Prostate cancer (PC)
FACTS....no hype, no promotions, nothing to sell you! (The Google advertising at the top helps pay for my website costs).

© copyright, 2011, R. Fleischer

prostatecancer.htm

The PRIMARY purpose of the information in this very long article is to EDUCATE "YOU".  By "YOU" I mean men who don't have PC or are in the early stages of prostate cancer; or are just worrying about the subject.  Perhaps you are concerned about regular PSA testing and rectal exams.   This article was specifically written, and is kept up-to-date, to help YOU make intelligent reasoned decisions on YOUR health. 

This article is also meant for your "significant other" to read. 

There is a very considerable amount of information here about prostate health and prostate cancer (PC), MUCH of which is rather difficult to find in one place....or, to find at all.  This article was originally written to be a chronicle of my personal experiences together with a lot of solid medical information... and not much was edited out initially.  In 2010, having had several 'complaints' about the excessive length of this article, I edited (shortened) the part about my personal experiences to a considerable degree.  So, to state what should be obvious here, I did have prostate cancer.  'Did' is past tense.   My surgery was in May 2003.  Officially I am not 'cured' until May 2013, the tenth anniversary of the surgery, providing my PSA is still low at that time.   

The gland is the PROSTATE.....NOT 'PROSTRATE'.   PROSTRATE means lying down on the ground!

This article generally totally avoids go-go ideas, the latest unsubstantiated 'cures', etc.    I do not have things in this article that I cannot back-up from SOLID sources, typically such as from John Hopkins, and other such recognized sources of information.    There is nothing here from so-called 'doctors', whether they are really MD's or not, that are, to put this bluntly, quacks, or that have something to try to sell you, and thus are not reliable sources.

Be sure you do not skim this article the first time you read it.   ON PURPOSE, I have NOT indexed this long article like a technical book would normally be done (with a table of contents at the beginning and a formal index at the rear of the book ...with citations). The information here is technical in some places.  I have written this article mostly in layman's terms, trying to avoid the worst of medical terminology.  I have included some technical terms, because you will be exposed to them.

If you HAVE been recently diagnosed with Prostate Cancer, you are likely to be quite emotionally involved.   Read this article more than once, as you are unlikely to absorb enough with just one reading.   You will become better informed, and then you will be able to intelligently discuss your situation with your doctor(s).  
 

I suggest you keep the URL, and NOT the article, in your computer...as I DO update it now and then.   Save the URL as a 'Favorite', or in your 'Bookmarks' file.

If you are interested in my BMW motorcycle repair technical articles:  http://bmwmotorcycletech.info.  That is my HomePage, and DOES have a link to this Prostate Cancer article, near the bottom.  The Website contains mostly technical articles on BMW motorcycle maintenance.

SOME general practitioners & other medical professionals including radiologists, cancer specialists (oncologists), urologists, etc, either are NOT up to date, or will NOT tell you things that you probably should know.  SOMETIMES health insurance companies pressure doctors to withhold information in various subtle ways.  Average time spent with your doctors, particularly after the initial consulatation, is typically about 12 minutes, somewhat due to Insurance Company or Medicare and other pay rates, so doctor's tend to not tell you things that might bring about longer conversations.  
 

My e-mail address is (mouse click):  e-mail image.htm
Please feel free to E-mail me with any questions or comments on this article. 

I am NOT a doctor (As much as my parents wanted me to be, and even had me do my first year of college as pre-med), but I have an in-depth knowledge about PC.   I have studied...and continue to study 'the literature' extensively.  I belong to & monitor several major groups involved with trials, studies, the latest techniques, etc.  Many are listed and referenced later in this article.  I also keep in touch with doctors and other researchers at the leading edge of prostate cancer work.   You won't find much information in this article about the latest 'go-go' work that seems promising but has not been generally accepted as worthwhile.   I am not going to bother you with, nor promote, false cures, wild claims, etc.  In a few instances, briefly, I will cite some studies and information that has been reversed, as you may well run into the 'information' still being touted here and there. I will identify those studies and reversals.

Before I get into the rest of this article, you may or may not want to read the biographical article about me; or, you may want to do that later.   You can find mention of me all over the Internet, including my background; however, none of it is very complete.  I wrote a somewhat funny bio, and it is accessible from my homepage....it is under "who the hell is snowbum".  I made that a hyperlink for you.    I am, at my core, simply a nerdy, technically-minded engineer, who insists on knowing everything (well, I have SOME limits!) about whatever I am interested in. I have a very high curiosity level.   I also have a high level of skepticism.

I have done a lot of research about PC; and, have had my verbose writings vetted by recognized medical experts, some of whom spoke freely, provided I did not quote them by name.  I invite you to investigate what I say in this article.  If you find ANYTHING not accurate, please quote your source(s), etc., when you E-mail me the information!  I am VERY proud of the fact that there have been NO SUCH reports...so far (you could be the first!).

The meat of the article begins here

If you are embarrassed or squeamish by discussion of, or words like prostate cancer (well, you got THIS far didn't you?), penis, ejaculation, orgasm; biopsy, sexual functions,.. etc....THEN I suggest you stop here and go back to my BMW Motorcycle Technical Articles; or, go do something else.    If you are NOT embarrassed, but are getting jollies; you are sick, warped, weird; and, I haven't the foggiest idea what to tell you.   :-) 

 I have tried to write this article not only for those with a diagnosis of PC...but, also for those not so diagnosed.  I hope that you men, and your 'significant others' (never liked that Politically Correct term), who want to be educated about Prostate Cancer, will do some thinking; and get tested regularly, maybe even change your diet and get more exercise.  Don't stop here, suddenly, because you think that I am a faddist...because exercise...and most especially, DIET, DOES influence the occurrence of PC, THIS IS PROVEN.  It is hardly the only influence, of course!   PC is very likely due to a combinations of environment (including chemicals and foods), diet, genetics and/or race, and age.

 All the information presented here is absolutely true as far as I know.    I have tried to NOT overemphasize; NOR to gloss over things.    I will explain what you NEED to know.  I have consulted (on a great deal of the information in this article you are reading) with truly knowledgeable medical doctors, experts in their fields.... and I tried to generally avoid those who were involved with my personal care...mostly so I will be giving you honest, fair and probably way-overly-complete information.   At the end of this article are Addendums, and information on certain books and other sources of information.   Also, a revision date for this article....so you can see when it was last updated.   

I have NOTHING...ZERO....to sell you!.....I am not selling nor promoting vitamins or quack cures or promoting certain doctors nor hospitals. 
 I WILL provide you with a LOT of free information!

Prostate cancer, PC or Cancer of the Prostate, is very common.   A rather high percentage of men will have it sooner or later.  The incidence is CONSIDERABLY HIGHER than for women's breast cancer.   Most men NEVER find out that they have prostate cancer, nor will they die from it; rather, they will die from other causes such as accidents, heart attacks, etc.    In the U.S.A., men have a 50% chance of SOME sort of cancer in their lifetime.  But, only about 1 in 10 men need treatment.   Do NOT get complacent by that seemingly mild figure.

Of the cancers that men are likely to face, skin cancer is likely #1.  Prostate cancer is probably #2.   About 234,000 new cases of prostate cancer are detected every year.  About 30,000 men die from prostate cancer every year. With the Baby Boomer Generation upon us, and living much longer, I expect both of those figures to go up considerably.  In fact, I think the figures will double within the next 20 years.  A considerable number of men DO die FROM prostate cancer every year.  But, don't get into the mathematics too deeply.  Yes, I know that you can easily see that something near 13% of the NUMBER of those being diagnosed are dying every year...but, statistics do not tell all of the story, and statistics CAN be misleading.  Keep in mind that statistics are often "interpreted" for very specific reasons....perhaps to sell you something or sell you a specific type of treatment.

You do NOT want to die from PC.  It is likely to be a bad process, can be quite painful; and, for some men, the amount of strong narcotics needed to control that end-stage pain are eventually large, and you will essentially not have a pleasurable life at that point, nor considerably before.    You will also likely be taking drugs to suppress testosterone, which have their own not so nice side-effects.  You could even have your testicles removed; which is not done all that much anymore...but is certainly cheaper than some long-term use of some drugs (and, with somewhat LESS side-effects!).   

Scared??...my intention IS, yes, at this moment, TO SCARE YOU JUST A LITTLE.....to get you to read ALL of this article!   

Prostate cancer is BIG business, and many doctors have a vested interest in their particular specialty, such as a Surgeon/Urologist/Oncologist versus a Radiologist (or Radiologist-Oncologist).  Because of this, one must be cautious in what one hears and reads.    In my case, I had straight talk from MANY sources, probably due to my initial knowledge, and my careful selection of these sources.  I also had some medical background, which helped.    Do not take these words about vested interests lightly.  'Vested interest' can be financial or experienced specialty.....or both, plus a few other things more subtle.

The risk of developing prostate cancer increases with age, and that RATE of increase is FAR greater than for ANY other type of cancer.    The risk if younger than 39 is about 1 in 10,000; if between 40 and 59 it is 1 in 103; for 60-79 it is 1 in 8.   Within those categories, the risk rises to the higher numbers as one gets older in that group age spread.   The RATE by country also greatly varies.    At the low end of risk are countries like China, India, Japan, and Italy.  At the top end are Switzerland, Australia, Sweden, Canada, and U.S.A.  

As immigrants living in low risk countries move to and live in the top risk countries, their PC rates rise to roughly the norm for the new country.   That makes one tend to think that environment and foods are large factors.   In fact, very serious connections between foods and incidence of PC have been shown over and over.  I believe it is likely that a combination of various chemicals in our environment and in/on our food, will eventually be shown to be synergistic, and promote cancers.

 Of many suspected causal agents, chemical substances called free-radicals (these are always attacking us) are definitely a problem.   When younger we have natural protection amounts of anti-free-radical chemicals in our bodies; that is, they neutralize the free-radicals.   Pre-cancerous lesions are found in roughly 33% of ALL the world's men, in their 30's.    It appears that younger men are protected by an abundance of anti-free-radicals.  We have less and less of this 'protection' as we age.  

Human beings in the developed world are living much longer.  As we live longer and longer, we have more TIME to develop Prostate Cancer.   It is also VERY apparent that some types of foodstuffs are helping bring about PC.   Some food preservatives are very suspect now; not just the probable effects of having hydrogenated fats in your diet (which also seem to be heavily involved with women's breast cancer).  The hydrogenated fats study was funded by our own U.S. Government, was done in Finland, and the report suppressed (I am NOT kidding!). I saw this research summary long before I was diagnosed, or even had any interest in researching PC. 

The DRE (Digital Rectal Examination...the gloved finger of the doctor up your butt...) can NOT detect more than about 40% (at best) of prostate cancers.  Hence we have the PSA test which is in such widespread use.  The PSA test is NOT a 100% reliable test, but, it is very helpful.   The TREND (or, Velocity) of your PSA readings is usually vastly more important than the absolute value; but, not always.    Please keep this in mind:  'TREND/VELOCITY and ABSOLUTE VALUE".  You COULD have a low PSA, and a doctor might find cancer with his finger (feeling for nodules)....or he might not!   But, that DRE, and the PSA test, together, are PRESENTLY your 'keys' to likely finding a problem early, and thus being able to deal with any problem before it becomes a big problem.  We simply do not have any decent reliable, or even partly reliable testing besides  PSA, Free PSA, and DRE.  There are some tests in research, but it may be a long time before they are proven and accepted.   I will list these in one of this article's Addendums, when appropriate.

THE key to preventing a fair amount of PC is probably a life spent with moderate exercise and proper diet, and with some help in not having a familial history of PC, nor being African American. 

THE key to a CURE (if you HAVE PC) is to remove or destroy the cancer BEFORE it breaks out of the prostate gland.   It MAY be curable if confined to the seminal vesicles, but if it gets into the lymph nodes, it is NOT curable, it will always spread, likely already has, and PC cells have a nice affinity for bones, although it CAN spread to almost anyplace.  One MIGHT still have a long life, or a normal lifespan, depending on what that means.  Lifespan will depend on your age, already expected lifespan, and on the aggressiveness of the cancer cells.    Cell aggressiveness is part of the so-called Gleason Score consideration....which I will get to in depth later.

A 'cure' may not really be necessary for you.  Age, life expectancy and what is found in various tests, are all required to make an informed decision.   In many instances, in fact, possibly a large percentage (some think upwards of 40% of PC cases detected)....there is not enough life expectancy from normal aging to warrant serious intervention.  That means, that for QUITE a few cases of PC, there really is no GOOD reason for surgery or radiation...with some caveats.   If you had 10 or 15 years left to live, per life expectancy tables, do you REALLY want to go through VERY serious surgery (or VERY serious radiation.....not to mention hormonal treatment, etc)?   All these things WILL affect your quality of life.......or, would you rather follow a regimen that is well-proven to work well in the vast majority of PC cases?    You NEED to make educated guesses or estimates for yourself.  The problem for you is that there are very few absolutes, when dealing with PC.      The UNFORTUNATE FACT about Prostate Cancer is that VERY FEW who have it, have tight cut and dried treatment.  That means that YOU need to be WELL-INFORMED.

There WAS a system of PC management called 'watchful waiting'.  It is mostly obsolete.  For those who are on watchful waiting, the latest type is "ACTIVE watchful waiting".   YOU must decide, perhaps with your Urologist's help, if this ACTIVE method (I outline it below) is for YOU.   Frankly, if I had been older, perhaps 70+, I might NOT have selected surgical treatment....assuming CERTAIN CRITERIA....so read on....

ACTIVE watchful waiting management has several types of names.  It can be called Supervised Prostate Cancer Management, or even the old Watchful Waiting, or Expectant Management, or Active Surveillance, Active Oversight, or Active Monitoring......or more.   All of these mean much the same thing nowadays....specialized watching and care by a medical professional, with the idea of avoiding surgery, avoiding radiation, avoiding drugs.  This 'option' makes a tremendous amount of sense for a lot of men.    Did you know that about 1% of men who go through serious prostate surgery are found to NOT have PC?  Did you know that 25% of men with PC diagnoses turn out to have a cancer that is so tiny, so insignificant, that real experts (Sloan Kettering, or Johns Hopkins sort of 'experts') question the reason for the surgery??     In fact, the risk of the surgery in these cases likely is much worse than any possible questionable gain.   Surgery and radiation that are probably unwarranted are also being done on men who are fairly young.  

Many physicians today don't even recommend PSA tests for men who have a statistical life expectancy of 10 years or less.  The reason is that most (not all!) prostate cancers are very slow growing, and these men are very likely to die of old age, or something else, long before they would die from PC.   The recommendation against PSA testing at advanced age is actually reasonable, if you stop and think about it.  However, how long will YOU live?

It is important to YOU to realize that almost all medical-speak is in terms of averages. Where do YOU fit in with an 'average'..???

***It is VERY important to realize that if your PSA is low, let us say under the value of 4.0 (previously that was the cutoff value for further investigation), the statistics tell us that you have a 15% chance of having prostate cancer.   HOWEVER, only about 15% of THOSE men will have a HIGH GRADE (fast growing) cancer.  Thus, 15% of 15%, means that if you have a PSA of 4 or less, you have a 2.25% chance of having a high grade fast growing cancer.    There are other more complicated ways of looking at these simple statistics.  The Government, and some in the health care system, might say that PSA testing, showing 4.0 or less, is not worth doing biopsies, ....after all, if you have 4.0 PSA, your chances are only a bit over 2% of having a fast-growing nasty cancer.   But, are YOU willing to take that chance?    Suppose your PSA is 4.0 .....do you want to have a biopsy series?  Suppose the biopsies DO reveal cancer.  What is your age and life expectancy?  What is the grade, or virulence, of your cancer?   Much to think about.

***In the last several years some reports have come out at government levels, that are interpreted strongly to have the interpreters argue AGAINST PSA TESTING.   Please take that with a grain of salt........and, be SURE to think carefully, and read fully, those various reports; before YOU make a decision about YOUR testing!

What if you are in your mid-sixties (typical for a man finding out he has PC), has no feelable nodules by DRE, your PSA is under 10, and biopsies show a Gleason sum of 6 or less....and THAT is in only one or two of the biopsy cores?  
***Well, YOU are then probably a very good candidate for deferred treatment....in fact, you may be just as much a candidate for this type of active management, as is a man in his seventies and eighties who has an aggressive tumor!

A NUMBER OF STUDIES....fairly substantial and well done studies....have shown that deferred treatment is probably the best way to go, under some circumstances.  This has been shown to be true in the USA, Canada, and other Countries.   

You MIGHT WELL decide on NO radiation, NO surgery...and you may well find that you have saved yourself a LOT of the problems with interventional 'treatments'.  Don't stop reading here...I am not some nut case that is against surgery or against radiation!

In order for this type of Active Watchful Waiting with delayed intervention (if needed at all) and management to work properly, you MUST have a diagnosis that fits the below information, and you must follow what I have put below.  Remember, that the risks and side-effects of surgery and/or radiation and/or hormonal, etc., treatments, may well FAR surpass the risks posed by the cancer.   What I am listing here has worked VERY well for the large majority of patients with PC. That does NOT mean I am 'promoting' it...just that I want you to be informed about ALL types of treatment.  This information was NOT developed by me, but by a very major cancer research group.

Unless your PC situation is such that it is an immediate threat to your life (that it leaves you no alternative to radiation or surgery), then you might want to think carefully about what is just below.....after which I get back to the main article information.

When to THINK about Active Watchful Management of PC:

a.  Your biopsies shows a Gleason Score 7 or under.  If curious about some of these things, see the Johns Hopkins "Prostate Disorders", 2008".
b.  Your PSA is under 10.
c.  Your FREE PSA is more than 10%.
d.  If you have been tested regularly for PSA, then the velocity is NOT greater than 0.75 ng/ml per YEAR. 
NOTE!....many doctors will use about 0.35 ng/ml rise per YEAR as the point of cutoff for even doing biopsies.  Lots more on this later in this article.
e.  You have Clinical stage T1 or T2; AND, the cancer has not broken through the prostate (that last item is pretty iffy to determine, actually).
f.  You are older than 65.
g.  You get tested for PSA once every year (previously 3 or 4 months).
h.  You get transrectal ultrasound of the prostate every 6 to 12 months.
i.  You repeat the biopsy tests in 12 months.  
j.  Biopsies are performed if a PSA velocity exceeds 0.75 ng/ml per year.
k.  Your DRE is not showing any nodules by feel, and you get this done once a year.

These are stringent requirements.   Item (e) and (h) are often not part of the above list.  Some doctors would not use (f).

 SOME Research has cast DOUBTS on previously accepted theories that for most men over the age of 70 or so, that 'watchful waiting' is better than treatment.   It now appears that SOME type of treatment, probably hormonal at that age, will INcrease lifespan.   Whether or not such treatment improves Quality of Life, is another story.  

Before I get into the rest of the article, since I already have introduced some technical terms, here is some information:

Gleason Scores or Sums, are a way of identifying the stage of prostate cancer as seen from examining the tissues from biopsies of your prostate gland.  
Doctor's use those Scores, and other things, to describe your Clinical Stage of disease.

Stage T1-C:  PC has been found via needle biopsy, and is too small to be seen on scans, or be felt.

