In writing this story, I hope that men will realize the importance of a simple PSA blood test, and someone will be spared the misery of a life-threatening cancer.
In October 1995, my wife and I were excited as we left our home in Portland, Ore., for a new winter home on a golf course in Indian Wells, Calif. I was 64 and had worked hard for as long as I could remember. Now my life was about to change. I was not going to retire - I don't think I could ever do that - but I was going to take more time away from the business and see if I could at least graduate from lousy golf to poor golf. My wife, Marcy, and I arrived and settled in. In a reasonably short time our house became a home and we were happy and content. We played golf, cooked, swam, went sightseeing, and enjoyed our time together and with old and new friends as well.
One day in December, I saw an ad in the Desert Sun newspaper for an estate-planning seminar, and Marcy and I decided to attend. I liked some of the things I heard and wanted to institute a couple of plans in my estate. Because the plans were funded by life insurance, I had to have a physical exam. No problem, I thought. I felt fine and breezed through a stress test with good cardiac readings. A few days later, I received a call that my blood-work results indicated that my PSA was elevated. (PSA, or prostate-specific antigen, is a protein produced by the prostate gland and is normally found in very low levels in the blood. PSA blood tests are used to find and monitor prostate problems.)
This had to be a mistake, I thought. I'd had a PSA test within the last year or year and a half and my reading was well within the 'zero to four' range, which is considered normal. I was told my current reading was 7.9 - too high for insurance! Sure there had been an error, I made an appointment at Eisenhower Medical Center in Rancho Mirage to have my PSA rechecked. It came back 7.6.
I called my urologist in Portland and he told me to come home immediately, so Marcy and I flew to Portland the next day. A digital exam and an ultrasound exam did not reveal any conclusive problem. I knew that it was possible to have an elevated PSA result without having cancer.
Still, my doctor wanted to be sure so he ordered a biopsy. Doctors took six specimens; the procedure was uncomfortable but painless. Two days later I was told I had prostate cancer. I was told it was serious and that I had to do something about treating it soon - very soon.
I'm not sure I heard all the words. I was devastated. My emotions ran the gamut from anger to fear to self-pity. Marcy was far more composed. She kept telling me we would get through this together.
My doctor explained my options. He was patient and caring. I had known him since he was a little boy, and now he was trying to put the best spin on a bleak situation. He also is a surgeon and he said I should have surgery to remove the prostate gland as soon as possible. He explained the possibility of impotence and incontinence to us, pointing out that the new 'nerve sparing' surgical technique lessens the possibility of incontinence tremendously and of impotence to maybe 50-50.
I recall listening attentively and then blurting out, 'Are you sure? I mean I feel terrific, or at least I did until a couple of days ago.'
He explained how fortunate I was to have detected the cancer at a very early, treatable stage. He said if you don't know you have it until you have symptoms, it is usually too late.
I asked about 'watchful waiting,' or taking no action to treat the disease until it progresses. He told me to put him in my will and in a few years ... . That was an answer I did not want to hear, but it made the point I had to do something - and soon!
I was afraid of surgery and especially the long recovery period and possible consequences. I wanted to learn as much as I could about the disease before I decided what to do. My doctor did not necessarily concur with my decision, but he knew I would not change my mind. He wanted me to have a Lupron injection immediately and to have one each month for three months and then treat the cancer. Lupron, a brand name of a synthetic version of a hormone, would curb my body's ability to produce testosterone, which is what the cancer cells feed on. It also produces unpleasant side effects that vary with the individual. Some men gain weight, grow breasts, tire by mid-day and lose their sex drive. The good news is that when the Lupron treatment is over, your body slowly returns to normal.
In addition to cutting production of testosterone, Lupron injections shrink the prostate gland so that any procedure will be more effective. Also, Lupron helps to contain the cancer in the gland. This is very important, because if the cells escape the prostate gland and get to the bones or the lymph glands, your odds of long-term survival diminish greatly.
