Patients speak about prostate cancer and laparoscopic radical prostatectomy
John Keenan, New York, New York
A story of dramatic complications from Lupron hormone treatment.
In November, 2003 I insisted that my husband, John, go for his yearly physical. I made his appointment, which he kept, just to please me.
It was December when our doctor called to tell John that his prostate PSA test was up from the previous year (3.5 to 4.2) and suggested a repeat blood test in two weeks. That test result was 4.5, so our doctor told John to see a urologist.
He did so quickly, and on the first visit the urologist took a prostate biopsy. Since John's brother had died from prostate cancer we both expected to hear the worst, so when we returned to the urologist in early January, 2004, we were not surprised to get the results. John had prostate cancer with a Gleason score 7. He was told that one side of the prostate was free of cancer, and that the other side had 3 spots out of 6 samples taken.
Since John is retired, we usually spend at least four months (winter) in Florida. This diagnosis meant that our plans would have to change and we would have to focus our attention on what decision he should make as to prostate cancer treatment.
John's urologist also has treated our friend's cancer. He gave him radiation treatments. The doctor suggested 5 weeks of prostate cancer external beam radiation for John, followed by seed implants two weeks later. Radical Prostatectomy was not recommended for a man of 70 years or older, since recovery was difficult and afforded no better outcome than radiation and seeds. LRP was never mentioned.
John decided to go with the radiation and seeds, with two procedures to be done immediately followed, in two months, by the radiation etc. The first procedure was Prostatic Microwave Thermotx, which microwaves the prostate, through the penis, for 45 minutes. This process is supposed to help shrink the prostate. The second procedure, done a week later, was a female hormone implant (Leuprolide Acetate Implant) called Viadur (Lupron), put into John's left arm, to last one year, also to shrink his prostate. John was told to expect to have "hot flashes", "sweats", "tender breasts", and "mood swings". He was never told about the possibility of high or low blood pressure or severe headaches. ( We found this when we searched the internet).
Ten days after the implantation we went to see an Oncologist to discuss his plan for John's treatment. A nurse took John's blood pressure which was much higher than usual. (John takes medication that controls his pressure). The nurse suggested that John had "white coat syndrome" and was just nervous about having cancer. The Oncologist told us about the procedures that would begin in two months and suggested that John get marked (tattooed) for treatment before going to Florida. We made an appointment to do just that. A few days later we cancelled the appointment opting to wait until we returned from Florida.
We arrived in Florida on February 20th hoping to rest, relax, and forget about cancer for awhile. Our daughter, Jacqueline, who lives in Florida, had been telling John about Dr. Krongrad who does LRP surgery, insisting that he make an appointment to meet the doctor and discuss his case with him. John was reluctant since he had already decided what he wanted to do, but finally agreed to do so.
It was early March when Jacqueline drove us to our appointment with Dr. Krongrad. He explained LRP and said that John was a candidate for this procedure. Dr. Krongrad was very patient with us and answered all our questions. All three of us where very impressed. A few days later John made a decision to have LRP rather than radiation and seeds.
Shortly after we arrived in Florida, John started suffering with headaches. Since he has a high tolerance of pain, he paid little attention to the pain and just lived life as usual. On March l8th John kept an appointment with his dermatologist and mentioned his headache. The doctor took his blood pressure (which was over 200) and told him to go to an emergency room immediately. We did that and after several hours his blood pressure was stabilized. He was sent home with instructions to see his doctor the next day. (That is when we remembered the high blood pressure reading in the Oncologist office l0 days after the Viadur implant). We contacted Dr. Krongrad and told him what happened and that John wanted the implant removed. Since he doesn't do implants, he made arrangements with a plastic surgeon to remove the implant, that afternoon, March l9th.
On March 20th at 8:30 am John went to the local firehouse to have his blood pressure taken. His blood pressure was again so high that he was taken to an emergency room by ambulance. He was hospitalized for 4 days with his blood pressure going very high and very low. When he was discharged we contacted Dr. Krongrad who suggested we see Dr. Levine, the cardiologist that John would be seeing for clearance for surgery.
Dr. Levine took over the job of stabilizing the blood pressure. It seems that even though the implant had been removed, the Lupron remains in the system for weeks. Dr. Levine added medications and instructed us to monitor John's blood pressure and heart rate several times a day, telephoning him, at his office, every morning and every afternoon before 5 pm. with the results. After two weeks John was well enough to go to Dr. Levine's office for the pre-op testing. All the test results were good so Dr. Levine approved the surgery. John had been through some ordeal, but didn't want to postpone the surgery, if possible.
On April 19th at 6 am. John entered Aventura Hospital's 6th floor where he was given a bed and prepared for surgery. John, Jacqueline and I said a prayer. We all kissed and then Jacqueline and I went to the waiting room.
A few hours later (it seemed like forever) Dr Krongrad came to tell us the good news. John was in the recovery room, doing well, and the procedure went very well. He would be in his room before long and that was when we could see him.
Jacqueline and I were elated to know that the operation was a success and that the cancer was gone. The pathology test of John's prostate showed that both lobes were cancerous but, thankfully, it was fully encapsulated indicating that the cancer had not spread beyond the prostate.
It is now almost two months since the surgery. John is feeling fine and is almost fully recovered. He has some discomfort, for which he takes Motrin, when necessary. He has good control of his urine during the day, but needs some protection while sleeping. His bowel movements are normal, with full control. Even his blood pressure is normal again (he takes only his original medications).
John says that the worst part of going through the surgery was the gas pain he experienced. He never thought he would have to pray to pass gas. This phase lasted for three days. Dr. Krongrad had said clear liquids only until the gas was expelled, so John was weakened from lack of food. His strength returned, however, as he began eating a normal diet.
We can't begin to thank everyone enough. The success of the surgery has given John a new lease on life.