Note that T2 with or without letters following means that the tumor is only found INside the prostate gland.
Stage T2-A:  The doctor can FEEL the tumor via his finger in your rectum...but there is less than 1/2 of one lobe having such.
Stage T2-B:  As above but MORE than 1/2 of one lobe.
Stage T2-C:  As above, but feelable in both lobes, cancer is still inside the prostate gland.
If your cancer is in one of the above 4 Stages, and your Gleason Score is 7 or below, your cancer is probably CURABLE.

Stage T3:  The cancer has broken through the prostate gland, is sometimes called 'locally advanced'.
Stage T4:  The cancer has spread to other organs, and is sometimes called 'locally advanced'.

N:   The letter N refers to the lymph nodes staging. 
N0 means that no cancer is found in the lymph nodes looked at.
N1 means that there was one positive node found, and it was less than 2 cm across in size.
N2 means that there was over 1 positive node found; OR, that one at least was 2 to 5 cm across in size.
N3 means that any positive node found was over 5 cm across.

M:  The letter M refers to metastasis...that is, spreading. 
M0 means that the cancer has not spread outside the pelvis.
M1 means that the cancer has spread outside the pelvis.

PC in Stages T3, T4, and M, are not presently treatable with surgery or radiation.  Hormones may be used to prolong life and reduce pain.  

Keep in mind that if you have PC, you need to make a serious decision......what to do, or not to do.  You should NOT hide from this decision that will have such an effect on your life.  YOU are the one, not your doctors, friends, nor me!, that must be informed and make this decision.   Your doctors may make suggestions for treatment, but YOU need to be informed so as to ask your doctor the correct questions, ETC.  It is YOUR LIFE.    

I know this is difficult; but, do not be hasty to do anything.  PC grows very slowly, even the more aggressive types grow somewhat slowly.  It is not a medical emergency. Dr. Peter Scardino of Sloan Kettering points out that "Because localized prostate cancer takes so long to progress, 90% of all men diagnosed with the disease survive 10 years REGARDLESS of what they do".   

The rest of the article now continues...

NOTE!!!...This article does NOT go deeply into treatment for ADVANCED prostate cancer!!  ('ADVANCED' here means that radical surgery or radiation methods are unlikely to be very helpful).  There is SOME mention herein about some treatments for more advanced cases.   Even for early stages of prostate cancer, sometimes age and physical condition CAN make radical prostatectomy, even radiation treatment,  INadvisable.  Sometimes some types, or all types, of radiation treatments will be inadvisable. 

 Individual cases vary.  Always do a LOT of investigating, do not believe the first story or diagnosis or prognosis or type of treatment recommended.   In some situations, NO treatment is the best treatment, and in some, surgery or radiation (including radioactive seeds), are, or are not, a good idea, but hormones might be used successfully (but not for an actual cure).


Prostate cancer begins, it is believed, by one rogue cell, out of many billions of normal cells.  That rogue cell divides, and then the two divide, then the 4 divide...this goes on and on.  The first rogue cell is distorted more or less, not normal looking, and may be lightly distorted....or horrendously misshapen.  Eventually, enough cells are produced that are distorted, for a pathologist to see them in a big forest of good cells.  The distorted part that pathologists particularly concentrate their look at, under their microscopes, is GENERALLY the distorted nucleus.   The larger the percentage of those misshapen cells and nuclei in an inspected area, the worse the situation.   These are the most aggressive in multiplying. 

Bad cells do not get born, develop, and naturally die off in the same way normal cells do, and thus bad cells keep dividing and multiplying.   This is a very complicating factor, especially in treating advanced cancer.

The absolute cause of PC is not truly known for sure, but all research to date shows it can be genetic (not in my case, as far as I know).  BUT, diet and exposure to chemicals, etc., are FAR more important.    Things in ones diet that seem to be implicated in PC are nitrited/nitrated (cured) meats; meats grilled over a flame where dripping fats can burn; not enough tomatoes, and maybe not enough of some other antioxidant food items.   It is public conjecture, at this point, to lay blame heavily on such as heating foods in the wrong plastic containers (implicated in other cancers); and so on.

Prior to 2007, I had found mixed information from studies on cruciferous vegetables with regards to PROSTATE cancer.  But, by late 2007, enough studies had been completed to allow me to say that I HAD found fairly conclusive information on the helpfulness of cruciferous vegetables (Kale, Broccoli, Brussels Sprouts, Mustard Greens, Turnip Greens, Cabbage...).  The results of the studies SEEM to indicate that these have some goodly preventative value; and, in particular, seem to have a rather substantially beneficial effect on the virulence of any PC that develops. Anti-oxidants are helpful in reducing risk.  There are some other foodstuffs that SEEM possibly beneficial in prevention, and maybe if one already has PC.   A few minerals in truly insufficient amounts, such as zinc and selenium, were originally thought to be a problem.  That has now been questioned.    Very detailed studies on zinc and selenium have now been done, results were not supposed to be available until the year 2012, but the blind type and very detailed studies were halted in 2008, when it was found that doses of Vitamin E, and doses of selenium of 200 mcg were not only NOT helpful, but were HARMFUL.  It is entirely possible, that those living in areas with extremely low selenium in foods and water will need a SMALL supplement, but this is entirely UNproven at the present time.  

The helpful lycopenes in tomatoes (which, in some early studies, seemed far more active after cooking than raw tomatoes, but other studies had opposite results) are now known to be absorbed nicely if eaten with a bit of olive oil.  Some research has showed that the beneficial effects of tomatoes is "only" if eaten with vegetable oils;  in particular, olive oil.  It appeared from later research that the value of tomatoes had more to do with whether or not they are eaten with such oils, and less to do with whether cooked or not.   This is because prior studies involved mostly those who used cooked spaghetti-type of tomato sauces...this is, actually, a simplification here.  It is now believed that fresh tomatoes, cooked, and then eaten in sauces or dishes that include olive oil, are more protective than in other forms.  I think the confusion is partly because of the way our digestive systems process oils, and how certain things dissolve, or bind, to SOME types of oils.   The cooked versus uncooked is still a partial unknown.  Best to eat both.  With small amounts of vegetable oils.  The lycopenes in tomatoes do not appear to PREVENT you from getting PC.  This is tricky, because you could have a very tiny tumor, and it might not even raise your PSA, but the tomatoes may well help.  It is pretty well proven, from studies reported on in late Summer of 2007, that lycopenes (tomatoes are the big source) really DO help greatly in preventing prostate cancer from progressing.   What does all this mean?  Well, you'd better have plenty of tomatoes in your diet, detected PC, or not.

 AVOID hydrogenated oils and fats!!!!!!

In most publications the public reads, one sees printed:  "If caught early enough, PC is typically 100% curable".    Think about that.  What does it REALLY mean?  What the heck is 'typically'; what is 'curable'???  What is 'early enough'???

'Curable' does not mean you are left as you were before any treatment!!!   They do not put THAT in their article headlines!!...the articles do NOT hardly discuss THAT at all!   Cured of cancer, as medical doctors use that word, simply means cancer-free for 5 years or longer (10 years is the officially accepted time for PC).     'Cured'  means you are likely to have a more normal life-span, and not die from prostate cancer and its effects.     'Cured' may also mean that your PSA tests show machine lower limits, or nearly so of testing, for at least 10 years after your treatment is completed or stops.   Since sometimes PSA will spike, temporarily, after surgery; same for radiation and hormonal treatment, the 10 year period begins after the spiking settles down.  Prostate cancer surgery or radiation may well leave hidden a small number of cancerous cells in the body (much more with radiation, usually), sometimes these may grow and eventually show up as an increased PSA reading, after some years of low machine-limits testing. I think that 5 years, or maybe 6 years, is probably a reasonably good time to consider oneself as 'cured'....in the sense of making long-term plans and goals, etc....providing your PSA remains low.   You could probably be more aggressive and use 2 years, and be fairly accurate.   Does this mean you put your life on hold for 2 or more years after treatment...NO, I do NOT mean that.

Men past age 50, and some past age 40, are recommended nowadays to have at least what is called a DRE, Digital Rectal Examination, at every yearly regular medical checkup.   The physician uses a gloved finger, inserted into the anus, and feels for lumps or hard nodules, through the wall of the rectum.   Some men find this embarrassing.   Get over it!   Be sure to ASK for it, if it is not offered.  I really consider that YOU ARE AN IDIOT IF YOU DO NOT GET CHECKED, PROPERLY, YEARLY!!!   UNfortunately, the physician can not feel much of the prostate (remember, that 40% PC detection rate is BEST case)so this is not a 100% check, not by any means.   Each year you are checked, increases the chances of finding a problem IF YOU HAVE ONE developing.  FINDING a problem does NOT necessarily mean you need treatment or further testing, but it might.  

The other common test, called the PSA (Prostate Specific Antigen) is usually recommended yearly at age 40+ for blacks (African Americans), 50+ for whites (incidence of PC is earlier for blacks, probably genetic, but this is NOT known for sure).  I feel even EARLIER is better for both groups.   Even if you have to pay for the PSA test yourself, it is cheap insurance.   Note that my advice is contrary to what some doctors and government agencies or groups may advocate.... particularly if your age is within 10 years of your life expectancy.

***You should ASK for a PSA test....and record/write down the readings yourself, and keep the written record for the rest of your life...adding to that list after every PSA test. If you can, have the PSA test done by the same lab every time, and do NOT have ejaculatory sex within 2 days prior to the test....it can skew the results of the test. Some relatively well regarded doctors (not hardly all!) at even such as John Hopkins, say that ejaculatory sex or a DRE, within a day or two does not affect PSA readings.  My advice is to disregard what they are saying; and do what I said:  no sex for 2 days prior.   Bladder or prostate infections can also skew results of the PSA test.  Infections should be FULLY cured first; then wait awhile longer, before the PSA test.  My advice is to NOT have a DRE (finger exam) done by your doctor within a few days prior to the PSA test.  That DRE can affect PSA by as much as 10%.  I am not sure just how much ejaculatory sex can affect PSA, but I THINK it is considerably more than 10%.  That can skew your PSA velocity calculations!!!   I cannot overemphasize the need to get both of these tests regularly and to keep YOUR OWN records.  YOU want to keep track of your PSA...don't depend on your doctor's office.

   The situations where I MIGHT agree about you NOT taking DRE and PSA tests, is if you are dying of some sort of disease you already know about, or are within 5 to 8 years of your life expectancy, AND you take into consideration how long your parents lived, if they died of natural causes of old age.   So, if you have considered these things, and don't wish to have your PSA tests done, then I have no problem with YOUR decision.  It could be a good decision, depending on circumstances.    You may want to read the rest of this article to be better informed.

If you don't get these tests done; and you don't die of something else;...and, if you get advanced prostate cancer, you can then learn all about nasty radiation and anti-hormones....because it will likely be plenty advanced when they find it from advanced cancer symptoms.  It will be too late for surgery; and radiation is likely only going to be used to kill bone pain...which is likely to be substantial.   You also will lose your libido likely well before all that, and have some not so nice side-effects from various drugs, etc.

NOTE:  some insurance companies won't pay for a PSA at too young an age, or just won't pay period.  Find some place having a 'health faire' and pay the lower fee, and get your baseline PSA.  DO IT!!!  THEN, do it every year!!!  KEEP YOUR OWN RECORDS OF PSA LEVEL.

The prostate gland produces a substance called Prostate Specific Antigen and releases it into the blood stream, thus "PSA" is measured with a blood test.   This substance is natural, and the reason it is in the prostate in the first place is that it has an effect on the semen, so that sperm can 'swim' better...it is sort of a thinner on the semen.  This is layman-speak.

I had both that test and the DRE every year, for MANY years.   I kept a written record of the value of the PSA, and the date of the test. 

PSA values are measured in Ng/mL, which means nanograms per milliliter.  Now that you know that, you can forget it......as your readings will be numbers that I list below, so I will just drop the Ng/ml ending.

The American Prostate Society says that "the old rule of 'no worry' if the PSA is under 4.0"... is seriously out of date.... and obsolete.  This was confirmed in late 2003 and early 2004, by several very carefully done evaluations of large groups.   Also, recommendations on just when to get PSA tests done have changed.   

The values below are for men who still have their prostates, & have NOT had radiation to the prostate.

If PSA is:                   Then your next PSA test might be recommended in:
  0-1.0                                              5 years
 1.0-2.0                                            2 years
 2.0-4.0                                            1 year

There are plenty of WORTHY books available on the subject of PC.  There is an older and rather thick paperback authored by Patrick Walsh (The Prostate....a guide......).   That book may have been updated, I have not checked.   Dr. Walsh's later books on the prostate are also good.  Another older but worthy book is "About Prostate Cancer" by Ellsworth, Heaney, and Gill.   That one is published by Jones & Bartlett; who have a website, www.jbpub.com.    If you were to purchase some literature, I'd recommend those two books. ...BOTH of them; and see if there are later versions.  You might also be able to borrow some books from your regular doctor or a Urologist!  READ several of these.

It is not uncommon for men to get bladder infections, which can affect the prostate, and the PSA measurement.   Common bacterial infections in this area can skew PSA  tests.  If you have such an infection, your doctor may prescribe some sort of antibiotic, for at least 10 days.  For some men, these are chronic infections, and often the cause is that they are having sex with their partners, and the partners are re-infecting them.  Many men suffer prostatitis, for years.   As an aside note....for those with CHRONIC infections, ....10 days of an antibiotic is NOT!! ...long enough to for a cure.  AT LEAST a month on antibiotics, of a type that is known active against their particular bug, is needed.  That a month+ of antibiotics is commonly NOT KNOWN, in the treatment of chronic prostatitis, bladder infections, etc.

NOTE:  Some medicines DEcrease PSA considerably, which masks true PSA test results.  One example is Proscar (Finasteride).   Note that another PSA test, which measures PSA (that is NOT BOUND TO PROTEINS), the "Free PSA" test, is NOT generally affected by that drug.   Some medicines DEcrease testosterone, which CAN mask true PSA test results.  

Conversely, if you are taking testosterone, that can INcrease PSA......so get tested VERY regularly if taking testosterone type drugs.....as testosterone HELPS PC grow!!

***It IS possible for the PSA test to remain low, and yet cancer is growing.  That is almost never said anyplace.   If the cancer is small in size or involvement, and/or the cells are not overly aggressive (not overly malformed), your PSA may well be a "reasonable" value.   The PROBLEM is, WHAT is 'reasonable'.

Prostate cancer is ALMOST ALWAYS written about as being 'very slow growing'....and; that "many, if not most men, will have it eventually, and die from something else".   That is all true, but the literature almost never speaks about prostate cancers that are FASTER growing.  The books are generally UNCLEAR that the ONLY way to TRULY determine the full EXTENT of prostate cancer is serious surgery  (biopsies are reasonably good, just not as good as a surgeon handing the pathologist the entire prostate to cut apart, as well as lymph nodes removed earlier in the surgery).

A fair percentage of prostate cancers are faster growing.  Think of it this way, if you must, although this is twisting the mathematics for illustrative purposes:  51% ("most PC...") of cancers are slow growing; then, obviously, 49% are fast growing.   Which group are you willing to take YOUR chances on being in? 

The latest figures (Am. Prostate Society) for normal PSA (for men HAVING a prostate gland):
Age          African Am.PSA                   Cauc/Asian PSA
40-50           0-2.0                              0-2.5
51-60           0-4.0                              0-3.5
61-70           0-4.5                              0-4.5
71+              0-5.5                              0-6.5
Look at that table just above...then read this:  25% of PC found, is found in men with PSA BELOW 4.0.  Note too, that I previously told you that 15% of 15% of the cancers found with PSA equal to or below 4.0, were fast growing. That is 2.25%.    Had enough math here?

The gland, the prostate, which has several functions, including making the majority of ejaculate and carrying of sperm, tends to slowly grow over one's lifetime.  The larger the gland, the more PSA released into the bloodstream (as a general rule).  In a fair number of men, as they age, they find they are having urinary problems.....having to urinate more often, less capacity, having to get up at night to urinate.  Those are the usual signs of an enlarged prostate.  That condition, Benign Prostatic Enlargement, BPE, is NOT...in itself a sign of cancer!  It is actually a fairly normal situation for older men.  HOWEVER, if the situation continues too long and it becomes more and more difficult to empty the bladder, treatment for that is a good idea, before bladder walls, kidneys, etc., are affected. 

 Some have asked:  "Are there any benefits to having reasonably regular orgasms (ejaculation)".  Yes, there is.
Sexual relations ARE good for any man's health, providing their heart condition, etc. is OK for such.

 Some have BPE bad enough to warrant modest surgery for opening the urethra.  Surgery sometimes needs to be repeated as time goes on and the prostate continues to enlarge (another point not mentioned much about that surgery).  That type of surgery is usually done these days through the penis opening. 

The prostate is also a powerful muscle, that besides making fluid and collecting sperm, at orgasm forces its contents into the urethra and out the penis tip.  The contraction also forces more PSA into the bloodstream. The contraction is part (probably a goodly part) of the pleasurable feeling of an orgasm.   The two sets of nerves that control the erecting of the penis run along the surface of the prostate.  Dr. Walsh, book cited above, was part of the team that developed the 'nerve-sparing' surgery.  It is NOT always practical to save the nerves during surgery, depending on the extent of the cancer.  Radiation is not nice to the nerves either.  Those having radiation treatments for PC may find their nerves working fine for a long time....then they fail.  The reverse is often true for nerves spared by surgery...they don't work for awhile, then maybe they do, after a period of time, sometimes considerable. It is very clear from many years of clinical experience, that even when nerve-sparing surgery is done, that the nerves may take up to 2 years to begin to work properly again.   Thus, if a man has his prostate removed, and the nerves are spared, there IS a good chance of the nerves working again....but you MUST BE PATIENT.  Many men find that 18 months is needed, some a bit longer. 

 It is also fairly common, after surgery, for a man's erect penis to actually be a bit shorter (I will BET you NEVER see THAT written anyplace besides medical journals, and even then, rarely seen).  Many men think that their penises are too short, and that women prefer long penises.  This is all usually hogwash, it is just part of the male dominance over females thing (gay men tend to appreciate large penises, however!)....so, any shortening of a man's penis is a nasty side-effect of surgery...EH?   I have not found any definitive information on the amount of shortening when erect.  It is likely between zero and 1-1/2", with 1/2"-3/4" being relatively common.  Later in this article I will show a citation.

There is a gray area for PSA of 4-10.  Those in that area should very probably have an additional test called 'Free PSA', and maybe a prostate density (size) test (totally NOT painful), as larger prostates produce more PSA, skewing the readings higher.   My feeling is that if one's PSA has risen at a rate (VELOCITY) that seems unusual given previous history, and remains elevated after a course of antibiotics (and no sexual relations NOR digital exam within 48 hours MINimum, before any PSA test)....if I was a medical doctor, I would likely advise you to go see a Urologist, or at least ask your primary care physician for that 'Free PSA' test.  You'd want to do this before any possible cancer (it may well NOT be cancer!) has gotten out of control.  If the Free PSA test is over 25%, you probably have no further worries.  If regular PSA is 10+, usually the Free PSA test is not needed....as cancer is assumed.

