Patients speak about prostate cancer and laparoscopic radical prostatectomy
John Seibert, Wasilla, Alaska
July 1, 2003, my Wasilla Alaska urologist reads me the less-than-welcome results of my prostate biopsy procedure. 90 days and 4,100 miles later, on October 1, Arnon Krongrad makes the final snip and wiggles my cancerous gland out the seemingly much-too-small incision. The next morning, I walk out of North Shore Medical Center. Two days later, on a warm tropical night, Arnon, our wives Ruth and Bobbe, and I share a great dinner at Yuca, a Cuban restaurant on Lincoln Road Mall in Miami Beach.
My prostate was something I never game much thought to until November 1998, when, at age 49, following my annual FAA pilot's medical examination, the doctor asked "when was the last of your prostate PSA tests?" PSA, I said to myself, I wonder what that is. "I'm not sure," I replied. The nurse took some blood and the doctor said he'd see me in a year when my next medical was due. But instead he called in two days and said my PSA was high, 6.7 ng/ml, and this was something I needed to investigate. I had another blood test: PSA 5.1, still high. A subsequent prostate biopsy procedure was negative.
Over the next four years, semi-annual prostate PSA tests bounced round in the 4.3 to 8.9 range, gradually creeping higher and higher. My May 2003 PSA was 10.1 ng/ml, higher than 10 ng/ml for the first time. A subsequent biopsy showed a Gleason score 6 cancer in one of the six samples. My Alaska urologist and I discussed the options: operate, radiate, or just wait. He discouraged watchful waiting in my case: 54 years old, good health, with lots more rivers to paddle and mountains to ski.
The urologist suggested radical retropubic prostatectomy (the traditional prostate cancer surgery, which he does, quite well, I'm told), but he allowed that I could also look into the radiation treatment. He never mentioned laparoscopic prostate surgery. I set up an appointment with a radiation oncologist and ordered half a dozen books on prostate cancer. My radiologist ordered a bone scan and pelvic/abdominal CAT scan, which showed no indication that the cancer had spread beyond my prostate. He suggested a treatment regimen of three months of hormone treatment, six weeks of external beam radiation treatment followed by permanent prostate brachytherapy radiation. Yuck, were my private thoughts. Radiation didn't strike me as the route I wanted to follow, but open surgery didn't make me any more comfortable - the dilemma found in all prostate surgery patient stories.
In my independent research, I discovered Dr. Krongrad, to whom I sent a brief e-mail. Less than six hours later I received a reply saying: "Based on your description, you sound like a good candidate for laparoscopic radical prostatectomy, LRP . I will be in Anchorage later this month. If a meeting would be of interest to you, please let me know."
In lovely, warm weather (by Alaska, not Miami standards) on the evening of July 31, Bobbe and I walked the ten blocks from our Anchorage condo to Orso's restaurant, one of our favorite Anchorage eating places. The hostess showed us to the back dining room and there stood four Krongrads, including Arnon, 4,000 miles from his office, four weeks to the day after I first sent him that first e-mail. His manner was immediately soothing. We chatted about Alaska and their plans for sea kayaking in Prince William Sound and trekking across the Alaska Range.
In a few minutes, the Krongrads and Seiberts were joined by Herman, Pat, and Tom, members of the "Alaska LRP Fraternity," and their wives. Herman was only two weeks out from his LRP in Miami, and Dr. Krongrad quipped that he was really here just to do a house-call on Herman. Reverend Pat, minister of the Homer Christian Church, announced that he "dials direct" and said a beautiful prayer before the meal. Tom was the veteran. Over dinner, we laughed and told tall tales of wilderness, wildlife, and the adventures we had had and would be having. These strangers had in minutes become like family and Bobbe and I realized then that we were not in this alone.
Over the next month I talked to and e-mailed Arnon numerous times. I met again with my urologist and he reviewed the surgical options. He said that if I did choose laparoscopic surgery, it is important that I choose someone with extensive experience. He seemed a bit surprised that I had already had dinner with the surgeon I was thinking of using.
On Monday morning, September 29, Bobbe and I were at North Shore Medical Center at 9 a.m. and were immediately impressed by their efficiency and friendliness. At 2 p.m. we were in Arnon's office. Ruth came into the exam room and she and Bobbe resumed the conversation they had started over dinner in Anchorage. Arnon appeared and for a brief moment we were doctor and patient, but then return to a more relaxed John and Arnon. In his office he reviewed the benefits and risks of surgery.
On Tuesday evening Arnon called me at the hotel and we chatted, more like a friend calling before surgery than the surgeon calling before surgery. My alarm went off at 4:30 a.m. on Wednesday Oct 1, but I was already awake. I showered and we drove to North Shore Medical Center. The check-in and pre-surgery formalities went smoothly and again I was impressed by the demeanor of the nurses and staff. Arnon appeared and we talked some more and then I was rolled into the operating room (where it was cold). I was given a warm blanket, and someone said they were giving me something to relax - that's the last of the surgery I remember.
Later that afternoon I was in one of the private rooms, Bobbe beside me, IV in my left hand, catheter in my you-know-where. Arnon visited mid-afternoon and said everything went well. I felt tired but had no pain. A few hours later I went for a short walk down the hall and drank several cups of apple juice. Bobbe spent the night in the room (and had much worse night than I did, the chair not being all that conducive to overnight sleeping, perhaps designed by an airline). The next morning Arnon came by again and by 10 a.m. I was packing my bag and heading out to the car. Bobbe drove back to the hotel and I spend most of the day relaxing. A day later we were out exploring Miami. On Sunday we headed back to Alaska.
The next few days I felt like a new puppy tied to his new leash, the catheter. I did get somewhat used to it, but after 11 days I decided it was time for it to go, so, on Sunday afternoon (bad idea) I removed the catheter, with thoughts of incontinence, but the opposite happened, nothing. I was in urinary retention. After six hours and an ever expanding bladder, I made a trip to the ER and they kindly slid in a new catheter. Catheter Two stayed in another week and then, on Monday morning, it came out and my post-LRP incontinence began. At first it was a real wet drag, but slowly the initial Johnstown Flood became more of an afternoon dribble. Three weeks after the surgery I flew to Dallas and spent a week at the Exploration Geophysicist Convention. I now know the location of every rest room in the Dallas Convention Center.
On November 10 I had a follow-up PSA and met with my Wasilla urologist. My PSA measured <0.05 ng/ml. I made an appointment for another follow-up in four months. The doctor gave me a couple sample cards of Viagra (that department still not reporting in, though Arnon had preserved both the 'data lines' from the central processor to that important remote facility). I stopped by the store on the way home and bought a fresh supply of absorbent pads. I e-mailed Arnon the PSA results and he came back with a quick 'congratulations' and a reminder that patience is a virtue in the impotence / incontinence arena - patience having never been one of my shinning attributes, I figure this is an excellent opportunity to elevate it (patience) up near the top of my skill list -- the right combination of patience and action being the proper route through most of life's dilemmas.