Don't Let Them Cut You, Man!

By: Billy Glad, Saint Joseph Michigan
writer, film maker, photographer
Open (June 9, 2010)

When I found out my friend had been diagnosed with prostate cancer, I wanted to say: Don't let them cut you, man. I don't know anybody who is glad they had surgery. I never heard of anybody who is glad they had surgery. Resigned to it, maybe, but not really glad.

On the other hand, I never heard of anybody who is not glad that they had their prostate cancer treated with proton therapy, a 190-ton cancer-killing machine that can zap a tumor with sub-millimeter precision while sparing healthy tissue and causing very few -- if any -- side effects.

While you can and should advocate for something you believe in as strongly as possible in general, it doesn't work to try to tell the people you know personally what to do. It would be horrible if, after I advised him against it, my friend decided to risk surgery and it didn't turn out well, but even more horrible if he saw me as a constant reminder of his mistake. So I turned over all the information I had about treatment options for prostate cancer to him, hoping he'd come to the same conclusion I did and stay away from the surgeons.

It didn't turn out that way. Today he told me that, after meeting with three urologists, he's "comfortable" with surgery.

I can't imagine how anyone can get comfortable with an operation that is going to remove their prostate, their seminal vesicles, some lymph nodes and the involuntary sphincter that controls their urine, but all I could say was: Go to a good surgeon then.

Here's what someone I met at the Proton Therapy Center at MD Anderson in Houston, Texas, told me about the way surgeons make their pitch. He was getting "salvage" proton therapy to cure his cancer after a prominent surgeon in New York City botched the job.

The urologist is a surgeon, and, no matter how well he covers your other options, his emphasis will be on a surgical solution. He's not likely to recommend another surgeon either. In his mind, he is your best option.

He'll probably tell you about the factors in your case that favor surgery. He'll say your Gleason's score is low and that your cancer is in an early stage. The chances are your cancer hasn't spread outside the prostate yet. You're young. You'll recover quickly from surgery. You're healthy. The risk of complications is slim. You'll be in and out of the hospital in 1 to 3 days. Although a small percentage of patients have urinary or sexual problems, you'll probably be back to normal in a matter of months. If you have laparoscopic surgery, you'll recover even quicker. Robotic is better still.

He'll say your cancer is probably within the margins of the prostate, and, if you cut the prostate out, you'll remove the cancer entirely.

He'll warn you that hormones don't work in the long run, that you'll lose your sex drive and get osteoperosis. Your body parts will shrink. And he'll be sure to tell you that you might grow breasts.

He'll say radiation takes months and you have to go to the hospital every day. The radiation could damage your bladder, the wall of your rectum and other organs. He'll warn you that radiation destroys healthy cells along with the cancer, damaging everything from the epidermis as it enters your body to anything else it touches on the way out. Surgery will leave you with only minor scars.

Then he'll tell you that you can always try radiation if surgery fails, but if you try radiation first and it fails, there is nothing more a urologist can do for you.

Although everything he'll tell you about hormones and traditional radiation therapy is true, he won't mention proton therapy at all.

And he won't tell you that even if your sexual function can be maintained after surgery with ED drugs like Viagra and Levitra, when you achieve orgasm, you won't be able to ejaculate. Surgery not only removes the prostate, which supplies 25 per cent of the ejaculate, it removes the seminal vesicles that supply the other 75 per cent of your come as well. The tree shakes, but the leaves no longer fall.

Like my friend, my fellow patient was sold.

He decided on surgery and the operation was performed at a major hospital by an acknowledged expert in robotic surgery. He was out of the hospital in 24 hours. Like all surgery patients, he went home with a catheter and walked around with a urine bag taped to his leg -- in his case for 17 days. About 6 weeks after the catheter came out, he noticed his stream weakening, and then it stopped completely. His surgery had resulted in a stricture, assumed to be scar tissue abnormally growing around the point where his urethra was severed to remove the involuntary spinchter, then rejoined. He was made to feel that it was his fault that his body didn't heal properly, that it had nothing to do with the way the surgeon put his urethra back together.

At that point, he was required to insert a catheter into himself a couple of times a week to keep his urethra open. The surgeon told him it was no big deal; many people live like that.

After 8 weeks, he had a follow-up PSA test to make sure his cancer was gone. Even with a successful surgery, some prostate tissue might be missed, or the cancer might have crept outside the margins of the prostate before the surgery.

His cancer was not gone. He was forced to move on to radiation, and the radiation oncologist's MRI revealed a startling fact. The surgeon hadn't removed all of the prostate after all. He'd left almost a third behind. Radiation planning was suddenly tricky and hard. Traditional radiation therapy seemed too dangerous, but, in 3 months of consultations at 3 different hospitals, the medical establishment had nothing else to offer.

A friend of his recommended proton therapy. His wife did some research on the web, and my fellow patient ended up at the Proton Therapy Center at MD Anderson in Houston for two months.

Why, he asked me one day, would I travel 1500 miles to Houston, stay in a cheap hotel, be away from home, work, family and friends for 2 months, if all I could get here is the same risky radiation I could have gotten in New York? That's a rhetorical question, of course, because he and I both know that proton therapy is different. It cures cancer as well or better than traditional radiation, but with none of the side effects.

Here's what he said when he wrote to tell me his PSA was now undetectable.

"It is a big decision for anyone, but I've seen both sides of the coin. I am envious of the MD Anderson patients who seemed to vacation through their 2-month treatment, without worrying about surgical complications and with confidence that proton radiation wouldn't adversely affect their health."

It is a big decision, and it's hard for me to believe that someone would make it without questioning the proposition that proton therapy and other forms of radiation can be used to salvage botched surgeries, but they shouldn't be used as the primary treatment for prostate cancer. It seems to me if a treatment can kill cancer cells at the margins of the prostate, it can kill them while they're still confined to the prostate just as well, and kill them before they ever have a chance to spread.

So, if you've just been diagnosed with prostate cancer, I'm telling you what I can't tell my friend.

Don't let them cut you, man. Not until you've talked to a radiation oncologist at one of the 7 proton therapy centers in the United States -- or at least given The National Association For Proton Therapy's site a good look.

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