Are you getting the idea that getting your first PSA is a good idea, so you can have that baseline value, and have yearly PSA tests and that YOU should watch trends?

Even if the DRE finger test reveals nothing to your doctor, you should get the PSA test every year, and personally keep track of the numbers.  It works out better for most folks to have the PSA blood test done right along with the regular yearly physical exam blood and urine tests.  I highly recommend that you get the PSA test itself about a week BEFORE you see the doctor for your yearly exam, as said exam at the doctors office SHOULD include the digital rectal exam, which would affect PSA if that rectal exam was done within a couple days or so before the PSA blood test.  Do NOT have ejaculatory, or near ejaculatory sex within 48 hours prior to the PSA test.  Other things can raise the PSA value, so I advise you to AVOID getting your PSA test within 48 hours of bicycling, colonoscopy, ...and much longer for such as bladder infections being treated, prostate infections being treated.

   How much of a rise per year is OK?...hard to say exactly, but maybe 0.7 or 0.75 is the limit, and anything at or above 0.5 per year is questionable.   That rise per year is often spoken of as either RATE, or, VELOCITY.   There is more information on the RATE of increase in this article....particularly note the section on managed waiting.   The rate (velocity) should not be over 0.75 ng/ml per year....for those already diagnosed.     In the last few years, a value of 0.35 rise per year has been bandied about, the idea being that if your rise is below that amount, you do NOT NEED BIOPSIES, because your chance of having prostate cancer is very small.  That is true.   You must make the decision, in cooperation with your doctor.

If the PSA test is higher than normal, you MIGHT have prostatitis, so ask the doctor for 10 days of a good antibiotic, then after you use up all 10 days worth, wait 5 days or so  (don't do anything to get re-infected), then get retested again.   By the way, and this is little known, even by some doctor's:  if you suffer from prostatitis regularly, then a 10 day course of antibiotics is NOT NEARLY long enough...get at least a months worth.   Otherwise, chronic prostatitis will return.  Cipro is usually used, but some bugs need Keflex, or something else.   Remember no sex nor DRE within 48 hours prior to the PSA test, and be off the antibiotic for 5 days.   NO SEX here means both no partner and no orgasms, NO insertion of penis into vagina (or anyplace else....).  No hand jobs!   No bicycling, no recent colonoscopy, etc.

****If your PSA shows a rising trend that is questionable over a period of time and/or higher than expected for your age, you probably should go see a Urologist and get further tests done.  Waiting can KILL YOU.  Waiting can make things more serious, the treatment more involved.   Do I have to keep mentioning this sort of thing?     Even if cancer is suspected, and you have to have the biopsies....what REALLY!....is a very FEW minutes (3-10) of being uncomfortable....compared to MONTHS of horrible pain and other nasty side effects?  DO keep mind that I am not promoting biopsies...as mentioned earlier in this article there are plenty of situations in which even biopsies may be unwarranted....and, see below for recommendations by the APS.

So, you are having biopsies done??:
What is usually spoken of in most "learned author's books", although maybe not so succinctly, is that combinations of the value of PSA in the normal regular PSA test; plus the test called 'FREE PSA'; and the results of DRE; and possibly the results of a nuclear bone scan; and PSA velocity....will all usually be combined with biopsies of the prostate, for an over-all idea of things.   A pathologist looking at the biopsy tissue samples will GRADE the samples and then assign a 'SCORE' ...usually called a Gleason Score.....and the results of all this is typically a fairly good idea....again, not foolproof....of one's cancer status.   It is entirely possible to have a modest PSA, and have no detectable cancer in biopsies, hence several types of tests to rule things one way or the other.   The biopsy samples are usually taken with a needle, via the rectum, more on this later.

Biopsies CAN miss cancer.  In order to try to prevent missing something, usually at least 6 samples are taken.   The latest information from The American Prostate Society is that at least 10 or 12 are far better at detecting PC.     If your PSA stays questionable, you (or more likely your Urologist) may want you to have a repeat biopsy some time later.  As many as three series of biopsies might be needed over a period of a number of months in unusual circumstances. 
NOTE!:  The need for 10 or 12 core samples is emphasized more and more nowadays by the most learned doctors.

NOTE!....The American Prostate Society recommends that biopsies probably are not needed...in fact, recommends they not be done......IF....the "free/total PSA" test (a special type of PSA test, that your doctor can order) is ABOVE 25% of your total PSA.    The reason for the recommendation against biopsy for those men is that if at or above that percentage, it virtually eliminates the possibility of prostate cancer.   Source:  American Prostate Society, update Volume 8, Number 6, Fall, 2002.    

NOTE!....if a biopsy comes back from the pathologist with a note using such words as 'atypical' or 'suspicious',  do get a repeat biopsy after waiting for your first biopsies to heal, and consider having the samples sent out for a second opinion from another pathologist.

There are several ways for the lay person to think about Gleason scoring: 
A pathologist will evaluate the organization and the structure of the tissue from your biopsies.  The pathologist looks at the cell centers, the nuclei, and assigns a Grade.   The first area of a biopsy he analyzes is the largest one under the microscope.  If close to normal, he assigns it a "1", if extremely distorted in shape, size, and nuclear discoloration, it may be rated as high as "5"; obviously there are in-between grades of 2, 3, and 4.    A second area, less significant, is then analyzed.    The two Grades are then combined for a Total Gleason Score, something like this:   3 + 4 = 7

The Gleason Score, to put this in MY way of thinking, is a scoring of the amount of misshapen cells and thus the AGGRESSIVENESS of the bad cells.  The pathologist will combine grading, and come up with a Gleason SCORE. A Gleason 1  means that the cancer at THAT place/biopsy sample, as looked at under the microscope, shows the cells nearly normal looking, and the tumor can be expected to be VERY slow growing.      The Total Gleason Grading Score is what is commonly called 'The Gleason'.   However, you may see it reported as two numbers, such as 3 + 4.     Total Scores of 7 and higher are more serious.  The FIRST grading number is more important than the second number, that is, 3 in 3 + 4.    Mine, at the pre-surgery biopsies was 3 + 4 = 7.  This was reduced with the pathology at surgery-time to 3 + 3 = 6), which is better than 4 + 3..   

Prostate cancer cells are very difficult, if not THE most difficult, for a pathologist to interpret.  Pathologists make mistakes.   Second opinions of the same tissue samples may be needed, and YOU may have to initiate such.    

Gleason 1 is often called 'well-differentiated'.  Gleason 4 and Gleason 5 means that the malignant cells are growing and aggressive.

You might see on your pathology report (be sure to get a copy) something like PIN, or Prostatic Intraepithelial Neoplasia.   This means, if LOW GRADE, that it is not a forerunner of PC, and does not even belong in the report.  HIGH GRADE, however, can be a precursor of PC, should be in the report if found, and it was once believed that half of diagnosed high grade PIN men go on to develop cancer, latest research says about 1 out of 4.   

Gleason Scores of 9 or 10, and maybe 8, should have you demanding relatively immediate treatment.   If you decide on surgery, the Urologist-surgeon will want the swelling of the prostate from the biopsies to go down...that is, the prostate to shrink....and he probably will have you wait a month or somewhat more, which is fine, as it is very important that the surgeon be able to do his job as best possible, and a large swollen prostate makes things harder on him.  

Taking drugs to shrink the prostate is NOT a great idea prior to surgery, as it may heavily mask proper pathology of the tissue samples during surgery. 
 

I will assume, from here-onwards in this article, that the Total Gleason Score, and other tests, ...are such that cancer is diagnosed.    

Once such a Total Gleason Score is determined (with some variance possible depending on the pathologist's skill and interpretation), then the doctor tries to determine a STAGING.     Staging goes from essentially nothing found really bad, to very serious stages where the cancer has spread into all sorts of areas of the body.   ONE thing is probably true, once the cancer gets outside of the prostate (with maybe some leeway if only in the seminal vesicles), it spreads, and is NOT CURABLE, although its growth can be slowed, and symptoms that arise can be dealt with.  More or less.  Generally speaking, you are in trouble if the cancer has spread much.  

I list factors involved in describing staging earlier in this long article....and later too.

There is a tendency for surgically removed prostates to score higher.   Whether this is due to the time lag, or the pathologists looking at the original biopsy, is not known to me.   In my case, the pathologist at the hospital rated my removed prostate slightly lower in Gleason than the pathologist who did the biopsies analysis, which is probably a bit unusual...but there MIGHT be a tendency for SOME biopsy pathologists to assign slightly higher values.   I have ZERO knowledge that this could be so, it is strictly conjecture. Even for well-trained pathologists, reading samples is rather difficult for Prostate Cancer, so that could be the real reason.

  It is possible for the PSA to be LOW, and you have cancer.   If your PSA is rising a wee bit with every yearly test, doctors have charts for what type of rising is acceptable, and what is suspicious. I've put the important information for you well above in this article.   

 At the slightest suspicion, showing something strange over a period of time, it is likely time for a biopsy.  Putting this off can cause you major problems later on.  Heed my words!!!!   I did NOT put it off, am QUITE happy I did not!

In my situation, my PSA tests, and DRE checkups, were all quite normal for many years.  One PSA test in 1995 was a teeny bit higher at 2.2 (who knows, I might have had sex the night before....I did not know about sex having an effect on the test then); and, any minor infection of the urinary tract (bladder, prostate, etc.) can raise the PSA.  Most doctor's will... or SHOULD... have you on antibiotics for a 10 day period, then off for maybe 5 days or a week, then get re-tested, if your initial PSA test was a bit high.   My PSA settled back down...under 2...until 2000, when it reach 2.2 again.  In 2001 it reached 2.8, still  low.  That means it rose, but not at a truly alarming rate, unless that continued.  The value was not high for my age either.     Doctors, using the OLD guidelines, did not anticipate problems when men have PSA readings under roughly 4.0.  SOME still think that way.    That 4.0 idea is an old generality, and is now is thought obsolete by truly knowledgeable sources....see information earlier in this article.  SO!...LISTEN UP!....that 4.0 value is OBSOLETE!!!

I was due for my next annual physical in March of 2002, but I had changed insurance carriers, and the new primary-care doctor (I had to select one and was finally assigned to him), did not, or his front office nurse did not, check off the place on the paperwork for a PSA test on my normal blood tests at that time.  THAT was THEIR mistake.  I ignored not having the test, as my PSA had always been rather low.   THAT was MY mistake.  When I next saw the doctor, near the end of 2002, I asked for the DRE and PSA test, and it came back at 5.9...a large jump.  An antibiotics routine dropped it to 5.4.   Those readings were NOT overly alarming for my age and charts (65 at the time), but the RATE of increase was VERY suspicious.   My PSA was 2.8 somewhat over a year earlier.  The RATE was MUCH higher than the 0.5-0.7 increase per year that is usually considered reasonable.   He referred me to a Urologist, who recommended 'a biopsy'.  My biopsy was scheduled for March 2003.  

The biopsy is NOT fun.   It is not horrible.    This is what my Urologist had me do, and he and his technician did/had me do:
1.  Discontinue any type of aspirin or ibuprofen product for 10 days+, prior to the procedure, to lower any risk of bleeding.  Other products on a list of things I was not to take were ginko biloba, vitamin E, Aleve, ANY vitamins, any medicinal herbs.
2.  Have a very light meal and then clean my lower bowel out with a Fleet's or other water-based enema two hours before the biopsies.
3.  I was given Cipro antibiotic tablets, and was to take ONE, one hour before the biopsies.  After the biopsies I was to continue taking Cipro for three days (twice a day), drink lots of fluids, and watch for bloody urine and if any fever developed, of 101.5°F (confusingly one piece of literature provided to me said 100.4°) or higher.  MORE on this later....as I had a problem, a serious side-effect problem, from the biopsies....most folks do NOT.
4.  I was assigned to tiny room at the doctor's office, with the usual patient's table, and some equipment in the room.   I undressed, and lay on my left side.  First a technician inserted a small probe through my anus into my rectum.  This was not painful in the slightest.  He had an ultrasonic display, similar to one you have likely seen on medical TV shows that show a baby in the womb...etc.....and he had a recorder for that information, and used this probe to 'map' the size and location of my prostate and make lots of knob twisting adjustments on the machine.  This took maybe 5 minutes.  Then came the biopsies.    Some doctors will have an anesthetic gell applied.

After the mapping mentioned above (I found out later, because I asked, the size of the prostate was 49 cc, I am not sure if that means anything for ME), the Urologist came in and fiddled with the probe.  Attached to the probe was some sort of biopsy needle.  My understanding is that this thing is LOOONG, and about 0.050" in diameter, I can't say,  I did not see it.  Probably best not to see what is behind you (sorry for that pun).   It is fashioned into something called a biopsy gun, and the doctor positioned this item, then called out...for my benefit...'1....2....3'...and there was a popping noise and that needle jumped into me.  The needle goes right through the rectum into the prostate.  It also carries whatever nice germs it can, right along with it! That was why the doctor had me take CIPRO before...and for the next 3 days.  You probably would prefer this rectal method rather than another method I've read about that is in use, for prostate biopsies....through the penis.  I've NOT had that done, and I feel very squeamish about even reading about that procedure!  The first biopsy tissue-taking sample was only a bit painful.  5 more followed.  By the last one, it was definitely UNcomfortable, and I was wincing.   I would NOT have liked a dozen; but usually that IS best.      NOTE:   Sometimes a strong anesthetic gel is used, and there is no pain to speak of.  Some men are more sensitive than others to pain from a biopsy.     Sometimes during a biopsy a small vein is punctured, or a surface hemorrhoid, etc....and you could have a small amount of bleeding for a short period of time. 

This was NOT screaming pain though, and the doctor used no anesthetic gel, that I know of.  The entire biopsy part was over in maybe three minutes.      Would I do it all over again, knowing what would happen?.....I sure would.  At least now I have a chance at living out my normal lifetime.
I had some complications from the biopsies, nothing lasting, and in 2010 I removed the many paragraphs from this article that previously had a full description.

My biopsy samples had gone to a pathologist for interpretation and the pathologists 'estimation' of the "Gleason Score".  Mine came back, quite some days later....as: "3 + 4 = 7.   NOTE that this was THIS pathologist's report, and that this was of biopsy tissue taken well BEFORE my surgery.  That 3 + 4 = 7  is borderline between fair and not good.  Anything from  "= 8"  upwards is BAD. 

The written report came back as: Adenocarcinoma of the prostate.   The Gleason Scoring identified cancer in two lobes of the prostate, and with techie stuff about how much % in what lobe, what area. 

One of the samples came back a bit suspicious, for another type of cell, possibly from the prostate capsule being breached;  and, the doctor started arrangements for me to have a Nuclear Bone Scan.  My suspicions are that the Nuclear Bone Scan test was partly a save-the-doctor-from-being-sued if he did not, type of test.   Theoretically, that Bone Scan test will show if PC has spread into major body areas.  In fairness, however, the test DOES help the doctor to 'work up' the disease staging.   They never did, upon surgery, find any cancer cells outside the prostate gland.

Regarding this Nuclear Bone Scan.  This whole body scan, totally painless, is done by first getting an injection of a very short-term acting radioactive element into an arm vein, coming back after 3 hours, and then lying flat and quiet in a huge machine for nearly an hour.  It is something like an scanning X-ray.  Bones take up the radioactive stuff more than regular tissue, especially cancerous bone.   The results do NOT mean that no small groups of rogue PC cells were circulating in my body bones, taking up bad residency; just that the ODDS of it are less; or, rather, that it was not extensive enough to show up.  The results came back negative for the Nuclear Bone Scan.  At this point, from the pathology, I knew that I had prostate cancer, had had it for awhile, it was of modestly high grade, and needed treatment. 
                
The decision problem was WHAT treatment.   It was up to ME to decide on the treatment, once having learned all I could about WHAT treatments were available for my specific situation/tests/etc.   My doctors were good at telling me the options.  Better to be over-informed.  Being the very nerdy engineer-sort, I now started into a tremendous amount of reading of various books, recognized official sources, purchasing a book of nearly 500 pages authored by a well-known expert in the field, ETC...lots of ETC.   The Urologist had also given me a mess of literature to read.  I had already previously been researching official, knowledgeable websites of several prostate cancer and general cancer organizations, sending for literature, etc.  I did a LOT more of it. I went so far as to talk to doctors who were prominent in the field.  I knew plenty of medical terminology, knew my way around doctors, so got some REALLY good information.      Even today I keep up with it. SOME information is just not presented in such a way that laypersons can understand it....and I am a trained engineer with a wide-ranging technical background.   Some information is JUST PLAIN WRONG.   You are reading the benefits from all my reading, discussions, and skepticism.

I talked to my Urologist; and asked for a second opinion, this time not from a surgeon, but a Radiologist-Oncologist.  My reasoning was simple.  There are three ways to treat MY cancer situation and results of testing.  I was either not a great candidate for other options (like radioactive seeds), or many options were for more advanced or far advanced cases.  I did not feel my situation warranted Active Watchful Waiting.  For some men, that might have been an option.  My options were: 
1.  Do nothing, assume I will die of something else, or hope for new techniques and cures to be developed later on.  In MY estimation I was too young for these options, and my Gleason Score too high.
2.  Beam radiation of one sort or another.  This scars you so much inside that #3 below is not a later option for most surgeons, as there is usually MUCH greater side-effects and complications.  Some types of radiation are FAR easier on you, if you have to choose radiation as treatment.  Investigate carefully.   Conformal beam, proton beam, blah blah...lots of radiation methods.  This category probably should include the radioactive seeds methods.   There are a number of things being done, including freezing, etc.  None of these things fit me well.  I will have a lot more to say about radiation in this article.
3.  Serious surgery...two types are available.  One type is less invasive and you heal faster, BUT it is far less dependable for a cure, for a variety of reasons.  I opted for the radical procedure, done through a goodly incision down the belly.  The word 'Radical' as used by doctors does not mean what you may think.   Here, it means TOTAL removal of the prostate. This allowed for a variety of treatments following the surgery, IF they should be ever necessary.  The method I chose was the 'Gold Standard' for treatment in my situation, but the recovery period was likely to be longer as opposed to arthroscopic surgery....., and longer yet due to my age.....so I was informed by all the literature (the BASIC recovery did not really seem longer in any respect, to what I'd read, maybe I was just in better shape to start with, or the doctor more talented).  I will have more to say later in this article about surgical methods for PC.

In April  my PSA test came back higher, at 6.4.   PSA's over TEN (10.0) are BAD news....I wanted treatment long before 10.0!

Appointments were made for a formal second opinion with the Radiologist-Oncologist. The Radiologist-Oncologist was quite frank, quite friendly and informative.  It surprised me that HE FIRST brought up the option of surgery, radiation afterwards IF needed...as probably the best for the widest range of options for ME.  I had expected a surgeon to promote cutting, a radiologist to promote radiation.  I did not get self-centered pressures from either of them.   Amazingly, so I thought, this also was the case with two other medical-field folks I consulted via E-mail.  I have information that says you may not be so lucky, so be cautious.  After meeting with him, I had nearly decided upon surgery.

