t be updating much for awhile. My next exam is August 28th when we will get my PSA score. Let’s hope it is 0.00000!

Good luck to all.

UPDATED

August 2007

 

Good news received today, August 24, 2007. My PSA value came back as 0.00 three days before my three month check up with Dr. Kella, the surgeon who performed the robotic assisted surgery.

TBTG !!! Mike.

 

UPDATED

December 2008

 

Great news. After 18 months, my current PSA is staying at 0.00 so it looks like the surgeon got all of the cancer.

Unfortunately, he also got some of the nerves that affect ED as well, so am having to deal with those issues. At 66 I know my sexual drive had been on the decline before the surgery, but after the surgery my imagination and innovation has to prevail. Fortunately, I am married to an incredible woman who is open to talking about these issues and we are working through them. I have tried the external pump and it does work, but seems so foreign to our natural way of doing things I understand from friends that the internal pump is terrific, but again, I think we have to be honest with ourselves and ask what other factors may be affecting our sex drive: weight gain, age, or whatever?

I have asked myself many times if I should have chosen radiation instead of the surgery and still come to the same conclusion that the robot-assisted laparoscopic surgery was the way to go. My recovery was quick. I have had an occasional erection that surprises me, even though it doesn’t last very long, and I have lots of fun snuggling with my wonderful love of my life.

 

 

UPDATED

January 2010

 

Have 0.00 PSA and am now on a yearly cycle with my doctor/surgeon.

Unfortunately have experienced some serious ED issues which is a combination of age and the surgery. I’m glad the prostrate is gone with the cancer, but am saddened by the head problems ED delivers to the patient.

 

Mike's e-mail address is: dmhorridge@stic.net