Urologists

It's high time I continue the story of my journey towards Loma Linda, the tale that I started in the post "Beginnings" last Saturday.

It's also time I add a picture, so here are the Loma Linda Hills where I walked last Sunday. Peaceful.

Back to my story.

As I said, while I waited for the date for my next biopsy to come around, I attended the ACS Man to Man meetings where I encountered a Texas Tech colleague of mine who had undergone radical prostatectomy performed by my own urologist. He had suffered intense depression and continued to be incontinent. We didn't even bother to talk about sexual function. He had since change urologists. I had known this colleague ever since I came to Tech in 1995, and I had always considered him a wise man. But he had simply accepted his (and my!) urologist's directives without question and without doing his own research, and now he was paying a terrible price. A cautionary tale to be sure.

One night at Man to Man, Dr. Girish Vallabhan presented a talk on the DaVinci robotics approach to prostatectomy. I was impressed with this method because recovery time is much less due to the smaller incisions, there is far less bleeding, and most amazing of all, the surgeon can actually see clearly what he's doing, unlike the case with open body surgery in that area. I was still convinced that, if I had to treat my cancer, it would be via proton radiation, but I thought that, if I had to undergo surgery, robotics would be the way to go.

However, what really caught my attention in Dr. Vallabhan's presentation was seemingly more minor. He indicated that he took at least 12 samples in a biopsy, and when I asked about anesthesia, he assured me that he always deadened the prostate because otherwise it was pretty rough on the patient. Tell me about it. These procedures—a minimum of 12 cores, under local anesthesia—corresponded to what I had read in Marckini's book as well as the other ones.

When my biopsy date loomed a couple weeks away, I called my urologist and, of course, was connected to his nurse. I asked her if I could please have local anesthesia for the biopsy. She replied that the doctor doesn't do that "because we can't find long enough needles." I was shocked. And disgusted. This was clearly not an equipment problem; if doctors nation wide, and in Lubbock itself, could find the tools, they obviously were available. I believe this was clearly lack of willingness to update old practices as well as blatant disregard for the well-being of patients. Nor was this a hole-in-the-wall, back-alley clinic. This was the urology department at the Texas Tech Health Sciences Center—a medical school that teaches the new generation of physicians. I called Dr. Vallabhan, scheduled a biopsy with him, transferred my records, and severed relationships with my previous urologist.

In due course, Dr. Vallabhan conducted a 12-core biopsy, plus 2 extra needles in the area where the cancer had originally shown up, and he did it under local anesthesia. I wouldn't recommend it as recreation, but it was a totally different experience than I experienced under the sadist who had worked me over before. Even more wonderful, the report came back totally negative. Either the cancer had gone into spontaneous remission, or the needles had missed it. I came to understand later that the latter was the more likely explanation. In any case, I called Loma Linda, cancelled my appointment, and began another year of watchful waiting—getting regular PSAs and scheduling another biopsy a year down the road.

During that year, Dr. Vallabhan discussed proton treatment with me. He said that according to his associates in radiology, it really wasn't all that different from other radiology, and that it incurred virtually as much morbidity (side effects) as did other treatment options. He also gave me an article by Dr. Patrick Walsh questioning the efficacy of the therapy because no recent studies had been published. And finally, he said that, while the immediate side effects of surgery could be devastating, they tended, over the long run, to improve, while those from radiation tended to worsen over time. Nevertheless, he avoided terms like "voodoo medicine" and "experimental procedures."

June 2009 approached, bringing with it my third biopsy. I'll pick up the story here at a later time.

Treatment count: 13 down, 32 to go.