I hated the idea of having to decide between TWO treatments (surgery or radiation) both of which were highly distasteful.   The worrying, thinking, whatever, was distressful.  Distasteful and distressful are hardly the correct words.   About once or twice a week in the time all the consulting was going on and well before surgery, and when my stress reached a very high level, I would chop up a Valium pill into 4 pieces....or even 6, and take one teensy piece before bedtime.  2 mg did wonders for my ability to sleep for 5 or 6 hours.  As I told a friend, or two, 'I would rather be back in combat, than have the surgery'. 

I met with my Urologist.   I now knew enough to tell him, after some prior Internet searching about his qualifications & track record, what I wanted to do.  I talked with the Urologist about his method of surgery and decisions in the operating room based on pathology reports, etc.  I had already made the informed choice before meeting with him that HE was going to be MY surgeon.  He was highly qualified, well thought of by his peers, had done hundreds of these surgeries, and with excellent outcomes.

In my questioning of the Urologist...which was fairly detailed, he told me that he does not use hormonal therapy before the operation in my situation.  I found out why after reading more, as some books HAD  mentioned it being used.  The definitive books explained that using hormones prior to surgery might make the surgery a bit easier, as it shrinks the prostate, but it also can hide things from BOTH the surgeon and especially the pathologist who will examine the tissues!  It appeared my prospective surgeon was quite on top of every technique, as I questioned him about this, that, and other things.   NOTE!!!...do NOT misinterpret what I just said.  In the cases where RADIATION is to be used instead of surgery, the use of hormones prior to radiation may be very helpful in increasing survival rates....particularly when the cancer is Gleason 7 or higher, and/or the cancer is large.  This pre-radiation hormone treatment might take several months; and it also may have side effects such as PERMANENT erectile function problems.
I now wanted to crawl into a hole and make it all disappear.

At this point, a discussion of treatment options is needed here.  NOTE that there are a LOT of various treatments...and the type (hormones, surgery, radiation, chemotherapy...and on and on), depend on one's particular situation and condition.    Basically, for ME, I had what I believed to be GOOD options, but without surgery, we'd never know the TRUE extent of the cancer.

Radiation (of all types):  Generally thought of as 'you get one try' at this.  Starting with radiation treatment GENERALLY will keep you from having surgery later, although some doctor's might be convinced to do 'salvage surgery' if the radiation fails.....but the risk of side-effects after such salvage surgery are far greater than if the surgery is done first.  Beam radiation can always be done AFTER surgery.   Some people are not candidates for surgery...due to age, advanced cancer, etc.    Some cancer victims may have an advanced PC that indicates radiation is not a good idea.  There are several versions of radiation available (that includes radioactive seeds, etc., that require simple surgery to implant), and one advanced technique, multiple beam conformal type, WAS available locally.  It is done daily, 5 days a week normally, for about 5 or more weeks.  The reason it is daily is to enable one to have continuing radiation to kill those cells that resisted dying and re-grew.   You scar up inside, so you can't (or most surgeon's won't) have surgery afterwards if the radiation does not work.  Radiation really is, to MY way of thinking, sort of like putting some of your insides on a grill and being browned.   Possible side affects can be serious problems with urine and bowels.  Impotence is a possibility too...and it tends to not show up until a couple of years later! (where the surgery shows that up right away, and if the nerves are left, one side or both, you may gradually regain potency).     The advantage to radiation is that no serious surgery is done, and you are not going to have a serious surgery type of recovery. One additional DISadvantage to radiation is that you won't know if your cancer had spread...unless other tests were done, and SOME tests, such as pathology of a removed prostate...(or removed lymph nodes usually)...are not part of radiation treatment.   The 'BIG' disadvantage is that if radiation fails, your options are more limited to the serious hormones, chemotherapy, etc., as used for an advanced cancer patient.  As mentioned,  most doctor's will NOT even attempt a prostate removal after radiation treatments...it is messy, hard to do, and serious side effects are FAR more likely.   If you are having trouble making a decision about radiation versus surgery, do keep these things in mind.     If you need serious treatment, if you are not in reasonable physical condition to withstand serious surgery, radiation MIGHT be best, not necessarily THE answer.  So there are lots of treatments, including surgery, hormone suppression, various types of radiation....and combinations.  One common treatment for those opting for radiation is radiation first, and then hormonal treatment if the PSA starts to rise again.     

Do not forget that in many instances, some form of Watchful Waiting is appropriate...do not head for surgery or radiation without a lot of thinking and investigation!

I decided that leaving hormones and radiation for AFTER surgery (IF necessary) was THE way to go...for ME.   So far, even as I edit this article again in May, 2011, none such have been needed.

Surgery:  Open type PC surgery tends to be bloody, and the procedure sometimes lasts a few hours.  It can be especially bloody when doing fine work like saving your erection nerves!!  I consider it a VERY GOOD  idea to give two units of your own blood (called Autologous blood) well ahead of time, even if your surgeon uses a 'cell-saver' during the operation.   That is, for a period of maybe 3 weeks ahead of time, you will at one week intervals, go to a blood bank and get one unit (one pint) of blood, to be saved for use in YOUR OWN SURGERY...if needed then.

So, what can you expect after the surgery?    I will assume here the most serious surgery, classic open surgery:  DAYS (2-3 typically nowadays) in the hospital, long recovery (weeks) at home.  Probably 'drains' coming out of one's abdomen for a short while (usually removed before leaving the hospital) PLUS, a plastic tube (aka catheter) annoyingly and CONSTANTLY up one's penis for a fair amount of time (2 weeks +), while you heal internally.  Having a urine collection container strapped on your leg so you can be mobile, or a larger type carryable around the house.   Before and after the catheter is removed, you must learn to use the bladder as the hollow bag muscle it really is, for keeping your urine inside you, doing Kegel (key-gull) exercises .  Probably have to wear urine control pads or briefs or whatever type of continence control product you will prefer... for awhile... as you  retrain muscles.....  even well into the future, maybe forever, may still dribble some if lifting something heavy, or otherwise straining...and hence wear a Depends or similar pad.   Some very few patients never recover good control.   NOTE that while this information is rather depressing, improvements in techniques have lessened the recovery period for, probably, the MAJORITY of patients.   I have gotten mostly very favorable reports since ~2009!

 For myself, I did not know if my adult lifetime of ALREADY doing Kegel's would help after the surgery (yep, those exercises that enhance orgasms....I'm always for better orgasms!!).  SO....you also, if smart, do Kegel exercises!...before and certainly after surgery.  Frankly, Kegel's are great for one's sex life, cancer or not!  After cancer treatment by removal of the prostate gland, you should understand that your bladder itself is one big muscle, and you can train it.    Hopefully you will develop muscle control at the lower part of the bladder (your surgeon will CUT the urethra and CUT the lower part of the bladder away, and SEW the remnants together...and it is critical just how this is done).     You also are very likely to be impotent, that is, have no MENTAL ability for erections, which could be forever if your surgeon had to remove the nerves (two sets, they run along the outside of the prostate).  YOU might be lucky and keep one or both sets of nerves, and they might even, after all the bruising of surgery, work properly, or sort of, later...maybe much later...up to 2 years later in some cases.   Whether to remove the nerves or not is something each surgeon needs to decide when he has you open...and you should discuss it before surgery.    I think most surgeons will remove the nerves if they stick to the prostate; or, there is a question about the spread of the cancer. 

 I was lucky, I kept my nerves.  I looked forward to them working again, we have a long familiarity and life together, I intended to keep that relationship. 

*****It is very clear from many years of clinical experience, that even when nerve-sparing surgery is done, that the nerves may take up to 2 years to begin to work again.   Thus, if a man has his prostate removed, and the nerves are spared, there IS a good chance of the nerves working again....but you MUST BE PATIENT!!  Many men find that 18 months is needed, some a bit longer.****

Vacuum pumps and Viagra, etc., do work for most (NOT all) men if the nerves are gone or seriously damaged.   In any event, typically 'they say' you retain your sexual physical feelings and ability to have an orgasm (so long as your cancer does not advance and you have to take hormones).   Some chit chat I have had with some who have kept their nerves tends to show that your retention of sexual and orgasmic feelings will be GREATLY lessened, particularly in the first 6 months or so.  If you ever have orgasms, they WILL always be DRY orgasms.   Your orgasms will NOT be the same feeling as before.  You are not going to father any children, as the ducts from your testicles are going to be cut and tied off.   Sort of a vasectomy, done higher up.    The ability to have an erection by stimulation may be with you naturally, or not, depending on many things, but Viagra, Levitra, Cialis, etc., will usually work, once you find the proper dosage.   You are fairly likely to have a somewhat shorter erect penis.

Surgery is 'THE Gold Standard' for treatment.  Side effects are the usual post surgery items, but also incontinence; impotency, death (unlikely from the surgery itself, but one rarely might hear of someone having a blood clot in a leg that travels to the lungs), and a host of other nice things.   My Urologist informed me that after surgery I would awaken to find large long cuffs on my legs, driven by a pump-motor under the hospital bed.  These inflate and deflate at short intervals, to help prevent blood clots.  He uses general anesthesia, but with pain medication fed to the spinal area afterwards (epidural anesthesia).  The surgery is QUITE serious, CAN be lengthy, and the older one is, and the worse one's physical condition, the more chance of problems....not to mention the surgeon's skill at helping you not end up with incontinence and erectile non-functioning worse than they could be.  It helps to NOT be fat and out of shape!  The chances of the various side effects are also highly dependent on the ART/technique/experience of the particular surgeon.  Obviously it also depends on how far the cancer has gone, so some fair portion of all this will depend on the extent of the cancer that the surgeon and pathologist find, in the hospital at time of surgery;....and, that particular surgeon's approach to dealing with what he finds.   Surgeons want to take some extra tissue (flesh!) around the prostate, to be sure that there are no or few cancer cells left anyplace.  As usual, they have their own word-speak, and 'good surgical margins' means no infection found in the small amount of extra tissue that they remove.  Or some such interpretation.   They may also use terms like negative or positive surgical margins.  You can AND SHOULD ask your surgeon/urologist how he deals with things he finds, do this ahead of time, and be sure you both are in agreement!   

BUT.....how do you find out about YOUR surgeon's competence and abilities?  hmmmm.   In my situation, I had no hope of traveling to Johns Hopkins.    Johns Hopkins Hospital has a terrific reputation of doing great work in the area of Prostate Cancer.  It would be a first or near first choice by me for treatment if circumstances had been different for me.   But, that does NOT mean I am 100% happy with everything that comes out of Johns Hopkins;.......  I have read some disturbing reports on statements made by a certain doctor at Johns Hopkins in March of 2003 (not directly PC)...in which this doctor was seeming giving wrong, highly inflated that is, data in statements on TURP procedure results; and, worse yet, regarding a treatment called PVP, he seemed to be making derogatory statements not founded in fact.  My conclusion was that he had a personal interest in promoting certain methods.   You can obtain a summary of this in the Volume 9, Number 2 Summer 2003 UPDATE of the American Prostate Society.  Source cited at end of this article. 

 I also was not about to trust the diet of Michael Milliken, who supposedly licked his serious prostate cancer by a radical diet change.  I did some internet searching, talking to other doctors, etc.   The Radiologist-Oncologist that I consulted for an examination and second opinion was very direct and friendly and informative; he even gave me the information that MY Urologist had done HIS kidney stones...(and vasectomy, when I mentioned our conversation to my Urologist).   Nice little club.   I PAID a small fee for research into my Urologist's qualifications and standing.  I also talked to just plain folks, finding these on my own.   I did not ask the Urologist for a patient list. You could.   I found some folks that knew some of his patients.  Nothing but good things to say from any of them.  I gave weight to input from the Radiologist/Oncologist who had had this same Urologist work on him; and particularly I gave weight to the referral by my primary care physician....a doctor for whom I have the very highest respect; I REALLY lucked out when I selected his name originally when I changed insurance companies.  IF I had not been so confident of these folks, and other inputs, I would have been even more aggressive about looking into my Urologist's long-term success.....and failure.....rates.   Words to the wise, for YOU!!

Some surgeons will not continue the operation if the lymph nodes (removed and checked by a pathologist while you are on the operating table) show cancer involvement, some will if the involvement is small. My Urologist and I agreed that the prostate removal surgery stops if a node shows serious cancer.   If the surgery is stopped after pathology shows lymph full of cancer, then you have only radiation and anti-hormones (or castration) left as good treatments, so there is no good reason to continue the surgery, with its aftereffects and healing.  Serious lymph involvement almost always means the cancer HAS spread.  Cancer in the Vas Deferens is not limiting...so I understand.     Surgery just to remove and examine lymph nodes is sometimes done in combination with the other type of prostate removal, called the PERINEAL approach.  Getting to and removing the lymph nodes is a fair procedure in itself.    IF one's age and physical condition permit, I am NOT much in favor of the perineal approach, only the retropubic approach.  The pelvic lymph nodes are the first place PC usually spreads to.  Once well-established there, the cancer has probably spread elsewhere's, and removing the prostate might well not help you at all, and make things somewhat worse....the surgery is MUCH more extensive to finish the surgery to remove the prostate.  That is why the surgeon may want to stop if the lymph are infected badly.

Prostate cancer is FED by testosterone, the hormone that, in many ways, makes us men (did you know that women also have small amounts of it?).   In later, more serious stages of prostate cancer, 'anti-hormones' (generic slang used by me here) are used (or castration, removal of the testes) to slow PC growth after it escapes the prostate...and in some cases, before.   Those escaped PC cells get into all sorts of things in your body eventually.  NOT all testosterone is made in your testes (balls).

UNfortunately, SOME cancer cells are not affected by the elimination of testosterone, those hormone INsensitive cancer cells keep growing.   The percentage of hormone sensitive versus hormone INsensitive cancer cells varies with individuals.    Dying from prostate cancer is VERY unpleasant to contemplate.  The cancer spreads, and likes to take up lodging in bones, where it creates intense, hard to get rid of PAIN, that requires rather high doses of opiates, so high that you don't get to have much of a life.  It can also spread into all sorts of other areas, wreaking havoc.    Because of the sensitive and not-sensitive nature of the cancer cells....and the percentage of each of which varies....cancer that has spread is never treated with the idea of treatment being a cure....at least that is unlikely, probably for the foreseeable future.    The idea will be to SLOW the cancer growth.  Sometimes the slowing can be substantial....but also too often one dies too quickly.

I decided that just facing up to things early on (facing up to, is NOT decision making as to treatment!), and sharing my feelings, and information, was what I should do with my friends, and even with those I barely knew, if they asked.     All of this discussion definitely helped reinforce my resolve.    Each piece of literature I read helped me to understand other pieces of literature.   Questioning my Urologist, and the Radiologist-Oncologist, answered nearly all the rest of sub-questions.  I also contacted several Prostate organizations/groups, etc.    Walsh's very thick paperback was the best, generally, of all the books....including those on loan from my Urologist.  Walsh's book explained quite a few things where other books and literature could be confusing.  Walsh's book also added much information.     Some prostate organizations also had some literature available, I sent for those things, and some was quite helpful.   By reading a huge amount of literature, one gets, FINALLY, a nearly full explanation.   

 Some final information was only obtained by some dogged investigation, and talking to some experts in the field....do NOT take this simple sentence lightly.

My biopsy Gleason was 3 + 4 = 7.   My staging at that time was some type of T2, my Radiologist guessed at T2a.  The Urologist said T2.  What I worried about most was if the cancer had spread.   Lymph nodes.  Bones.  The Nuclear Bone Scan is known to be IN-accurate about 25% of the time.  There are other places besides bones.  Here we go, another place for worrisome percentages!   What I was not worried about was erection problems....well, not overly.  I was more worried about incontinence after surgery;....a few men have permanent problems.   I was only modestly concerned about dying of prostate cancer....concerns about an early ugly death, would be dealt with AFTER I did whatever treatment would be the initial choice.    Men vary in what they worry about.   I wanted to stay alive, in reasonable happiness, and think about retiring and riding my motorcycles, and having some fun.  I'd worked hard a large part of my life to prepare for retirement.  Now was not the time to shrivel up and feel sorry for myself.  

UNfortunately it WAS now a time to worry, have some sleepless nights, and have to make serious decisions.  It was also a time to deal with doctor's, hospitals, labs, and....medical insurance company.

I honestly did not truly feel...mentally....like doing anything but hanging around the house.   Luckily, a friend of mine tended to get me off my butt.   We spent the Easter weekend, we went to Church services; we went to Del Mar to see The Night Of The Horse, eating a picnic 'dinner' right at the show;...GREAT SHOW; and we attended Easter Sunday services outdoors.   We had Easter Sunday dinner with family.   I drove back to my condo in Palm Springs mid-evening that Sunday.  I had intended to go back earlier, and spend some time alone, thinking.  Probably just as well that I did not spend much time at that. 

In April 2003, ...I had a decision day.   THIS was the day, the appointment at my Urologist's, at which I was to STATE VERBALLY my choice of treatment.  I was under a LOT of stress.  I was nervous.  I had a sour stomach.    I was now mentally committed to a certain course of surgery.  We had a good discussion.  I told him that my decision was to have him perform the radical retropubic surgery, as soon as he could arrange it.  The surgery was then scheduled for a later date than I really wanted, but this was LIKELY in line with the 6-8 weeks of healing after biopsies, that was wanted by the doctor. We discussed trying to save the erection nerves only if safe to do so, and several other things.    I agreed with his view and policy that if major lymph node involvement was seen, that the surgery would be stopped, and I would then, after a month or so, be going to the Radiologist-Oncologist.  If the PSA began to seriously rise again at some later date after surgery, the Radiologist-Oncologist was the backup treatment; this was agreed to be THE way to go. 

With the surgery option taken, and the major important details agreed upon, at this point it was now up to the Urologist's office to get an approval for the surgery from my insurance carrier.  Then we would obtain a surgical date.  I was to 'donate' blood, for myself.  This is called autologous blood.   I found out from the surgical report after the operation that I had lost an estimated 600 cc of blood, about 200 of that was put back into me.  After the surgery, during recovery, one of my units of blood was also returned to me.    Approval for the autologous blood drawing was needed.   Medicare, not the insurance company, was involved with autologous blood donations.    Details, details.   The biopsies area was still in healing mode, the cancer likely slow growing, so the books said, so I understood why the surgery was not put on an emergency basis, but I was still very concerned about having this 'thing' in me, cancer, growing.  I wanted it OUT of me....yet I HATED the METHOD of removal!   Actually, I did not like thinking about it all.   

I was to have three weeks before the surgery to have my two (2) self-donated (autologous) blood units collected...the Blood Bank literature says they hold blood for 42 days, but the Urologist said 3 weeks.  Never found out about that discrepancy.     I thought about that schedule and with a look at a calendar, I decided to have the blood taken a week apart, then to have 8 more days before surgery, to allow my body to rebuild my blood before the surgery.  They were to call me when I had approval for the autologous blood-letting.  I had to follow up on this rather considerably. Frankly, I found that I had to follow-up on a lot of things for myself.   Meanwhile, I had already started taking iron pills, two per day per the Urologist.  Iron pills can be very constipating.  Plums and other natural fiber containing foods (particularly strawberries!) are tasty though.    I went back to my Tahoe home to do many  things, as my next trip to the condo would likely be the trip for the blood-letting, then the surgery, and then a fair amount of recovery time. 

