by Jim Sliney Jr
Ken L., a scientist and passionate painter in New York City underwent treatment for prostate cancer. He is in remission now but there was a moment where the decision to get a second opinion may have saved his life.
WHAT IS THE PROSTATE?
The Prostate Cancer Foundation describes the prostate as “a small, squishy gland about the size of a ping-pong ball.” The prostate plays an important role in reproduction, because it supplies the seminal fluid, which mixes with sperm to create semen. The prostate gland is located between the base of the penis and the rectum.
WHAT GOES WRONG WITH THE PROSTATE?
The prostate gland continues to grow gradually as men age. Here are the three primary problems that people experience with their prostate all of which relate to its enlargement.
- Benign Prostatic Hyperplasia (BPH): the prostate naturally grows with age. If it grows too much it can begin to obstruct urination. BPH is not cancer.
- Chronic Prostatitis: a common inflammatory problem also called Chronic Pelvic Pain Syndrome. Pain may appear in the lower back, groin or penis.
- Prostate Cancer: Like all cancers, cells grow out of control and crowd out normal cells.
HOW TO TEST THE PROSTATE
Tests to detect problems with the prostate include:
- Digital rectal examination (DRE): a physician will place a gloved finger into the rectum and feel the size and shape of the prostate. They are also looking for hard areas or growths, where such growths are on the prostate and pain sensitivity.
- Prostate-Specific Antigen (PSA): a blood test that can measure the levels of this antigen. The higher the number, the more aggressive (and potentially dangerous) growth is.
- Ultrasound of the prostate: gets a sound-picture of your prostate
- Biopsy of prostate tissue: taking a sample of the tissue of the prostate to look for cancer cells
LET’S WATCH AND WAIT
Ken told Patients Rising,
“My first and only symptom was frequent urination, particularly at night. My doctor monitored me for 5 years before I was diagnosed with prostate cancer. I was examined at every visit. Urologists are very keen on doing digital exams! But they only showed an enlarged prostate, not necessarily cancer. I often wonder if I should have had a biopsy performed sooner – I think he should have ordered a biopsy when my PSA got to be about 10.”
Having some Prostate Specific Antigens in the body is normal. If the PSA is in the normal range, it is common for doctors to take a “watchful waiting” approach where they assess the risk of cancer over time. But the definition of “normal” has been changing.
Until 2008, medical professionals encouraged yearly PSA after 50 years old. Technically, a PSA value between 0 – 4.0 ng/mL is “normal” but higher numbers do not necessarily indicate prostate cancer because other factors like infection or inflammation can cause the number to go higher. More recently, “normal” varies by age and race. The value of watchful waiting is important because for many years prostate cancer was treated too aggressively which led to anxiety and other reductions in quality of life not to mention dangerous medical procedures.
Ken was seeing a urologist that his internist had referred him to. That urologist “watched” but may have done too much “waiting”. It wasn’t until Ken went to a different urologist (“because my first doctor stopped accepting Medicare”) that he was quickly biopsied and officially diagnosed with prostate cancer.
MAKING INFORMED DECISIONS
A specialist determines what treatments are appropriate and when based on what they know about the cancer.
Ken says, “I initially saw a urologist and radiologist at one hospital. I thought they explained the possible treatments and side effects very well. But looking back, I think I should have looked into other therapies, like lower-dose-radiation, more carefully.”
Being informed by your doctor is both your right and their responsibility. But responsibility also falls on the patient to get all the information possible to make an informed decision. Ken is a scientist and knows much more than the average person about how cells work. However, that didn’t make ‘being informed’ any easier because, as Ken points out, “It is difficult even for a well-educated and somewhat knowledgeable person to make rational decisions when confronted with cancer.”
That’s because a cancer diagnosis is unlike any other kind of diagnosis. Knowledge does not protect you from the mortal shock of cancer. In that state of shock, you are still expected to make huge decisions relatively quickly. This may be the best reason to take the time and get more than one professional perspective on your condition.
THE VALUE OF A SECOND OPINION
Ken’s next step was to get a second opinion. Ken’s Medicare, like most insurances, cover a second opinion, possibly a third if needed (call and ask). Some insurers ever require a second opinion.
“I consulted a urological oncologist. He initially suggested to continue monitoring but after he got a second opinion of the pathology slides (biopsy results) he recommended immediate treatment.”
The doctor at Ken’s second opinion appointment, himself got a second opinion of the biopsy results. If Ken didn’t seek a second opinion, and if that doctor hadn’t sought one, Ken’s treatment might have been delayed and that may have been the difference between successful treatment and disaster. Always get a second opinion.
TREATMENTS for PROSTATE CANCER
Ken and his doctor made a plan. Ken received hormone ablation therapy followed by targeted external beam radiation therapy.
- Hormone Ablation Therapy: also called Androgen Deprivation Therapy (ADT) or Androgen Suppression Therapy. Androgen is a male sex hormone. By lowering androgen levels or stopping androgen from reaching the prostate cancer cells, prostate cancers often shrink, or stop growth. However, it is not a cure.
- External Beam Radiation Therapy (EBRT): Literally shooting the prostate cancer cells with focused beams of radiation to kill them. There are other types of radiation therapy like Three Dimensional conformal radiation therapy (3D-CRT) or Intensity modulated radiation therapy (IMRT). They work on the same principles as External Beam RT.
There are other treatments options as well that Ken and his doctor did not opt for:
- Chemotherapy (anti-cancer drugs that go throughout the body)
- Radical prostatectomy (removal of the entire prostate gland plus some surrounding tissue and the seminal vesicles)
- Radioactive drugs (similar to chemotherapy)
Ken is now considered to be “in remission”. He will be considered “cured” once he has been in remission for 4-5 years. Not only is he still painting, he and his wife travel to painting classes through the U.S. and Europe. He is optimistic, and with good reason.
More technologies and treatments are available than ever before to treat prostate cancer. Understanding what his options are and staying vigilant, yet patient, reduces the fear of recurrence and gives him the best chance of success going forward.
Jim Sliney Jr. is a Registered Medical Assistant and a Columbia University trained Writer/Editor who creates education and advocacy materials for patient support groups. He has worked closely with several rare disease communities. Jim also coordinates the patient content for PatientsRising and collaborates with other writers to hone their craft. He’s a native New Yorker where he lives with his wife and all their cats. Connections: Twitter Quora Email