I seldom gave much thought to my prostate. As long as everything worked "down there," my small, chestnut-sized gland lived in splendid anonymity.
I never imagined prostate cancer (PC) would happen to me. And I certainly didn't know about its gritty realities. It was the "old man's problem" that most people awkwardly referenced in hushed tones when talking about their grandfathers and great-uncles.
For years, my doctor routinely performed a digital rectal exam of my prostate and ordered a PSA (prostate-specific antigen) blood test. In the spring, my PSA level spiked and I was promptly referred for a prostate biopsy. After three distressing weeks, I learned that the pathology report indicated there was cancer on one side of my prostate. I remember going emotionally numb in that moment.
Seven days after my diagnosis, I was standing in the crowded waiting room of the leading urologist in Atlantic Canada. For the first time in my 64 years, I felt old; this was my new peer group. Some of the men seemed vibrant and carefree, others looked defeated and morose. Which, I wondered, would I become?
My survival instinct kicked into overdrive. I was not going to be a victim.
The surgeon explained my treatment options. I could have my prostate removed (radical prostatectomy) or pursue a course of radiation and/or chemotherapy. If I chose radiation, subsequent surgery would be impossible because of scar tissue.
Then the unexpected happened. My survival instinct kicked into overdrive. I was not going to be a victim. I attempted to gain control of this unsettling situation by intellectualizing it. I tentatively scheduled the surgery, reviewed the information packet from my surgeon, and began researching PC on the internet.
The Canadian statistics are startling: an estimated one in seven men will develop PC during his lifetime, and one in 29 will die from it. In 2017, 21,300 men were diagnosed with PC (21 per cent of all new cancer cases in men) and 4,100 men died from PC; the annual number of new PC cases is expected to nearly double between 2015 and 2030.
The side effects of radical prostatectomy can be devastating to one's self-esteem and sense of masculinity: incontinence, erectile dysfunction, sterility, dry orgasm, and related anxiety and depression. If nerve-sparing surgery is possible, sexual function can return but it takes months, sometimes several years, for regeneration, and often requires various therapies.
The current PC science is inconclusive. There is still no test to determine which PC cases will progress aggressively. The PSA test is not a reliable indicator for diagnosing PC and is highly controversial. Some preliminary studies suggest that patients are being over-diagnosed and over-treated, and that the best approach is active surveillance.
When I told my boss about my cancer, he did something truly wonderful by putting me in touch with a friend who had had prostate surgery six months earlier. He became my mentor throughout the process, relating the therapeutic benefits of keeping a journal and candidly sharing the intimate details of what it is like to be a PC patient — something a physician rarely understands. I felt the bonding of the "brotherhood" as never before.
My mentor had had a robotic-assisted laparoscopic prostatectomy (RALP),which is common in the U.S. but currently unavailable in most Canadian hospitals. RALP is much less invasive and permits faster recovery than conventional surgery; however, there is no significant difference in the long-term outcomes of the two treatments.
I felt the bonding of the "brotherhood" as never before.
The more I learned, the more confused I became. For a week, I agonized over my options. I contacted the nearest RALP clinic in Montreal, but was unwilling to wait six months for surgery with a hostile, unpredictable enemy harboured within my body. I would do everything in my power to avoid being among the 10 per cent who have aggressive PC.
Once I had made my decision to have conventional surgery, I tried to keep distracted from negativity and not to overthink things. Following my mentor's advice, I found a physiotherapist to teach me Kegel exercises to strengthen my pelvic floor and enhance bladder control.
A month after my diagnosis, I walked into the operating room. The surgeon, his well-honed team and I stood briefly in a circle, and he asked if anyone had a question. No one did. There was no turning back. I woke up euphoric that the surgery was over. My hospitalization lasted only two days. As I struggled to sit up and resume walking, I felt helpless and vulnerable. But what I remember most vividly was the medical dramas of patients in much worse circumstances swirling around me.
My wife and I stayed in Halifax for several more days in case of complications. There were none. My spouse provided loving support and care for an often irritable patient throughout this ordeal. Each day, I made noticeable progress, and soon stopped taking pain medication.
I want to give back by doing for others what my mentor did for me.
I became focused on the mundane but crucial tasks of micromanaging my body. Was there blood in my urine? Were my bowel movements regular? Did my catheter bag need to be emptied? Was it clean and sanitized? What type of incontinence pad would I wear when I moved to the next stage of my recovery?
Fourteen days after surgery, my doctor removed the catheter and 23 staples. I was amazed that I had such a high level of continence. Two weeks later, I could drive again. A month after my surgery, I learned that my PC had been contained within the prostate capsule and had not metastasized. I did not require any radiation or chemotherapy, just routine checkups. I felt I had won the lottery!
Still, I braced myself for the other post-operative indignities that might follow. After all, PC does not let you live life on your own terms.
Not everyone would have opted for my response to PC, but I have absolutely no regrets. My encounter with PC has been life-changing and life-affirming. It has taught me the wisdom of living fully and purposefully in the moment. I have joined the YMCA and hired a personal trainer. I am attending a local support group, mentoring a friend's brother through a prostatectomy (I want to give back by doing for others what my mentor did for me), and encouraging all my male acquaintances over 40 years old to have an annual PSA test.
One of my enduring realizations is that PC remains a "guy thing." I have become part of an informal fraternal community outside the medical establishment; as veterans, we take seriously the duty to pass on an accumulated male lore of experience with PC.
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Most of all, as I get back to my life, which will never be the same, I feel immense gratitude as a survivor. My priorities have come into stark relief. Friends comment that I am always smiling, but I also feel humbled to have been more fortunate than many men. I am appreciating that reality acutely this Movember.
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