Finally I had a confirmed date for the surgery in May 2003.   I then arranged for the blood-letting schedule exactly as I thought it should be.    I stopped taking the small amount of aspirin that I normally take every day, to lessen surgery area bleeding, which makes things complicated for the surgeon.  

I now had things to do like an updated Will and a updated Durable Power of Attorney for Health Care.  I finished those on May 1.    I returned to Palm Springs on May 2, 2003.   I quit taking vitamins.  Now I was off aspirin, off vitamins, but still on iron pills and strawberries.   I found it VERY wise to continue eating LOTS of strawberries (prunes? figs?)  for some time after the surgery.  

May 4th:  No alcohol from now on until well after the surgery. I seemed to have lost any appetite for alcohol.  Probably the stresssss...ah, yes, stress.   All sorts of things ran though my mind at times.    I thought about the surgery when I lie down at night to go to sleep...and sometimes when I wake in the morning before getting out of bed, and sometimes for no good reason I can think of, during the day.  I have a sour stomach in the morning at times, likely from all this thinking.  No wonder my appetite for beer, wine, Scotch, and a good cigar was in remission (I was sure it was just temporary, it was not)!  

May 5th:   Preparations for the surgery begin more seriously.  It is time to go to the Blood Bank, deal with paperwork, insurance, Medicare (blood bank gets paid by Medicare), and ...oh yes!.....giving a unit of blood.   Giving a unit of blood takes 12 minutes of paperwork for the first unit (2 minutes for the second one a week later), and 4 minutes of nurse preparations, and 5 minutes of totally painless blood-letting while one could, if one wanted to, suck on a bottle of water.   If you want to, you get to look down from your reclined position, see the complicated looking plastic bag being rocked back and forth by the machine it sits on.   During that first unit draw, I remember wondering about the Heparin, an anti-coagulant, that they put into that blood.  What would happen if that was put into me at the time of surgery...or afterwards?....would I tend to bleed more?   Would the heparin in that blood unit defeat my being so careful not to take aspirin?  Never did ask about that.   Probably would not affect things, way more than one unit of blood in a human, the one unit would be diluted greatly.  Maybe.  Still curious.  Maybe some day I will ask someone associated with a blood bank.  OR a doctor.  Or both.

After the vampire attack, I got off the blood-letting table and....THEN...I got to go off any diet I might have been on, and enjoyed what snacks were there for me, as I was informed to sit for 15 minutes, in the lobby in my case, so they are sure that I was feeling OK.  I felt just fine, and treated myself to a 'single serving package' of chocolate chip cookies (TWO, huge, in one package), and a half cup of cofffffeeeeee, plus the water.  Orange juice, soft drinks, other bad sugary things...all there, waiting for the appropriate taste bud(s).    I noted that two other people, who were snacking like I was, tended to like the same chocolate chip cookies.   

May 12th:  Time for another Unit of blood to be drawn by the kindly vampire assistant at the local BloodBank.   On this second visit, they said nothing about the lobby waiting period after my substance removal. I did it anyway, as I was now an expert at not only giving essence to their plastic bag, but in locating the chocolate chip cookies.  I noted the various types of plaques on the wall....some were pictures or maybe a name or more than one name, of some folks who donated regularly...for use by other folks....Gallon Club...etc.  

May 15th:   Telephoned the Pre-op department at the hospital.  Made an appointment.

Weekend:  Drove 120 miles to spend some time with my close friend and see some other folks, attend the old motorcycle parts sale at Irv Seaver's BMW, and generally take my mind off things.....sorta!    My friend would later meet me in Palm Springs.

May 19th:  Off to the hospital for pre-ops testing and lots of paperwork.  Surgery was "still" set for the next day.   The pre-ops is almost factory-like, efficient, friendly.

I am not happy with things, I'd rather run away to the mountains, than face all this.

May 20th:  Within an hour of arriving at the hospital....why is surgery always scheduled for early morning (7:45)...when I am not ready for anything but coffee and the daily paper?..... I am under the knife.   I found out later that that actual surgery took about 1-1/2 hours, prep and cleanup made it bit longer.   I was told by my Urologist that the 'erection nerves' slid right off the prostate capsule, not 'stuck or glued-like'.   This meant that the nerves had no involvement and could be, and were, 'saved'.  Maybe saved to work again at some future date?   I could hope so (they do work now, and quite well!).     Sometimes 'saved nerves' don't regain function.  It would likely be awhile before they could actually starting working again, the trauma from surgery 'does things to the body'.    I have had conflicting reports on these nerves and how they repair themselves....or don't ...from any trauma, bruising, whatever, over time.  What is true, is that if the nerves are left, undamaged except minor bruising, they have a good chance of functioning again.  Radiation, on the other hand, usually leaves the nerves functioning FOR AWHILE, then KILLS THEM within 2 years.

 I stayed in the hospital until the third day.. I did not feel up to leaving on the 2nd day when when asked to do so; this was my choice.   I was barely up to leaving on the 3rd.  Yes, they tried to rush me out, 49 or 50 hours after the surgery!!!   Frankly, I still feel a bit of HMO type pressure on the surgeon had something to do with this, but this is pure speculation.  I was at the hospital a total of about 80 hours.   The billing was about $1,000.00 per hour, averaged.

Ah, yes, trauma to the body!   I can attest to that!     ...I had, for about a week after the surgery, hot flashes!   Good thing I was mostly INside the air-conditioned house....with the ability to put on and take off clothes, instantly (as instantly as my pain allowed).    It was HOT in Palm Springs....outside. The doctor said that all sorts of strange things could come about, temporarily, as the trauma to the body resolves.  I found that to be so. 

 At the hospital I found my appetite near zero, could hardly eat, yet, with all the IV fluids, and drinking of water, and retention AND urination; somehow, ....I put on 10 pounds!  I could eat only by forcing myself, a darn shame as that hospital has a semi-gourmet printed menu, and you order by phone!  I was impressed.  I kept a printed menu...in color with pictures no less.    At first I was on a thin liquid diet unfortunately, and the Urologist's order to go a regular diet got mislaid somehow...and I knew it had been changed, so I complained, and this was fixed.  So, I got 1-1/2 meals, so-to-speak, before discharge, of quality gourmet food.  Finally I ate eggs, yoghurt, juices, cereal, French toast. With the U.S. at some odds with the French, over Iraq, I idly thought it should probably be British Toast, but the British don't know how to cook properly.  :-)      Shame I did not enjoy that special menu much more; like for lunch and dinner.  Still, I thought I would not try to find any special reason to go back and explore gastronomic delights at any hospital. 
   
 While in the hospital I had a small drain (tiny tube) coming out of my lower abdomen, usually called a JP drain, removed after a day and a half.  It fed a small squeeze bottle...cute thing, it was like a perfume bottle, most are just a very small plastic bag.  It was emptied (and measured, like all emitted body fluids) regularly at the hospital.    I still had the final Foley catheter, #20 French for those interested, which I was taught how to use properly (how to change between the large bag and a leg bag when appropriate) before my leaving the hospital.  It was mildly annoying, not painful. It would likely be removed in about 2+ weeks (so I had read in the various books).  HOWEVER... I knew that it was critical that the Foley catheter remain in place while the joining-suturing of the urethra and bladder heals.  That sutured place is the 'Anastomosis'.    The Foley catheter was held in place, (besides its internal balloon), with a sort of, outside my belly, common clothes-type 'button', with nylon suture material, said material leading inside into and through the bladder wall, and tied to the catheter.    One of the annoyances after the surgery, besides dealing with tender bowels, pain, and strange symptoms, is putting up with the Foley, one must keep it sanitary, at the penis-to-catheter junction, to avoid infection, ...you carry it with you---a must, since it is tied to you!....and empty the bag, etc. Some doctors will have you clean the penis tip area and use Neosporin or other antibiotic cream ointment there.  There is a small 'leg bag' for when one wants to put on pants and move about in society. That leg bag never worked particularly well FOR ME some of the time.  I went out once and I had a nice embarrassing leak, from the Foley catheter well above the bag area, at the penis tip.  I simply grinned (grimaced?) mentally; and, ignored what I assumed was every person within a mile staring at my wet pants.  No one stared of course. Reminded me of the time I landed a small airplane at Concord-Buchanan field, dressed in 60's paisley clothing and....ooops.....another story.

Back at the condo, I avoided putting on any clothing except a large T-shirt, and some old military-acquired hospital anti-skid socks....even in my condo patio (the patio has very high walls).   The reason was my extreme sensitivity of the incision/staples area to touch...especially the re-growing belly hairs...when touched, it was like needles...BIG ones.   It was interesting to see the facial effects on those friends who visited me during that first week++.     No pants, a shirt, a catheter, urine bag, VERY HUGELY swollen testes/penis, with a tube coming out of it, 6 inches of so of metal staples down my middle....you get the idea.  Depending on the visitor, I 'kept it all' somewhat hidden behind a robe;...my attempt at some sort of decorum and modesty.  Unfortunately for SOME of my friends, I don't really have much modesty, never did, and even got some perverse pleasure out of my shocking appearance (of  NOT  keeping things hidden behind the robe, well, somewhat).  Perhaps that attitude helped me heal.

To tell the truth, I'm the type that will not think twice about kissing my sweety with vigor, in public; nor, think much about my usual summer attire....old Levi cutoffs, very short, very old, very tattered.  It helps to get away with this by being physically gym-toned.  Wearing this type of clothing and a raccoon hat on one's head when camping in the woods...tends to get one a reputation....of some sort....or...whatever.   I have a modicum (or MORE than a modicum) of perverseness;...among my other great attributes... AND, I suppose, some almost gallows-humor helped ME deal with the situation.

In the hospital, pain was wonderfully managed by the teeny catheter in my back/spine (epidural anesthesia), but the day before release day, I was put on small amounts of codeine, the back attached catheter removed.  I think, with hindsight, that the catheter in my spine should have been left in another day, until my actual release, which should have been the FOURTH day, not morning of the third (and they TRIED to make it the second!).  There are seemingly no side-effects to that catheter method.  I did NOT suffer any headaches, which I had always heard was a possibility with 'spinals'....I was told THAT was UNlikely for this particular type of spine-fed anesthesia, especially for adults, even for someone like myself, who has had migraine-like headaches for decades.  It was true, I got up the next day at the hospital, walked around, had not the slightest headache....nor were my legs, etc., feeling any numbness.   I was VERY sore, and found it difficult to do that walking though, but I forced myself, knowing it was very good for me, and the staff thought it OK that I wanted to.

All the I.V. connections were removed just before I left the hospital.    One side-affect I had while at the hospital, was a very bad case of gas pains, that was not cured immediately by taking anything for it, and I gave up on taking anything for it.   I actually think these gas pains were far worse than any pain from the incision.  Except if I coughed...BIG pain!    The gas pains seemed to ease up on the last hospital day, and mostly disappeared after I got home, then returned somewhat, then disappeared about the 5th day after surgery. 

For about a week+  I was fairly UNcomfortable sitting.  That finally disappeared totally as I approached the third week. However, some slight internal feeling...in the rectal area, lasted for a couple of months.   For the first two weeks I was not happy sitting at my computer.   I was also well aware that I should not sit in one place for long, to avoid Deep-Vein-Thrombosis.   I did foot exercises all the time, to pump blood around.   The window for DVT is from the time of surgery to about a month, with the first week and a half as the most dangerous.  In the hospital, constantly inflating and deflating cuffs on my legs were used.   At home, I did those foot exercises....and walked.  

Re-cooperating at home was in some ways easier than at the hospital, in some ways more difficult.    The hardest part, in the beginning, was the same as at the hospital (even with the hospital's very fancy adjustable bed)....getting into and out of bed...or a couch.  There was also the mentioned sitting in my computer chair...and even when standing up for any period of time.  I did, after all, have an incision, a big one, and a whole bunch of me had been seriously cut, INside.    I had Tylenol with codeine for pain, which I used in rather small amounts for ONE day.   I chose to have a bit of pain, not all that much really; because avoiding constipation was a constant concern, and I did NOT want to use the codeine, which is very constipating, and there are no good substitutes for opiates for me.    My method of choice for constipation was high fiber fruit, and that meant massive amounts of strawberries; and, of course, lots of water.  I forgot that prunes and figs were very good for this, unfortunately.    I also ate bran cereal, and live-culture yogurts.  I treated myself to fat-free bran cookies at around the second week+.    I am the sort of person who will find all sorts of ways to skimp on $ for some things (cheapskate), but will pay almost any amount of $ for the BEST fruit,,,,,(and best mechanics' tools sometimes!);....and so this continued for the fruit.   Some friends brought me an entire lug of strawberries.  I could never eat them all when fresh, so I cooked all sorts of things with them that would last awhile in the refrigerator.

I found that the re-growing hairs on my stomach were, in one area particularly, staying super-sensitive, and any shirt movement on them was honestly QUITE painful.    This lasted some time, about two weeks, slowly decreasing.   Few other patients I know of, have had this to the extent I did.  MOST patients do NOT have nearly the symptoms during recovery that I had.

For such serious surgery, the side-affects, in the very beginning, were not very much....to my way of thinking.  Little did I REALLY know (book reading is not KNOWING!) about the coming incontinence, and the need to deal with constipation and avoiding hard stools, all for longer than I had thought.   For about 10 days I was taking an antibiotic, and had an appointment at the Urologist about 2 weeks following the surgery.

A few of the immediate post-surgery complications/problems:
....some blood leakage and BIG swelling into the scrotum/penis area which finally went away after a week.  I should have taken a picture.  I suspect that this was not too abnormal....those cut lymph nodes need to drain someplace, while they make new pathways for themselves.
.... a medium sized rectal hemorrhoid that shrunk adequately, then disappeared, in about the same amount of time.
....  one or two substantial floaters, probably blood, in my left eye. I worked on getting an appointment with an ophthalmologist, who saw no tear in the retina, etc., but, just in case, referred me to a retina specialist.  That specialist saw no immediate problem, but cautioned me on what to watch out for.   No connection to the surgery was made...and the floaters disappeared in a few weeks.
....very early-on after I left the hospital I had one rather bad night of warm bottoms of my feet....and the next morning my feet were VERY sore when I tried to walk.   Some calf soreness was apparent for about a week, I exercised my feet fore and aft to TRY to relieve that.  The foot soreness lasted a long time, actually.   Naturally, that first sore foot morning was the morning, 5 days after surgery, when I scheduled myself for a first outdoors walk around the condo complex.  This pain in my feet and some in my calves, was very worrisome, as I was concerned about deep-vein thrombosis (DVT), a possible killer.  I saw my physician about 9 days after surgery, when it had let up some but mentally bothered me, he put me back on aspirin, and said to watch it, and if not resolved in several days, he'd have a DVT scan done.   It resolved enough...but I kept my hospital bands on my right wrist...for fast admission without hassles, for a full month.   For the first two weeks I kept within a few miles of a hospital.     Most of the men I have talked to that had this cancer surgery did NOT have my foot pains.  MY suspicion is that the lymph was draining downward, and making my feet sore.
....Urine had been a bit bloody after the surgery...sometimes more than a bit, and cleared up some, then turned a bit bloody again.  That resolved within maybe 5 days after release.  This was normal.
....It hurt...a fair amount.... if I coughed.... for the first 5 or 6 days after surgery.   In fact, coughing was about the only time I REALLY hurt.  The pain lasted only a few seconds though.   I got adept at careful coughing.   I had NOT taken ANY pain medications beyond the first day at home; that one codeine pill, and did not need any, which really surprised me.   Almost all prostate surgery patients will have pain if they cough, during the first couple of weeks or so.
....Bowel movements were a constant problem....it felt like my colon outlet to my rectum had decreased in size and was traumatized.  I did not use strong laxatives, preferring natural foods.   One can NOT bear down with one's internal muscles after this operation, at least not the first week.  You have some of these rectal muscles CUT during surgery....and the prostate sits ON the rectum.  Bearing down HURTS!....one needs lots of healing time!    I was still kind of tender in that area, even well into early June....and a bit of it still left well into July, although any need to use quantities of really high fiber foods greatly lessened within 2 months.   Some surgery patients have informed me that they have NOT had the problems like I did.

7 days since surgery:  Put on leg urine bag, put on floppy trousers, a T-shirt, nothing else but tennis shoes, and went for a walk.   Already nearing 80°F, not even 8 a.m.....headed for 108°F today....got in several blocks, before I felt a bit tired and returned.   Walking with no underwear, and with the catheter and bag....was interesting. Visits by friends over the last week or so was much appreciated....one in particular brought me fresh fruit every day or two.    The visits were the most appreciated of anything.    I especially enjoyed the enormous amounts of fresh strawberries these friends often brought....nothing like TASTY high fiber foods for my constipation!   I ate strawberries in every way imaginable.

 The next day I went for a longer and rather brisk (?) walk, leaving me a bit sweaty....but not so tired like yesterday after I returned.   Feet and right calf still ache some, but trend is towards better.....and some areas of body swelling are lessening, and my tissues are giving up some of their excessive fluids.    Went to the Miata, simulated driving it, pushing in clutch, etc.....ZERO problems, so could drive if I had to.   Don't want to, yet, as I could not handle the HEAT, if I should have had a flat tire, etc.  Just in case, made sure I had fresh water container in the Miata trunk.    I'm still sort of stuck to being around the condo all the time.  I think it best to not push things too fast.  Outside the condo, the temperature officially was 108°F by 2:30 p.m.

10 days post-surgery:   I've been making a point of getting up early to avoid the heat, and then going for a rather brisk walk, lasting nearly 15 minutes.  Felt pretty good.  Bowel area pain is closer to OK, and seem to be getting better, but still tender.   My choice of lots of strawberries works OK.  I would not want hard dry stools at this point.   I am enjoying fresh berries, cooked berries, berries on ice cream (I am letting up SOME on fattening dairy products though), berries on waffles,,,,etc.   One day I had a neighbor and my roommate stop by a produce stand on a jaunt they were on, and they purchased an entire lug of strawberries.  I could not eat them all within even days before they would spoil...so,,,I cooked a lot of them....froze them, ate them, refrigerated them, found excuses for making waffles, pancakes,,,,,etc.    I'd been making lots of fresh lemonade from the lemons from my trees, eating tangerines from my tree, etc.   Life is looking up some.   My incision has healed a great deal.  There is no longer any truly painful area.   The Foley catheter only a nuisance.   The leg bag for the catheter did not always work well, twice I have seen the catheter leak, due to the bag internal valve not opening properly ....twice now in public... once badly....in the Supermarket that I finally felt up to driving to.   So what! ...  I found almost any modesty concerns gone.  Frankly, I have never had much modesty, and any I did have previously, is now hard to find.

 I felt up to mild light-exertion house cleaning, and also started developing and doing some exceptionally mild at-home exercises.   I could have gone to the gym but was being VERY conservative.  I noticed, the third time recently, that I had a spontaneous mini-erection.  Strangely, that did NOT happen again, for several months.  I suspect the traumatized nerves were having fun.  I hoped they enjoyed themselves, and would be up to my enjoying them more fully in the future. 

