Prevention
My life’s work is preventing diseases. The first question you might ask is “can prostate cancer be prevented?” It can be if you avoid risk factors. Here are some of them:
1. Choose your parent’s well, because there is an association with prostate cancer if you father and/or male relations had it.
2. Age. As males get older, their chance of getting prostate cancer increases. Most men will get prostate cancer, but they won’t die from it. Mostly it is very slow growing. However, we cannot distinguish yet from slow growing cells and fast growing cells.
3. Diet. A high fat diet is associated with (but does not necessarily cause) prostate cancer.
4. Smoking is associated with higher levels of prostate cancer.
There have been clinical trials using selenium and vitamin E supplements. These were halted in late October 2008 because not only did they not show a protective effect, but they were causing some other problems with the study subject’s health.
In my case, my father had prostate cancer. That’s one strike against me, but that’s something I didn’t have much choice in. The same goes for ageing. At my age (56), there is a one in one hundred chance that I could get prostate cancer. Lucky me. My diet is low in fat and always has been. I don’t smoke and haven’t had a cigarette since my experimental teen years. In short, there wasn’t much I could do to prevent it. There are web sites that tout supplements and special milk shakes that you purchase from them. These are all nothing more than shameless snake oil. Avoid them. Avoid any business that says they have a purchasable prevention method for prostate cancer. It doesn’t exist.
Treatments
I started reading about the treatments. Treatments fall into two broad categories: you can either remove it or leave it in. There is actually a third alternative: no treatment or more precisely, something called “watchful waiting”. I’ll tackle these one at a time.
Removal: This is called a radical prostatectomy. This is where a surgeon removes the entire prostate and possibly some surrounding tissue and lymph nodes. It can be done by cutting the patient open through a variety of places near the prostate, but the most common one is straight up the middle. An incision is made in the abdomen, thought the abdominal wall and they just open you up, cut out the offending parts, and then sew you back up. Pretty simple. The other, newer way is to use a robot to perform the surgery. Six holes are poked though the abdominal wall and various instruments are poked though these holes, such as microscopes, lights and reticulating “fingers”. The stomach is distended with CO2 gas to give the surgeon more space. The microscope blows the image up by a factor of 10.
In Place: There is radiation therapy, either by external beam or brachia therapy (or seeding). There is also hormone therapy, whereby the patient is given drugs that halt the production of testosterone, which in turn is supposed to stop the growth of the tumor. And finally, there is cryotherapy. It kills the cancerous prostate tissue in place by freezing it.
This story isn’t going to go into great detail about every treatment option, as it would take too long, but I’ll briefly go over the ones that I considered. More detail can be found at www.cancer.gov/cancertopics/types/prostate
The most distressing of all these treatments is that all of them have possible negative outcomes. With all of them, there will be incontinence and impotence. All men undergoing any of these procedures, and I mean every one of them, will experience both of these maladies, for at least some period of time and possibly forever. Other than dying, these outcomes are the most important to a man, and in particular, this man. If you have to go around wearing diapers for the rest of your life or not be able to engage in the joy of sex, then life isn’t much worth living, is it? Now, I know there are veterans with arms and legs blown off or who are paralyzed due to war injuries who seem to be getting along fine and are downright inspirational in their abilities to overcome their adversities and lead a joyful life. But I’m not them right now. I am a guy who is in near-perfect health, who did everything right to be that way, and right now, life as I knew it was over.
My odds of being incontinent post-surgery were 100%. Normally, most men would overcome this problem in six weeks to three months. I would have to wear kotex-like pads to catch the leakage. I could be one of a few percent that it would be worse and would have to wear Depends. There was a chance that I would have leakage the rest of my life.
Impotence was another matter. I’ll let you in on a little secret, just so that you can get an idea of my frame of mind at the time. I’m 56 years old. Never in my life have I had what is termed “a failure to launch.” A little research was telling me that 50% of men aged 40 to 70 experienced erectile dysfunction. I am by training and education and epidemiologist and I could tell that there was something very wrong in the way this statistic is presented, especially if you are 56. It lumps old men in the same group as young men, both healthy and unhealthy. I couldn’t tell how many 56 year old men are impotent. The only thing I could really tell from his statistic is that there were a whole lot of men with ED out there, like it or not. I also couldn’t tell from statistics (and you rarely can) who is actually dissatisfied with their condition. Statistics are cruelly cold and lack depth, emotion and quality. That statistic did me absolutely no good in assessing my situation, because I was fine at the moment. Other statistics said that if I had a radical prostatectomy, that my odds of regaining potency were only 80% and that I would be impotent for between six months and two years. That also means that the odds that I would be permanently impotent were 20%. And that was for a man my age that was in excellent health. I hated those odds. They weren’t good enough for me to relieve me of any stress.
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