In Sickness and in Health

The weeks that followed remain a blur for both of us. Thankfully, there was no evidence the cancer had spread to the bone or to any other organ. But that didn’t mean we were out of the woods. It was no longer a question of if or when to deal with Bob’s prostate cancer, but how. To quote Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer, Bob was in the “gray zone,” confronted with the choice between surgery or a combination of hormone and radiation treatments. “Here, after weighing all the facts, is where your own judgment matters most,” Walsh writes.

After hours of research, doctor visits yielding multiple opinions, and a clinic case review at a leading research hospital, we arrived at what we thought was our final decision. He’d undergo radiation and hormone therapy, rather than surgery. Because the cancer had already escaped the prostate, eradicating the cells and attempting to slow their spread seemed our best option. The two surgeons we spoke to were reticent to try to remove the prostate; the chances were small that they’d get all of the cancer that way. Further, even to attempt surgery, they’d have to take out more of the surrounding tissue than if the cancer were contained in the gland, and they would not be able to spare the nerves necessary for sex.

This was not, they explained, a cure. But it was the best advice they could offer given the circumstances.

Bob and I were still struggling to come to terms with this choice when a chance meeting changed everything. I was
at a business lunch in my role at the time as senior vice president of sales and marketing for the Baltimore Sun. At the lunch was prominent local urologist Dr. Sanford Siegel, who had joined me to discuss advertising for his large practice. But Bob’s condition was never far from my mind, and when the subject of the newspaper’s support for a prostate cancer fundraiser came up, I couldn’t stop my tears.

I tried to apologize for the distraction, but Siegel would hear none of that. “Who cares about business? This is a matter of life and death,” he said.

He insisted on conducting a case review on the spot, gathering information from me, and asking some of his colleagues, who happened to be having lunch in the same restaurant, to comment on Bob’s condition. He then made a phone call and paved the way for us to see a colleague, Dr. Herbert Lepor of New York University Langone Medical Center, who specializes in complicated prostate cancer surgeries.

Bob and I met with Lepor the next week. Unlike the previous surgeons, he advocated surgery, telling us there was a good chance he could remove all the cancer and Bob could retain continence. He did warn there was only a 50 percent chance he could spare enough nerves for Bob to achieve an erection, but Bob was OK with that. “I don’t want to live with a ticking time bomb inside of me,” he said.

Although complex, the procedure was by all accounts successful. Surgical margins — the area on the outside edge of the tissue that was removed — were clear of cancer. Bob’s PSA level post-surgery was undetectable. However, the cancer cells that were removed from his prostate were more aggressive than the biopsy samples had been and there was a “speck” of cancer on one lymph node. Statistics show that based on these findings Bob was at high risk for recurrence as micrometastases — undetectable areas of cancer outside the prostate — may have spread from this lymph node into other parts of his body. He was clearly better off than if they’d merely targeted the cancer with radiation and hormone therapy.

Still, once again we were in the gray zone. Should we do radiation right away (which could potentially cause the side effects we had hoped to avoid by choosing surgery) or wait and see if there were more definitive signs of recurrence? Once again, the PSA test was the tool for guiding our decisions. Monitoring his PSA level every three months, we got good news each time — undetectable. And statistics show that an undetectable PSA after the first year is a very good sign that the cancer has not spread.

So in September 2013, we celebrated our second Prostate Cancer Awareness Month with two milestones: my husband’s 60th birthday and one year cancer-free. We went on a dream trip, a safari in Tanzania, where we witnessed one of the most dramatic life-and-death scenarios in nature — thousands of migrating wildebeest crossing the Mara River, dodging fierce crocodiles. We will always remember hearing the Swahili version of “Happy Birthday” and sharing a cake with our fellow travelers in the central Serengeti.

We came home just in time to participate in our local ZERO Prostate Cancer Run/Walk fundraiser. In addition to a blue ribbon, Bob was given a cap labeled Survivor. That cap seemed to make him a safe person for newly diagnosed men to talk to about treatment options. Bob argues that it’s not fear that keeps men from asking questions, but rather a lack of reliable sources: “They don’t know where to turn. I sure didn’t.”

Bob also implemented a radical lifestyle overhaul to make his body as inhospitable to cancer recurrence as possible. “I have taken responsibility for my body and health in ways I never imagined a few years ago,” he says. After working with a naturopathic doctor who specializes in helping prostate cancer survivors, Bob now makes kale smoothies with a top-of-the-line Vitamix blender for breakfast, takes supplements, and works out almost every day.

Bob was never incontinent, but he did struggle for a time with sexual performance. He worked with a doctor at Chesapeake Urology and now, with the help of injections, our sex life is back.