I obtained a copy of the 'surgical notes'; and, as I had been told at the hospital, no cancer was found in the lymph; no cancer was found in the seminal vesicles; no cancer was found in the vas deferens....and, the prostate pathology was a 3 + 3 = Gleason 6, better than the biopsy Gleason score of 3 + 4 = 7.    NO spreading/penetration, and 'apical bladder neck and radial surgical margins negative for malignancy'.   My Urologist/surgeon had told me these details in much more brief fashion the morning after the surgery:....he said: "I LIKE being able to give GOOD news to patients after surgery".   Certainly made me feel a bit better.    I had an appointment with the Urologist about 2 weeks post-surgery.  I asked for and obtained copies of the surgical and pathology reports.  NO surprises.  For those interested, final pathology, in brief:  3 + 3 = 6, T2, NO.   That T2 means two lobes of the prostate had cancer, that 'NO'  is another type of grading, not a 'no' as in NOthing found, or NOT found. Here, 'NO' that means that no spreading (metastasis) of cancer in the lymph was seen. N1 would mean spreading to the lymph, and if  N1, the operation would have been stopped.  The Urologist cut the button suture, removed the staples, deflated the Foley, and removed it and the suture material, all at the same time, and rather quickly.  I should have saved the stuff...would have made nice engine gas line.  yeah, yeah. perverse humor.     Re: removal of the Foley: Not too bad, not great feeling, not too bad.    

Before leaving the doctor's office where the Foley was removed,  I was given two Cipro tablets, one for right then, one for the next day.   I was to watch out for any infection, unlikely as it is, and I was told that one possible problem (if it occurred it might be in two weeks or so).... a restricting of the bladder outlet, rather easily curable though, if one appreciates a device to cut things, being pushed up ones penis/urethra.   I hoped not to have to appreciate such a device  (note:  NO urinary restrictions were EVER noted, even years later, and I can pee just fine, much better than some time previous to the surgery).  Otherwise, per the doctor, I was on my own.  He gave me no guidelines.  I mentioned to him that I had never received any instructions or guidelines for pre-, nor post-, operation, I did that mentioning in such a way that maybe he would do something about that for future patients.  He probably let that one in and out his ears.   He offered no guidelines during this visit either.     It was not hard to assume that I'd better not be hoisting motorcycles around in my garage, nor lift heavy weights, nor do a 80 mile forced march with a backpack.  

While at the doctor's office, immediately upon the catheter removal, a small amount of urine leaked.  The urine STUNG!   It was that way for awhile that day.    I asked the doctor about recommendations for urine control pads/briefs.   The young nice cute nurse...(they are ALL young, nice, cute, at my age), comes in, I'm naked, neither of us embarrassed in the slightest, and gave me, upon my request, a Men's urine control pad, Depends, which I could now use, or a generic cheaper version (Generics, I found, are NOT as good as the Depends brand), instead of the darn bag.  
 

NOTE: many men, during the time they have the Foley catheter, will have a very slight leakage of urine at the penis tip, which will sting a bit.  That is fairly normal.

At this same Urologist's appointment, I obtained the various reports for the primary care physician, at his request.  The next morning, June 6th,...I delivered them....on the way to a VERY LIGHT gym workout...my first in some time.  It went well.   The pads are a nuisance.  I will continue doing Kegel's, whenever I remember....which can be in front of the TV, sitting here at the computer, when urinating, when driving, whatever.  Kegel's are THE secret to getting full urine control.   So I've been told.  Frankly, the leakage is a substantial problem to deal with, in many ways, in the beginning.    The thought that SOME FEW men never regain ""good"" urine control bugged me.    I knew what the books said about gaining control.  I was VERY impatient, and the incontinence was interfering with the lifestyle I wanted....but, I actually just got used to it, it became just one of those things in life one deals with.  The Kegel's DID work, and worked well, and I regained plenty of control....later.

NOTE:  Kegels are bests done, especially in the beginning, by combining quick ones with longer stronger ones, but do not overdo these.  The object is to increase muscle size and strength (bladder muscle) and NOT to see how tired you can make the muscle by doing dozens of repetitions in 10 minutes.    Later, the best Kegels are ones that are held, strongly for a count of 10 seconds.

 I was now doing Kegel's without the catheter.  Often.  More than often.  The incontinence was REALLY an annoyance.  In this beginning period I went through quite a number of pads every day, 4 or 5, but the trend was to less, and by early July I was using the same one from just before going to bed the night before, to mid-morning.  However, I might use 2 or even 4 during the day.  That usage continued for a long time.   As per the books I read, the first place one gains control, of sorts, is lying down; then, comes sitting.  Last comes standing, and maybe never 100% if straining, such as lifting something.   Doing the Kegel exercises is THE way to gaining continence control.     I ASSUMED that the stronger I could make this muscle control the urethra, the better, and I was right.

***NOTE:   This is MY opinion here:  The real secret to gaining control is to do at least one Kegel, standing, every time one urinates.  Holding that Kegel for SEVERAL seconds, 10 seconds if you can, is vital for a faster recovery.  I failed to do this strongly enough in the first three months.   Muscle tissue must be exercised, just as one might do at a gym, if one is to gain muscle size, strength, and tone.   All of these are needed.  IF one was to not do Kegels strongly enough....and especially if not done to the point the muscle is a bit tired, then you will not, OVERALL, gain the results you want, fast enough. I now do the Kegel's very strongly, and hold them considerably, to the point that I can feel the muscle getting tired.  I suggest a good strong Kegel, and not a large number of small ones at the same time.

3 weeks since the surgery:  All in all I was doing well.  Except for some bowel pain....and that damnable incontinence.   I packed the Miata for my trip to my Tahoe main home and I spent some time nude sun-tanning.  One of my body-building bud's called, is coming by for one of his regular visits, this afternoon.  I look forward to chatting with him.  I'm bored.  Spending too much time on the three e-mail LISTS I am a member of.    I left from Palm Springs for the nearly 500 mile drive to Tahoe.  Was a 4 pad day.  :-)  

I  practiced Kegel's during the drive.  Very surprisingly, got about 5 hours of sleep that night, and had the SAME pad all night...and well into the morning, and noticed that I have SOME control now.  I really hope this sudden change portends good things.  My hope level is higher.   I am sure tired from the trip, and 6000 feet of altitude change.  

(note: from most of the men I have talked to that had this type of surgery, the incontinence recovery has been similar to mine, give or take a bit). 

I had arranged my schedule to return to Palm Springs in July, and I had my blood drawn for a PSA test that same day.  I had an appointment with the Urologist.  He told me I am doing fine as expected, and the incontinence would likely get better soon....and to keep doing the Kegel exercises.   The results of the PSA test were 0.1 (the lowest limit of that testing machine), and that was good news.  That means that there are no signs of any of the prostate cancer having spread.    I am scheduled for a repeat PSA test, and a visit with that Urologist, in January 2004.   

Being very conservative, it was only on the one month anniversary from the surgery that I cut the last of the hospital bands off my right wrist (passing the one month danger period for possible Deep Vein Thrombosis). I was back at the gym, gaining back some strength, flexibility, and being careful not to overdo things.  I was again, as before the surgery, doing exercises that stretch the abdominal muscles....but now also doing them for the additional benefit of avoiding having excessive INternal scar tissue. I can do all my normal exercises, but MOST I had to do at lighter weights...although I slowly began to increase weights until nearly 80% of normal, by the two month point.  The urine control in bed at night improved, and frankly not bad at all, no pad changes have been necessary at night, after a month;....although sometimes I did, THEN, wake up and feel the urge to empty my bladder, one to three times a night. That was no longer true after some time.    

Because of the insufficient...so far...bladder muscle control, I could not allow my bladder to get too full, although I saw improvement here too.  My bladder initially felt like it had a quite small capacity, which was probably true to some degree, but there is also the effect of the Anastomosis and that probably is mostly to blame.   For the first month I was immediately leaking into my pad in my briefs when I stood up, but I had more control by the two month point, and doing a Kegel from sitting or lying down, as I made for the toilet, worked.    Leaking DID annoyingly happen sometimes during the day, as I walked around.  It was particularly so when I was tired in the afternoon, or was lifting something. That mostly quit before 3 months.   My understanding is that at least SOME lifting incontinence (they officially call it straining) may continue forever, but that did not happen with me.

 At this point I  'counted pads'  before I went to bed every night.  I put out four every morning, and before bedtime I know how many I am using during the day. 1 or 2 around the 3 month point.

At about the one month point I had some morning dizziness for three days in a row that disappeared. Never figured out why.   My suspicions are that it had nothing to do with the surgery. 

Sometimes I felt up to going to the gym, sometimes not, but I tried to force myself to go even when I am not feeling like it.  I look OK, but to ME, my stomach/waist is only fair.  Where did that 6-pack go?      The incision looks quite well healed.   I am slowly getting back into shape.  Very slowly.   

 NOTE that I am doing Kegel's whilst standing & urinating, to try to have better muscular control...and THIS IS WORKING.   It is very important for someone who has had a prostate removed to do this.    Mostly I try to urinate and do a strong, holding Kegel, or two or three, releasing a bit of urine in-between Kegels.  Mostly I urinate when I feel the need....BUT, sometimes I will, on purpose, let urine accumulate, stretching the bladder some.  Doing Kegel's only when sitting is not a good idea, and not nearly as effective in adding muscle control as when standing.  That is NOT to say one should NOT do them sitting.  The name of the game here is to strengthen that hidden INternal muscle, at the bladder outlet.    It is very important to NOT cut down on liquid intake.   It is very helpful to INcrease liquid intake, quite a bit.  The more one urinates the better it is for your body in general....but also for the advantage of more 'training' of that bladder muscle.   Doing Kegel's even when sitting, perhaps at your computer, is a GOOD idea.   I am not sure one can overdo this.

By 6 months post-surgery my energy level had at times come back to normal, sometimes lasting a normal full day.  My performance in the gym was still slowly improving.   The pad usage was usually about 1 per 24 hours, sometimes a bit less, sometimes a bit more.  Lifting weights at the gym or most anything heavy, or doing the stepping machine aerobics, SOMEtimes causes a bit faster pad usage.  After sitting for some time, upon standing, I previously leaked some into the pad, but that has not been the case for some time now.  Bladder capacity is definitely increased, and is nearly about as it was before the surgery.  Erections: not much, just some to moderate lengthening and thickening.   Orgasms are possible; they take a fair amount of stimulation.  Certainly not the great ones I remember. 

I have been driving the sidecar rig some.  I also started riding the solo motorcycle, but Winter is fast approaching.  It is still quite hot in Palm Springs, where my shared condo is, and the air-conditioned car is best for me in that hot weather, which I don't handle at all well, never really did.   My suspicions are that the doctor was right, a relatively full recovery takes 6 months.  It turned out that even 6 months was to be optimistic.     I hate to think how long recovery is for someone who was not in as good physical condition as I was.   

 I had a PSA test at the end of December 2003, and the results were, again, at the lower limit of the machine, 0.10.   I had another PSA in May 2004, a different laboratory, with the new high sensitivity machine....and the PSA was 0.04, excellent!  

My PSA generally remained low.  I got a glowingly good verbal and WRITTEN report from the doctor in 2005.  I took a copy of that report to my FAA flight doctor, and applied for reinstatement of my Commercial Flying privileges.  The FAA doctor said I'd get an UNrestricted Certificate, and, I DID. I do have to supply PSA tests and doctor's reports to the FAA for every yearly Commercial Certificate renewal.  That continued for 6 years, then the FAA stopped asking for it.    I'm having a LITTLE less trouble with heat, as ventures into 95+ degree weather showed.     NOW I can almost always get a natural erection of good stiff quality with stimulation. Orgasm's are not the same, nor, sometimes, as long-lasting; my guess is that without the contractions of a prostate gland, that is the reason.   Over-all, my health seems OK. Except for not having the energy of a 30 year-old, I am doing fine.  I am in fairly good spirits, and I have a better outlook on life.  

I still wear a Depend brand of Men's Pads, day-times.  I don't like other brands. I have found that House brands from Rite-Aid and Longs (now CVC) are bulkier, don't work nearly as well, don't fit nearly as well either.  They are mostly $2.00 a package cheaper, and NOT worth it.   I get my Depend brand when on sale.  52 pads in one package (note:  Depends has reduced some packages to 48 now).   I have accepted the fact that I will never have 100% perfect control.   Other men, in similar circumstances, have reported that they DO get perfect, or near perfect control.  Only a few percent never get any control to speak of.  Most of MY incontinence is now gone, except slight if very tired or once in awhile at the gym or elsewhere's if lifting something rather heavy.....this is as expected, but, once in awhile I leak just a tiny amount for no good reason.  I use one pad every day or second day.  I usually do not wear one at night when sleeping.

My various physicians had previously mentioned the possible use of Viagra, Levitra, or similar, if needed (haven't need them, might like to try them though...heee heee).  We men do tend to identify ourselves with our penises...EH?    As it turned out, my nerves began to work better, as time went on. 

With the continuing good PSA test results, I decided to "assume" that I am cured of the cancer (doctor's would likely  officially use that word after 10 years of low PSA; for ME, that means May of 2013) (FAA maybe after 6 years) ...but... some side effects will be with me, always.  Such is life.    I am feeling pretty good although I tire more easily...well, sooner in the day...  Age? 

I XC ski and downhill ski and do gym workouts in the Winter; and, in the Summer I will be at the gym, plus hiking, biking and whatever else comes up.  Exercise really DOES help me feel much better.    Good for my mental state too.  In late 2005 a close friend insisted I accompany him on a simply GREAT vacation in June-July, and he paid for the trip!....to Norway, to do the Fjords, and visit Oslo and Bergen, the Fjords being done via a ferry ship; the Hurtigruten Company.  

About this time I decided I was getting on in years, and it was time to work less.   I reduced my repair business to a lower level, so I could have more time to myself and for my housemate. 

I fixed up another sidecar motorcycle rig (I purchased the rig this time and modified it extensively) and also have my solo motorcycle, and I am generally enjoying life more, especially with now having a wife I am deeply in love with......after so many years of being a bachelor.  We travel some; camp some; go to concerts; cook together; go to dances (and even take dance classes).   I am feeling and looking pretty darn good for a guy in his seventies; all the plumbing works too!...not as good as when age 30 though!    We did a 5500+ mile trip on the Sidecar rig across the U.S. in summer of 2008.

Special note: 

I've been asked about this effect, and could never provide real data, just my own "I think" information....until now:

Sorry for how this looks and reads, but it is a Bitmap, copied from a respected Journal, and this is information that is very difficult to find!
 

Below are addendums.  I have edited and combined these for clarity.   Please read them, and then read to the end of the article.

The RATE of increase of PSA has been mentioned by me in numerous places in this article as being VERY important.   That importance seems to be constantly going up. The Pierpont Study is an example of this. 

This particular paragraph is MY interpretation, and MY input here, from all I have read:      A general rule; from me to you is, if your PSA is rising in any one year, at the same testing lab, under the same conditions (no sex for a couple days or so, no DRE, etc.) ....at or below 0.7 or 0.8 per year, you may well NOT need a biopsy.  Some Urologists use 0.5, and some 2.0.  I personally think 2.0/year is not OK; but that depends on your age and life expectancy.        Keep records!    If your PSA suddenly really jumps, get re-tested.    RATE (velocity) information may help with men WITH prostate cancer.   A 12 year study of about 1000 men included men from age 43 to 85, confirmed that when PSA levels increase LESS than 2.0 ng/ml per year, prostate deaths are very low.  Only 0.3% of men with PSA increases below that velocity value died during the 12 years. Keep in mind, however, that if your life expectancy from the usual mortality tables is high, then you may want to delve deeper if your velocity is over maybe .8 per year.   Research from large group studies shows that reducing the PSA testing/consideration threshold down to 2.6...'for further tests....such as biopsies'.........will greatly INcrease the PC detection rate, at little cost in additional false biopsies performed (perhaps from 2% to 6%, worst case).   Because of this, I believe that not only must a PSA that is rising faster than normal be investigated further, but that any PSA above 2.6 should be considered for further investigation.     Each man must decide for himself.  Keep in mind that biopsies cost much more than a PSA test, and so HMO's and other health insurance folks might well try to discourage doctors from having biopsies done.   One must temper all this with one's age; since prostates enlarge normally with advancing age, thus PSA normally also increases.     I guess what I am saying here is that one should get the PSA tests done regularly, from the same lab, and refrain from sex for a couple of days prior to the test (and no DRE either), and one should keep one's own PSA chart, and if one's PSA is over 2.6, it is time to think seriously about consulting a Urologist and seriously about whether or not to have biopsies done. 

Keep in mind also, that in an effort to reduce false positives; reduce costs; etc., some 'government types', or those allied with insurance companies....and quite a few other folks........are starting more and more to recommend AGAINST even having PSA tests done.   Interpret this as you wish.

  Additional and other Studies are confirming, yet again, that diet and exercise are effective against getting prostate cancer, and likely help AFTER PC too.

The latest research shows that 'salvage radiation treatments' for those who already have had their prostate's removed (and have had a rising PSA within a few to maybe 4 months after such surgery ...here I am not speaking about short term PSA spiking soon after surgery, will usually stop the cancer, and failure to do the radiation will allow the cancer to invade the body and probably will result in a shortened life.  NOTE, again, that it is NOT unusual for a PSA spike after radiation, and that the PSA usually settles down.
 

 This is being added due to a LOT of misinformation, half-truths, sound-bite type reporting, etc., in newspapers and on TV,  and I expect this sort of thing to continue; especially since old information is available on the Internet.   This deals with interpreting the article on prostate cancer and PSA testing, etc., that was in The New England Journal of Medicine, in May 2004.    I will greatly condense that article's information here.   As I pointed out much earlier in this lengthy article you are reading on this website, the PSA test, which is the best over-all test we have nowadays (besides repeated biopsies), previously had a doctor-accepted cutoff of 4.0.  That is no longer true, but MUCH needs to be said.  
    The Journal article points out:
15% of men with "normal" PSA had prostate cancer.
HIGH GRADE cancer was found in about 2.3% of THEM.
Before you get upset, consider multiplying 15% by 2.3%!....that resulting % (.00345) is very low.  All the half truths and miss-reporting did NOT explain this at ALL!
The lower the PSA, the lower the risk of cancer.
There is NO clear PSA level that guarantees no cancer.
The problem then is obviously what to do when looking at your PSA level.

**A summary was obtained from Dr. Ian Thompson, Chief of Urology at the University of Texas Health Science Center at San Antonio....and who was the Lead Investigator in the above Journal research:
A man in the U.S. has a 17% risk of being diagnosed with prostate cancer in his lifetime....and a risk of dying from the disease of 3%.     ((note from Snowbum here:  other reports show that there is a 11% chance of a man getting PC over his life.  This is not exactly the same thing as the 17% who are diagnosed)).  Think about those figures; and realize how figures are misused.  Just on one level alone, there is a 6% difference between these figures....and one could imagine the difference being due to false detections of cancer.  One could also see that 97% of men will NOT die from prostate cancer, but from something else (including old age, we presume)........OK, I admit to being a nerdy engineer-type!

