Bob (not his real name) is an 82-year-old prostate cancer survivor. He was diagnosed with prostate cancer in 2009, at the age of 68, and had a prostatectomy that successfully removed all cancer. Bob’s journey demonstrates why having regular prostate-specific antigen (PSA) screenings and following up with your doctor regularly is so valuable and important.
Bob had been receiving PSA tests annually since he was “around 50” as part of his yearly health check-ups with his primary care physician. Around 1999, when he was still in his fifties, he had trouble urinating, which prompted him to see a urologist. Bob’s urologist diagnosed him with an enlarged prostate and began to monitor his PSA closely.
Bob’s urologist proactively monitored Bob for cancer, using biopsies to assess risk and to diagnose. Some physicians will increase the number of tissue samples taken during the biopsy procedure if the probability of cancer is higher.
“After watching my PSA bounce around a little bit,” Bob said, his urologist performed a biopsy consisting of six prostate tissue samples, “and everything was good.” A couple years later, his PSA levels still fluctuating, his urologist conducted a biopsy of 12 tissue samples, “and that was okay” too, he said. No cancer had been detected.
But, as Bob explained, his PSA levels continued “bouncing around all over the place.” After consideration, his urologist commented, “‘You know, I’ve been fooled too many times,’” and in 2009 ordered a biopsy of 36 tissue samples from Bob’s prostate.
Prostate cancer diagnosis
Bob knew that prostate cancer was a possible explanation for his fluctuating PSA, but, he said, “at that age, I kind of considered myself bulletproof. So, I discounted it, but knew it was a possibility.”
When the results of the more intensive, 36-sample biopsy came back, “they did find cancer,” he said. “It was located more to the center versus the exterior of the prostate gland, so it was relatively early stages. And there was a good chance of getting it.” He was grateful his urologist had been so proactive.
Next steps toward recovery
His doctor offered a “number of solutions,” for treatment, he said, which he considered. He also spoke with friends who’d received prostate cancer treatment. One option was “isotope therapy” (a.k.a brachytherapy, an internal radiation therapy also called “seed implantation” or “interstitial radiation therapy”), which one of Bob’s friends had received. “All was good” for his friend for several years, but then PSA levels started to increase again.
Another option was manual surgery to remove the prostate (prostatectomy). “A good friend of mine had the manual surgery, very successful, but it was a long recovery time with the long incision,” Bob said.
A robotic-assisted prostatectomy was a third option. Another friend of his had had this procedure at a large academic hospital. It required only three small incisions, and therefore had a much shorter recovery time.
After weighing his options, Bob decided to have a robotic-assisted prostatectomy, which he described as “three tiny little, little holes. That was it. I stayed in the hospital one night; I walked to the car the next morning.”
Prostatectomy recovery and side effects
As he expected from minimally invasive robotic surgery, “The recovery itself was very rapid,” Bob said. “I was biking again in about six weeks.” There was, unfortunately, a side effect of the procedure. “The only unfortunate downside is I lost the ability to have an erection,” said Bob. “I dealt with it, but that was the side effect.”
After the operation, his doctors sampled tissue from the prostate, near the biopsy site, and from the surrounding lymph nodes, “and everything was clear,” Bob said, “so I had no chemo, no radiation.”
Looking back, Bob wondered if manual surgery, as opposed to robotic-assisted surgery, might have spared him the side effect of erectile dysfunction, but overall he felt gratitude.
“I survived prostate cancer. I know people who have had radiation and chemo, and I was very fortunate not to have to go through that part of it. I had very, very good medical support,” he said.
Reflections on the prostate cancer journey
Bob felt he was well informed about his treatment options and went into the procedure with a practical mindset. “I didn’t really have any fears,” he said. “You know, there’s always uncertainty, but I didn’t stress out about it.” The scariest part of the process, he said, was the shock after diagnosis that “something serious like this is happening to me,” and “maybe the realization I’m human after all.”
Not surprisingly, the experience changed him on more than just a physical level. “My episode with the prostatectomy was one of those steps in growth, realizing what’s important in life and what you should focus on with whatever’s remaining,” Bob said.
“I’m 82. And I know I’ve got a few years left, but not unlimited–like it used to be in my mind. It makes me more willing to let go of this life and focus on what I’m taking with me: my connection with God and my connection with other souls.”
Although Bob’s cancer was caught in early stages and his procedure was successful, he remains vigilant: “I still monitor PSA annually and it’s undetectable,” he said.
He hopes others take prostate cancer screenings just as seriously. “I just have always felt, get your PSA checked–that’s the best indicator that something’s going wrong,” said Bob. “PSA isn’t a definitive answer, and it’s not always accurate, but it says, ‘You better be paying attention.’”
To someone who’s hesitant about getting screened for prostate cancer or having their PSA levels checked, he would say, “Don’t be a fool and ignore it. Do it.” No one is bulletproof.