There is a risk, perhaps substantial, of having prostate cancer in what used to be called Normal PSA.
If a man has a PSA between 3.0 and 4.0, there is a 27% risk, if BIOPSY is used to determine yes or no.
OF THOSE WITH CANCER SEEN IN BIOPSY, about 1/4th will have aggressive type of cancer;...about a 7% risk of aggressive cancer in those with 3.0 PSA.
The risk of aggressive cancer is only about 1% for PSA 1.0.
Those with ADDITIONAL risk:  African-American; older; family history of PC.

The results of this study may convince more men get biopsies, and certainly more get PSA tests....and there is some concern...perhaps a LOT with the costs, unnecessary biopsies and treatments, etc.   It is a trade-off.  Biopsies do NOT always find the existing cancer...which is why a second round is sometimes done...and why 12 samples instead of 6 are often done.

There is research being done right now on better methods of screening and testing....protein profiling, for instance.....and research into genetic and dietary risks and behavioral risks.   I have nothing to add to that sentence, at this time.

Taking Proscar reduces the risk by 25%, but it MIGHT affect the ability to grade the PC, MIGHT actually cause a MORE aggressive cancer....all in the minority, but possible.  No further information on this yet either.

Dietary changes are not 100% proven yet....but...there is a large growing body of evidence that diet has a LARGE effect on all sorts of health items, and prostate problems are included.   Do NOT take this information lightly.   It seems like every few months MORE studies are completed that are saying Diet and Exercise are big factors in PC.

Two major studies were reported on in mid-2004.  Thousands of men had been followed for some years.   The basic conclusion of just ONE part of these studies is that there is NO PSA value below which a man can be assured that he has no risk of cancer.   The research found prostate cancer in hundreds of men (this particular study involved 2850 men) whose PSA's were ALWAYS under 4.0.    AND, 16% of those cancers were found in men who maintained PSA's BELOW 1.0.   NOTE that this does not mean that they needed treatment....read this carefully!     Careful analysis of the latest research studies has confirmed things I have discussed much earlier in this article you are presently reading........it is the RATE (velocity) of PSA increase that is the MOST important sign of problems.  Thus it is probably even more important than even previously thought, to start having PSA tests at a younger age, keep records of the values, and watch for value increases, and calculate the rate of increase as you age.   Many types of prostate cancers are so slow-growing that they do not need to be even diagnosed, nor treated.   For many, just waiting things out is the best course of action.  NOT so for all!   If one has surgery or radiation for a very low-grade cancer, the adverse effects may well exceed any anticipated benefits.    Many forms of cancers diagnosed in some types of cancer screening programs are indolent, nonlethal forms!....that might otherwise not have been even diagnosed during one's lifetime.    

 But, suppose you DO have biopsy tests.  
Here is the latest thinking:

The following is for men aged 50 to 74:

Gleason score           15 year risk of death
      2 to 4                            4-7%
      5                                   6-11%
      6                                  18-30%
note:  5 and 6 can be combined, and the result is 11-30%
      7                                  42-70%
      7-10                            60-87%
NOTE!....What this means, put another way, is that if you are 50-74, have prostate cancer, and your Gleason Score was 2 to 4, you have a rather low risk of death from it.  If 5-6, you have minor risk, which will increase as you age.     Many doctors now are convinced that so long as PSA tests rise slowly, there is no significant risk.  

The second study was by V.D. Amico, etc., and was reported in the New England Journal of Medicine of July 8th, 2004.   I will summarize the study here.   The study was designed to identify men with prostate cancer who would probably fail to be cured through radical prostate surgery, but the study gave results far beyond the original concept.   The MAIN thing for you to know is that the RATE of PSA increase....which is called the PSA Velocity, is THE critical thing, to identify risk (coupled with normal life expectancy, and so on). Thus, without any biopsies at all, watching your PSA is now CONFIRMED as critical.  ...and the MOST critical thing is the RATE of increase.

The study revealed, in an abstract by Kaplan-Meier, that the 10 year cancer-survival rate was 93% for those with PSA's doubling over 10 months or longer, and 58% with doubling less than 10 months.    

ONE more conclusion!    If the rate of increase exceeds 2.0 in any one year, at ANY level!!.....the risk of PC are SO high that a biopsy may uncover the disease LONG before it becomes INcurable!!!  READ this again!  

    Some things may be confusing to you, and some things may be not detailed enough. 
1.  At age 40-49, if your PSA is 0-2.5, your risk of having PC is AROUND 18%.
2.  At age 50+, (40+ for African Americans), if your PSA is 2.6-4.0, your risk is about the same 18%.
3.  At the same ages shown in #2, above, if the PSA is 4.1-10, the risk is about 28% for PC.
4.  At the same ages shown in #2, above, if the PSA is 10.1-20, the risk is about 70% for PC.
5.  At the same ages shown in #2, above, if the PSA is over 20, the risk is at least 90% for PC.
6.  The PSA velocity is all-important.  You need 18 to 24 months of good PSA monitoring to get an idea of the velocity.
7.  The DRE catches, at very best, MAYBE 60% of PC...and the big problem with DRE, is that by the time DRE finds cancer, or a suspicion of it, it may well be too late for a CURE.
8.  I have tried to leave out of this entire article MOST of the complications and confusions over a test called "free PSA".   Very basically, there are 5 types of PSA, 2 act one way, 3 act another way in the bloodstream.    One of the purposes of DOING a "free PSA" test is to enable the doctor to DECIDE if biopsies are a good idea.   Here is a rule of thumb:::  If it is BELOW 24%, AND the regular PSA is between 4.0 and 10, then biopsies are LIKELY to correctly find MORE THAN 90% of any existing cancer.      Knowing these figures might help you avoid biopsy, but 90+ percent is not 100.000%.

In late 2005, a number of longer term studies were reported.   It now appears that PSA, the substance, is PERHAPS responsible...again, perhaps!!....for PC.    PSA is involved with INFLAMMATION, and it is now becoming a very distinct possibility that PSA is the trigger for PC.   This is a fundamental difference...in that previously it was thought that PSA reflected just levels of an antigen, and that higher levels meant that something was going on, perhaps cancer.    It appears that the antigen's enzyme may be 'digesting' some cellular tissues, and helping to speed up the spread of malignant cells ...to other body areas!   I will add to this when I have good information.

*** FURTHER...more and more studies are backing up previous work, and seem to prove that if the PSA increases at LESS than 2.0 per year, the chance of death is very small, perhaps in a group, 0.3%.  If OVER 2 per year, it raises to 9.0%.    

The relapse rate with radiation of all kinds has been tabulated at near 50%, and while radiation may be the choice needed by some, surgery may well be the better....if it can be tolerated by the individual, together with all sorts of other considerations, of course.   You MAY see reports or articles that say that surgery and radiation are 'equally effective' over the long run.  BE SURE to read between the lines and ask very pointed detailed questions...figures are easily manipulated for public consumption!!    Trying to be fair here, I DO AGREE that if the PC is caught early enough, radiation treatments can be quite effective.   
It is my belief that relapse rates are improving as Physicians and Urologists and Radiologists, etc., get better and better at the various treatments and ...just plain care.    When I have definite proof of this, it will be in an addendum.

Some information on habits...diet....and...dietary supplements:    

This is not as controversial as you may think.   Certain habits and things in your diet will DEFINITELY increase your risk of PC, and many other cancers.    Confirmed is a connection between smoking; broiled red meat well-done or charred until the fat changes (partly to a carcinogen!); TRANS-fats...including hydrogenated fats (strong connection with cancer).   

Vitamins, supplements, etc:

Prior to the middle of 2008, information on vitamin and herb "supplements", in seemingly decently-done tests, 'showed' a reduction in the incidence of cancer AND reduced PSA. 
For information for historical purposes only, I list all the information here, and these are daily amounts.  NOTE that the latest late 2008 information is that Vitamin E and Selenium (200mcg used in the tests/trials) are NOT helpful, and are detrimental.  A very large number of men were followed in the primary Study (65,000 men!) for some years.  The Study was halted, instead of going all the way to year 2012, due to the HIGHER incidence of PC with selenium supplements at 200 mcg daily.   Selenium, 200 mcg originally ((which was seen to create problems)), and now maybe 80 mcg.. is being recommended, and it does seem extraordinarily helpful.....for all sorts of various cancers!   Few foods from other than from the Plains States, and from the SouthWest, contain much selenium.  NO information is yet available on people living in areas where the selenium level in foodstuffs and water is extremely low.   

I offer NO comments, other than what you see in this article, about 'supplements'....and the following was the best available information UP UNTIL MID-2008:

Vitamin E 800IU (unproven for PC now).   Vitamin A 10,000 units.   Vitamin E taken WITH selenium seemed synergistic (now unproven).  The Vitamin E that is best is the TRUE Vitamin E.....it is a family, including versions from alpha to gamma.   Vitamin E is a case where the PROPER form of the vitamin is helpful.  It must be, or at least contain, the GAMMA type of tocopherol.  The Alpha type may actually tend to deplete the gamma type, in one's body.   A recent John Hopkins report on E is really eye-opening.....for many purposes, but seems contradictory for use of E, with selenium or without, for PC.

Lycopene: ..several early studies tended to show that lycopene may help reduce risks of getting pc AND reduce PSA once someone has PC.   Tomatoes, anyone?  (always eat with a small amount of olive oil).   Much more extensive studies, reported in Fall of 2007, show that Lycopene (tomatoes) does not prevent getting PC, but DEFINITELY helps keep PC from advancing.   It may well turn out, as I think it will, that since PC starts, usually, in such a tiny tumor (which may NOT affect PSA, at its tiny size), that eating tomatoes regularly is going to be recommended, eventually....whether or not you have been diagnosed with PC.

 Proanthocyanidins help (often called OPC's)....no RDA for them, about 100 mg a day seems OK.   These, amazingly, seem to be the source for the French Paradox...how they avoid heart problems with fatty foods; and, these neutralize free radicals, and halt the growth of both hormone positive and hormone  negative cancers!!!    NOTE that the drugs that reduce or eliminate testosterone can NOT work on cancers not sensitive to that reduction!!  Finding OPC's is not really difficult, but one must look!....the most generally available source is grape seed extract or pycnogenol...but quality of brands vary.   100mg/daily.

Beta Sitosterol, 60 mg daily, appears to be of value....and seem to cut cancer cell growth by quite a bit.

Zinc is needed, about 12.5 mg.    ((zinc supplementation appears unproven...this comment by me in late 2008))

It seems confirmed that walnuts, blueberries, green vegetables like broccoli....are all VERY helpful. 

Latest information is that 6 mg daily of boron may be helpful.  Not enough data yet.

900 mg of curcumin....not enough data on this yet though.

....where can you get these various 'supplements'??   You can go find them by yourself, or, you can spend the $, and purchase Malegard. ....which contains them all, except no boron or curcumin.   ((comment by me, late 2008:  I would not be taking any selenium supplements over 80 mcg)).  Try 1-800-685-4912.  I have NOT used this stuff, nor do I have ANY interest, financially, in the product, in any which way.   This information comes from the American Prostate Society ((except my 80 mcg comment)).  (Please note that I have been watching this information and comparing with other well-regarded sources, and I believe that 200 mcg of selenium is way too high).  You certainly do NOT have to take supplements.   I do suggest you think about your daily multi-vitamin/mineral pill, or whatever you do or do not take.   I have NOT kept up with the formula changes (if any) on Malegard.   The information in this paragraph is for reference purposes for you, and I absolutely am NOT pushing this product!!!

IN FACT, at this point, I am pretty wishy-washy about almost all supplements, vitamins, etc.   The value is just not strongly proven...or, enough.

Doctor's deal with insurance companies; and most doctor's deal with them so heavily that the doctor has at least one office person JUST to deal with insurance...which runs their bills up, which you pay, one way or the other.   Doctor's can, thusly, spend only a FEW minutes with each patient.  FEW doctors have the time to really read and absorb much of the information that is published.      Thus, as a patient, or potential patient, YOU, YOURSELF, MUST! take a pro-active role, and be sure to ask questions, study literature, don't be passive.  If you need treatment, discuss it.  If a certain treatment is not what your doctor wants to do, ask why not.   If the doctor WANTS to treat you, ask WHY you need any treatment.   You may well find that you end up knowing LOTS more than your doctor, and if your doctor does not want to work with you, you then have the choice of keeping your doctor, or looking for another.  Mind carefully my comments in this article about the latest form of watchful ACTIVE management.

Many things are seen on TV, read about, etc.  Few hyped tests (nor treatments) end up being worthwhile.  Now and then I find out about something that DOES seem to have great promise.  One such was some experimental testing for what is called EPCA-2.   I will have more to say about this test in the future.  If it ends up being even half as good as it seems, it will augment the PSA test, and may well show REAL improvement in diagnosing PC, probably much much earlier than possible before.

MORE:

1. PC is found in 10% of men when the PSA is 1ng/mL or under; and about 12% when under 2.0; 15-25% when it is 2-4 ng/ML.   Thus, there is NO way to fully ensure you do not have PC, even with a very low PSA...but that test is the best we have right now (see above about EPCA-2).  
2.  One of the things some knowledgeable folks use to analyze PSA, is to think in other ways about the VELOCITY of change, that I have so emphasized in this article.   There is a Golden Rule for this.   If the PSA doubling time is less than 12 years, there is likely some sort of tumor growth, PC is probably evident.  Other factors will determine if anything should be done at this time.  In particular, if the PSA is UNDER 4, then small increases PER YEAR need watching and maybe diagnosis.
3.  If the PSA is between 4 and 10, you probably do NOT need a biopsy, if the FREE PSA test shows OVER 25%.
PSA (not the FREE PSA) values over 10 make no sense to get then a FREE PSA test, as you DO need a biopsy with regular PSA over 10.......and, speaking of biopsies....six core tests is NOT enough....10 or 12 is REALLY needed, otherwise you are wasting money, time, and may well be missing out on a thorough testing, that could cause problems later on.  Some doctors don't use a biopsy gun, but a biopsy guide...I think that brings more complications.
4.  Intraepithelial Neoplasia (PIN) is reported frequently, maybe 10% of the time, in pathology of the prostate biopsy tissues.  Do NOT let your doctor talk you into a repeat biopsy for just that.   To avoid unneeded biopsies when your PSA is below 10, and especially if 4 to 10, insist on a Free/Total test...if over 25% or so, you can probably reject a repeat biopsy.
5.  A Gleason SCORE of 8 or more needs solid aggressive therapy, right away.  Do NOT trust the results of the pathologist...get a second opinion of the samples....chances of a wrong Gleason SCORING are about 20%.
6.  If the pathology report comes back as "atypical-suspicious"...have the specimens sent to another pathologist!!!...if the second opinion is the same, THEN schedule a repeat biopsy.
7.  Except in rare instances, PC grows very slowly, it is NOT a medical crisis...don't rush to judgment on what to do. Think things through in depth.

SURGERY:

Choose your surgeon and your hospital very carefully.  The cancer recurrence rate for surgeons who have done at least 250 prostate surgeries is vastly less than for surgeons who have done only a dozen or so.   PC tends to recur in one of 14 men who were treated by a surgeon with low experience.   Hospitals with low numbers of prostate cancer surgeries will also have higher recurrence rates.    OVERALL, in the USA, 55% of men having surgery will not recover erections, and surgery fails in 25%.  So, pick your surgeon and hospital carefully.   Notice how these official recurrence figures of 1 in 14, can SEEM to conflict with earlier statements about near 50% success/failure/recurrence RADIATION rates, earlier in this article.   See how figures can seemingly say anything?  READ between the lines!  UNDERSTAND what is being said and meant. ASK questions!!!

Laparoscopic surgery and Robotics Laparoscopic Surgery ("minimally invasive surgery"):

Laparascopic surgery:    ... is a mixed-bag.  A report was released in October, 2009, in JAMA, of a large research project which was done by Harvard researchers, on a fairly large number of men who all were 65 or older.  This project specifically compared minimally invasive surgery to open surgery, for prostate removal.   The minimally invasive techniques were a bit better when comparing problems such as pneumonia.....but POORER for impotence and incontinence...by just about a doubling!   Hospital stays were shorter for these minimally invasive techniques. The rates for cancer control were similar.    

Robot assisted surgery:

Robot assisted surgery has become widespread.  The machines needed cost a hospital about 1-1/2 million dollars, and they end up PUSHING this type of surgery.   I am a bit cynical about it at present, and think that hospitals are trying to recoup the money they spent for the equipment, more than it having any substantial advantages (except, as noted).  Robot assisted surgery has some advantages, such as less blood loss...but as of September 2008, robot surgery success rates were NOT as good as traditional surgery; AND, the robotic surgery operating time is nearly TWICE that for conventional surgery.....perhaps upwards of 5 hours.  I simply cannot, in good faith, recommend robotic surgery at this time.  Note however, that YOUR surgeon, doing conventional surgery, may take vastly longer than 2-1/2 hours for YOUR surgery.  Ask!  Some robotic surgeries become struggles...and can last 7 hours.  ASK!   LONG operating room times are NOT very good for you!....compared to open surgery.

***NOTE:  in 2010 a large scale study was completed and the results were announced.  Nearly 800 men with EARLY STAGE prostate cancer were the only types in this study. Early Stage here means that the cancer had NOT escaped the prostate gland.  Different treatments were compared.  NO studies, NONE!...proved that there were lower risks of long term incontinence, nor impotence, with robot surgery.  This study also compared short, medium, and longer term outcomes for various types of treatments, including Radioactive Seeds.    It was found that the seeds were BEST for Quality of Life, as reported by the patients; with Cryosurgery the second best for this.....quality of life here included such as erection ability; and, in particular, incontinence....for the short to slightly longer term.  BUT, at 3 years or more, problems with sexual function were HIGHER.

Da Vinci Laparoscopic surgery:  This adds computer tech to help a surgeons hand and finger movements into surgical actions.   The surgeon may not be in the operating room.   I can't recommend this type of surgery if YOU are especially worried about the chance of permanently losing ability to have natural erections.   For this type of surgery, you should have small tumors, PSA's under 10, Gleason's of 7 or under, and a normal DRE.   See above on robot assisted surgery.

Nerve sparing surgery:  Your doctor should discuss this with you.  Save the nerves if you can.  If infected, get rid of them!

***Ultimately, choosing your doctor and hospital is probably more important than choosing the surgical treatment type.

RADIATION (etc...):

3D-CRT, which is 3-Dimensional Conformal Radiation Therapy works better as the radiation is increased...well, up to a point.  Radiation used to be given in RADS...and now is called Gy's...after a British doctor's name...Gray.

What are Rads and Gy's?...OK, for you nerdy types...the RAD was the old way of measuring radiation.  Nowadays, a more detailed way of measuring radiation is used, specified in GRAY's.     A Gray is abbreviated as Gy.   ONE Gray, or Gy, is:
1 multiplied by J/kg; which is same as 1M² times S to the minus 2 exponent.    feel smarter?
Explanation, simplified: A Gray is the absorption of 1 Joule of energy in the form of ionizing radiation, by 1 kilogram of matter.  Forget all that!  I am not going to explain it further!
If you need to relate Rad's and Gy's....just remember that 100 Rads is 1 Gy.

For the best results, Sloan Kettering's Dr. Scardino has studies showing that for the following radiation levels:
at 64.5 Gy:  about half the men had cancer 2 or 3 years later.
70 Gy:  about 1/3 of the irradiated men had a positive biopsy later.
81 Gy:  less than 10% tested positive for prostate cancer after radiation.
Dr. Scardino says that 70 Gy is too small a dose for any patient with a Gleason Sum of 7 or more.
ADDED NOTE FROM ME, 04/14/2010:   Upwards of 91 Gy is being used with Proton therapy, and results, SO FAR, seem to MAYBE indicate a better result.

Clinical stage of prostate cancer and your Gleason Score has a big effect on how radiation will work....or will not.
If you have Staging of T1C to 2a, and your Gleason Score was 6 or under, 90% of you might expect to be cancer-free after 5 years.  This drops to 81% for T2b and Gleason 7; and 60% for T2c and Gleason 8 or more.

IMRT:  Intensity-Modulated Radiation Therapy.  Can be very effective, and can allow up to 91 Gy, whilst still holding the side-effects to a minimum....and so this can increase cure rates.   IMRT is probably today's BEST radiation treatment.  It is also very expensive and requires a lot of expertise.  

Proton:   Urologists really used to, and some still do, tend to not think too much of Proton. Keep in mind what I have said in this article, that Urologists are into surgery, not radiation.   I have an open mind on the subject.  NOTE!  It costs many millions of dollars for the equipment (it is basically a cyclotron), and some think that it only offers about the same tumor control as X-ray radiation. MAYBE.  But, there MAY be LESS over-all damage.  Certainly, insurance companies prefer the X-ray radiation, it might be ~half as much cheaper.    Proton enthusiasts tend to, of course, think differently.  They say that Proton is so precise that there is much less tissue damage (no surface damage, no exit surface damage too)...that is, protons go right through without injuring tissues, before the beams converge at the cancer area. They also think that proton therapy targets the tumor better, over-all.  So, there is controversy between Proton therapy and IMRT.    Theoretically, proton therapy should have lower chance of lifetime risk from a secondary cancer in the radiated area. This would be especially important in a younger man, as radiation therapy that causes, eventually, more cancer, is not likely to show up for 10 to 20 years.

It was unclear, at the end of 2008, that even 91 Gy of Proton will be better at preventing recurrence of PC.  By the time I am re-writing this section of this article, in 2010, evidence is piling up.   HOWEVER, keep in mind that there is, so far, no careful clinical testing to actually compare results.  We won't know for some time yet. ...but there surely is 'some anecdotal evidence' that Proton will be, even at its considerably higher cost, more effective and less damaging, than IMRT. 

Cyberknife:  A registered trademark that has nothing to do with surgery by knife.  It uses a robot and computer controlled system to deliver radiation.   Detailed information is not yet available about radiation, effectiveness, etc.

Brachytherapy:   This is the implantation of radioactive 'seeds'....typically 50 to 150...of Iodine 125 or Palladium.   The radiation lasts differently between these two types, and the seeds remain in the prostate gland.
Due to radiation emitted from the seeds being described as by half-life (so long for each half life....that is, each half life period has half the radiation of the prior one), and the difficulty in my being able to describe the technical aspects in a way you can understand it easily, I have not attempted to do so here.    What I WILL say is that the treatment can be effective, BUT:
Experts in this field recommend limiting the use of Brachytherapy to men who:
Have a Gleason of 6 or less.
Stage T1 or T2a
PSA of less than 10.
Brachytherapy and beam radiation should not be used together.
Brachytherapy may not work well unless done by VERY competent experts.

*******NOTE:  in 2010 a large scale study was completed and the results were announced.  Nearly 800 men with EARLY STAGE prostate cancer were the only types in this study. Early Stage here means that the cancer had NOT escaped the prostate gland.  Different treatments were compared.  NO studies, NONE!...proved that there were lower risks of long term incontinence, nor impotence, with robot surgery.  This study also compared short, medium, and longer term outcomes for various types of treatments, including Radioactive Seeds.    It was found that the seeds were BEST for Quality of Life, as reported by the patients; with Cryosurgery the second best for this.....quality of life here included such as erection ability; and, in particular, incontinence....for the short to slightly longer term.  BUT, at 3 years or more, problems with sexual function were HIGHER.

Ablahtherm:
This is high intensity focused ultrasound, HIFU, which delivers cell-killing heat to the prostate.  I don't have enough REAL information to advise you.

Hormone Therapy:

The normal use of hormone therapy is to prolong life and reduce pain, when the cancer is advanced and has spread out of the prostate gland (metastatic), and this means AFTER other treatments have failed. Of course, if cancer is found spread into areas of the body, there may be no 'other' treatments done first.  Undesirable side-effects are fairly normal with hormone therapy.    Hormone therapy is also used to shrink the prostate prior to radiation (IMHO, it is NOT a good idea to use it prior to surgery).  Hormone therapy has been used by some doctors to treat EARLY stage PC.  This therapy is androgen-deprivation therapy...often just called 'hormone therapy'.  If your cancer is early stage, and localized, yes this treatment will have a big effect on your PSA, but it probably will do NOTHING about prolonging your life, and MAY be very harmful....and some think it can lead to an early death.   You can expect hot flashes, weight gain, loss of 'smarts' (declining mental abilities); it can make diabetes worse, and may trigger heart attacks.   A lot of men are on hormones when, in MY, and OTHERS opinions, they should not be.     The evidence against using hormone therapy for early stage PC is overwhelming.     There are exceptions.    Specific exceptions have been recently published by Dr. Michael Nuslund of the University of Maryland School of Medicine:   a limited number of older patients with HIGHLY aggressive cancer cells, that are on the verge of spreading.

Newer treatments for PC:

From time to time I will list certain things here, that may be of interest.  In NO WAY do I endorse these things.  These are for information only.
Some promising new areas of research include:
1.  Abiraterone seems to shrink large dangerous prostate cancer tumors in a high percentage of cases.    This drug is taken by mouth, and seems to have many advantages over anti-testosterone hormone therapy.   Approval...when?
2.  Provenge.  Phase III of a clinical trial is being done presently.  Provenge works with the cancer patient's own immune system.
3.  New tests that may prove to be better than the PSA test are undergoing clinical trials and comparisons in several countries.  The most promising may be released by 2015 if things go well.
4.  For those that have what is called Aggressive Prostate Cancer, some fairly good scale clinical studies seem to indicate that radical prostatectomy leads to considerably longer survival rates than radiation or androgen deprivation therapies...or combining both.
 

Clarifications, some newer things....and some comments:

1.  There is a fair amount of evidence that if you REGULARLY take Advil, Motrin IB, Aleve, ....ibuprofen....that you are likely going to have TWICE the problem in achieving erections, than those men who do not take these over the counter drugs.  For those of you who have had treatment, either radiation, or surgery, for prostate cancer, AVOID these drugs if and when you can.  Keep in mind that after radiation, erection problems might show up much later, while with surgery it is usually immediate. 

2.  I have been asked numerous times about Kegel exercises, mentioned in depth in the main body of this article.    The latest research and studies are reporting that 95% of men who do these exercises REGULARLY after prostate surgery were able to ELIMINATE urinary incontinence.  I have looked into these 95% claims, and I am not convinced of that very high percentage....due to how the tabulating was done. I think the research conclusions should be marked GREATLY IMPROVED, and not ELIMINATED.    My thinking, strongly, is that Kegels help almost 100% of men reduce incontinence, and that eliminating them absolutely entirely is a different story....depending on the surgeon's talents, your physical condition and age, etc.    I am convinced that Kegels are a HUGE help for all prostatectomy patients.     Do NOT hold your breath while doing them (I failed to properly note that earlier); but DO both types of the exercises, short squeezes lasting 2 seconds, and longer ones lasting 5 to 10 seconds.  These are not as easy to do when NOT holding your breath, but that is the best way, they are MORE effective when NOT holding your breath.

3.  You may well be confused by various reported 'studies'; government statements; and various other things, about whether to even have your PSA checked....and, if it is high, should you have biopsies, and if cancerous, treatments?
I cannot, and do NOT want to give definitive advice in this area, but, I will give you food for thought, and NEAR advice.  If your PSA is checked and is high, or you have biopsies and cancer is found, and you are nearing the lifespan typical for your family and close relatives, you may well want to do NOTHING.   This is particularly so if you are frail and OLD.   If you are in good health, reasonably young, it is not so easy to decide what to do; I'd be inclined to have surgery, if the cancer was aggressive (High Gleason score, after biopsies) and a lot was found in the prostate gland.    If you were, perhaps, in your seventies, and your PSA was tested as high (one can argue about whether or not someone in their seventies and later should even have their PSA tested), and most of your relatives died before 90, you might well just stop PSA testing, NOT have biopsies, and plan for a reasonably long life, because the chances are pretty good you will die of something else besides prostate cancer.    If you were in your forties or fifties, or sixties, my ADVICE is to get tested, yearly, and keep your own records.  The Government cites several studies saying that regular PSA tests,...and in some instances implies any PSA testing.....is a waste (of time, money, and??).  YOU must make your own decision.  I am NOT a believer in NOT doing testing.   What I AM a believer in, is being very careful about interpreting the results; and, VERY especially, I am a believer in keeping your own records on your own PSA tests!  It is my strong belief that in the present situation of available testing and treatments, that you SHOULD keep records yourself, and keep track of PSA VELOCITY.

4.
 

Ask your doctor:

Here are the things...a list if you will....of things to KNOW...and some to ASK your doctor.  This list comes from the Chief of the American College of Surgeons:
1.  NO questions should be off the table.
2.  There is no way to reverse a mistake in your diagnosis or treatment, when it could cost you your health...or your life.
3.  What is my first Gleason GRADE?
4.  What is my second Gleason GRADE?
(add both to get your Gleason SCORE)
5.  What is the experience of the pathologist who analyzed my biopsies?  What is his/her experience in Gleason Grades?  Do you recommend getting a second opinion about my Gleason score?  if not, why not?
6.  What is my Clinical Stage?
7.  What are my last three PSA's?......what is the velocity trend?
8.  What of the many types of therapies do you recommend?
9.  Of the procedures you recommend, what is the total number you have performed?
10.  How many of those, each, in the past 3 years?
11.  What percentage of men that you have treated have retained or regained:
      a. Erection capabilities?
      b. Urinary control?
12. Using the Sloan Kettering, Cleveland Clinic....or the Johns Hopkins...or the University of Maryland "standards of cure", what percentage of men have YOU cured?.....and explain that.
13.  What is your rating for my potential for a complete cure using the cure standards of those hospitals?
14.  Have you recommended postponing or deferring therapy, and using Active Surveillance for your patients?   If you have, please describe your procedures, how many men, and the outcomes to date, and how this may or may not apply to ME.
 

FEEDBACK:

 

If you have surgery, or radiation, or any other treatment that might be pertinent to this Prostate Cancer article of mine, I would like you to e-mail me with your comments.  I am interested in whatever you may wish to tell me....this can include your symptoms if any, the tests, the treatment, the result over time, continuing treatment if any, ETC.   I am particularly interested in the TYPE of treatment, the names and addresses of the medical people and facility involved; why you selected the particular treatment, doctors, ETC.   All sorts of comments may be pertinent.    I may use your information to help update this article, for listing doctors, etc.  I will  NEVER! retain your name and address in my files in any way shape or manner....UNLESS you just happen to be on one of my motorcycle mailing list groups....then your name is incidental, and has nothing to do with this article.  There is NO reference to you, PERIOD.   I do NOT retain e-mail addresses, nor names, nor any other information. I NEVER pass out any information regarding your personal information.  NOTHING in that regard, EVER!

I can be reached at:     E-mail Address

Surgeons, Doctors, Urologists, Radiologists, etc.
 

I have been very reticent to do any recommending or other commentary, or even HAVING this section.  I decided to incorporate this section in early May, 2011.  I have decided to simply include those I consider worthy of your consideration, and perhaps some comments.  I have a relatively long list now, but will be only rarely adding anyone here.  Just because these have numbers, does not necessarily put them in such order for quality, service, knowledge, technique, etc.::

1.  http://www.brighamandwomens.org/Departments_and_Services/surgery/research/UrologyResearch.aspx  Brigham & Women’s Hospital is in Boston, MA, and is associated with Harvard U.
The actual DOCTOR/SURGEON:  Jerome Richie, yes, the Chief of this division.  He does ONLY the retropubic procedure.  (Other staff does orthoscopic procedures).
He will likely use internal self-dissolving stitches, with some butterfly bandages.  You will be able to shower after leaving the hospital.  I have more than one report on his competence and excellent results, with short recovery times.

2. 

3.

4.
 

References:

 JOIN THE AMERICAN PROSTATE SOCIETY, BELOW; AND ASK FOR SOME BACK ISSUES.  ASK TO BE PUT ON THEIR MAILING LIST.   THIS IS A DECENT PLACE TO TRY TO KEEP UP WITH SOME OF THE LATEST IDEAS, RESEARCH, RECOMMENDATIONS, ETC.     This organization is, in MY opinion, a middle-left leaning group, with a different viewpoint.   They are NOT kooky and way-out-there.  An http://www.Google.com search for prostate cancer will give you a huge number of replies, but you probably will find it far quicker to use the following:   American Prostate Society.   1-800-308-1106
This is a non-profit organization, it has NO dues, NO fees, does NOT charge for ANYthing for Membership. You can get on their mailing list, very worthwhile, and past issues of their publication called "Update", are available.  They publish it quarterly.  
To get on the mailing list for the publication, simply write to:
The American Prostate Society
Box 870
Hanover, Maryland 21076
  Read between the lines in this publication, keep an open mind, a skeptical one too.....the publication is sent irregularly, about all sorts of things pertaining to cancer.   They will ask you to donate, etc.   Up to you.


The book:  The Prostate; subtitled "A Guide for Men and the Women who Love Them".  By Patrick C. Walsh.  This thick paperback book, with its not so promising title, is actually likely the best single book, over-all, years ago that I read.  It is available in paperback, and covers most everything you might need to initially know, besides what I have put in this website article, in dealing with the Prostate.  I have extensively annotated my copy.   It may have been updated, ask the bookstore.  The original version is somewhat out of date with the latest things...so, check for updates.  If there is no updated version dated within the last 2 or 3 years, then you may want to buy it for old information, much of which is still reasonably useful.

"About Prostate Cancer", by Ellsworth, Heaney, and Gil, and published by Jones & Bartlett....see www.jbpub.com    Get an updated version, if it exists.

NOTE that I have NOT recommended any other books from the local bookstore.

http://www.healthline.com/channel/urinary-incontinence.html has many resources on incontinence (i.e neurogenic bladder, stress and urge incontinence, etc) that might be useful.

http://www.malecare.com   Site is being revised, might have a new URL in 2010 (??), but, take a look anyway.

http://www.prostatecancerfoundation.org   Quite a decent source, be sure to browse this website's categories
They are going to a new website, it may be up and running:  www.pcf.org

http://www.prostate-online.org   education, information

http://www.PSA-RISING.com   Primarily for survivors, support, etc., but quite useful information on a variety of prostate cancer things.  (475) 362-4347

www.copingmag.com/prostate    Coping magazine

National Comprehensive Cancer Network 1-888-909-NCCN   The AstraZeneca Pharmaceutical Company website:   www.prostateinfo.com and their publication:  "Prostate Cancer:  What it is and How it is treated....a booklet for patients"  

http://www.cancer.net   (888) 651-3038

Department of Defense Center for Prostate Cancer Research    www.cpdr.org   (240) 453-8900

Cancer Support Community   www.cancersupportcommunity.org   (888) 793-WELL

Harvard Medical School-Prostate Knowledge   www.harvardprostateknowledge.org

MedlinePlus   www.medlineplus.gov

National Cancer Institute   www.cancer.org   (800) 4-CANCER

The "new" prostate cancer infolink:    www.prostatecancerinfolink.net

Patient Advocates for Advanced Cancer Treatments, Inc.   www.paactusa.org

Prostate Cancer Research Institute   www.prostate-cancer.org   helpline (800) 641-PCRI

The Prostate Net     www.prostatenet.org   (888) 477-6763

Prostate Conditions Education Council   www.prostateconditions.org  (866) 477-6788

www.ProstateCommons.com

Us TOO International Prostate Cancer Education & Support Network   www.ustoo.org  (800) 80-us-too

ZERO, the project to end prostate cancer   www.zerocancer.org  (888) 245-9455

http://www.rcog.net   this is a link to information on mostly radiological approaches, but NOT entirely.

American Urological Association  (and, the Foundation)  www.urologyhealth.org  
  (800) 828-7866 (hotline)  (866) 746-4282

 http://www.cancer.org  This is the American Cancer Society...see the Man-to-Man Program   (800) ACS-2345

http://cis.nci.nih.gov.   This is the National Cancer Institute, and one publication of theirs is:  "What You Need To Know About Prostate Cancer". 

Clinical trials, for such as angiogenesis agents are done by them:   1-800-422-6237 http://www.cancer.gov/clinicaltrials

http://www.cancercare.org   (800) 813-HOPE
 

I recommend you peruse this website:    http://drcatalona.com/    (Urological Research Foundation)
 

Last update:
10-28-2008.  Moderate update and clarifications, especially due to a large scale double blind test that was concluded, dealing with zinc, vitamin E, and particularly selenium
12-15-2008:  minor updates and clarifications, particularly dealing with PC percentages for =>4.0 PSA
03-16-2009:  Complete go-through of entire article, fixing typos, clarifying details, bring article up-to-date
05/31/2009:   minor updates and clarifications, and fix grammar and typos
08/09/2009:   minor updates...lots of clarifications....and clean the article up into sections, etc.
09/09/2009:  add new section:  Possible or potential new and newer treatments for PC:
10/14/2009:  expand information dealing with minimally invasive technique
11/23/2009:  Update two URL's; fix URL lists, where some had inadvertently been paired.  Remove one link as now it is the same as another.  Also add one URL reference. Remove two links entirely, as the sites have become less worthy of being listed here.
02/02/2010:  Add a clarifications and addendum section
02/07/2010:  Greatly expand Resources section
04/14/2010:  Add to information on radiation, proton, also explain Grays and Rads.
04/23/2010:  additional information from the study of nearly 800 men on such as robotic surgery and radioactive seeds.
05/17/2010:  Edited the personal stuff to shorten the article, due to some comments received.   Improve clarity in some areas
10/11/2010:  update Newer Treatments section
12/12/2010:  minor updates
12/16/2010:  Fix a hyperlink
02/16/2011:  very minor update
02/27/2011:  fix some broken or bad URL's
02/28/2011:  explain the 0.35 ng/ml versus 0.75 ng/mo rise in a year in more detail, and add items to avoid before PSA tests.
04/11/2011:  Expand the Clarifications area.
05/04/2011:  very minor updating; and began new section on Surgeons, etc. on 05/05/2011
06/28/2011:  repair a hyperlink
10/08/2011:  Minor update on why I believe PSA testing IS worthwhile, and a few other tiny changes
12/26/2011:  Very minor typos and grammar fixes.

 

© Copyright, 2011, R. Fleischer

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