So I took my first Lupron shot and we returned Indian Wells and started to learn about my disease. I talked about it openly. I felt other people might benefit from my experience and pay attention to having their PSA taken, especially if over age 45 or 50. I also learned about others who had experienced prostate cancer and how they had treated it. I got books and pamphlets to read. My sons got information about prostate cancer off the Internet and faxed it to me. In short, I crammed almost like I had years ago for college exams. My wife and I learned so much about the disease I think we could sit across from any doctor and talk intelligently about prostate cancer.
We learned that there are several ways to treat the disease. It is something like shopping for an automobile: Each practitioner sells his own procedure to treat the cancer. No single treatment is the absolute best.
I got second, third and fourth opinions. You can treat the cancer with surgery, but I ruled that out for me. You can have external radiation, which is done up to eight or nine weeks, a few minutes a day, five days a week. The Loma Linda (Calif.) University Medical Center Proton Treatment Center is famous for this treatment. I ruled this out because if the cancer recurs, the options for treatment are limited. I have been told the radiation causes the gland to 'melt' into the rectum, which would all but eliminate surgery if that is necessary in the future. It is sort of like putting a blowtorch on a ball of plastic - it becomes a blob. The flip side of this procedure is that it has worked well for several people I know.
FREEZING THE GLAND
Another treatment, and one I seriously considered, is cryosurgery, in which the prostate is frozen, killing the cancer cells in the process. This, too, has had good results in situations like mine, in which the disease is found early and has not escaped the capsule or gland. Marcy and I flew to Rochester Hills, Mich., to see about having this procedure. I was examined and had another biopsy (eight specimens this time), and they confirmed I had cancer and would be accepted as a candidate for cryosurgery. By now it was April and they wanted me to stay on Lupron another two months and then return for treatment.
The thing that changed my mind was an article in the May 13 issue of Fortune magazine by Andy Grove, chairman of Intel. His case was almost identical to mine and we had reached the same conclusion: In the final analysis, it's your own decision.
He had opted for a treatment in Seattle that, while a bit different from the one I eventually had, influenced me to look into it.
My doctor in Portland made an appointment for me at Northwest Hospital in Seattle to see Dr. Haakon Ragde who has perfected 'seed' therapy implants. This is a procedure of implanting palladium seeds filled with radioactive material into the prostate gland. About 120 seeds, each about the size of a grain of rice, are inserted with needles directed by ultrasound. The procedure, done on an outpatient basis, lasts about 45 minutes. You are given a spinal anesthetic that wears off in about three hours. You are awake during the procedure and aware of what is happening.
That is the procedure I had late in the day on July 16. The next morning I returned to the hospital for a short time to have the catheter removed. I also was given a CAT scan to see that everything was in place and all was OK. It was. We were told that we could drive home to Portland.
On July 18, I stayed home and spent a lot of time reflecting on the past seven or eight months. I knew I was fortunate and thanked the Lord and everyone I knew who had me in their prayers. On July 19, I returned to work.
BACK TO THE ROUTINE
More than 10 months have passed since the procedure. My routine has returned to normal. I am neither incontinent nor impotent. I have my PSA checked every three months by my doctor in Portland. I do not have to return to Seattle for 18 months. I work a full schedule; I have taken part in a demanding two-day car rally, have driven a 2,000-mile car trip and have resumed my lousy golf, but I am determined to play better!
When I asked my doctor if my cancer would be in remission or cured, he repeatedly told me this was a procedure to cure my prostate cancer. While I had some bad moments, especially at night with frequent and painful urination, it is partly my fault because I was reluctant to take pain pills with codeine.
I later learned that without treatment, I would have had as little as two years to live. In light of this, I must confess a very difficult, almost helpless feeling. I had always felt I was a strong person, a 'take charge' kind of guy. All of a sudden I was faced with my mortality and was totally in someone else's hands. My outlook changed very quickly about a lot of things, not the least of which are family, friends and the beautiful dawn of a new day.
Finally, let me again stress the importance of a PSA test with your annual physical. I know I owe my life to an insurance salesman and I can't even buy a policy from him. But with a few years of normal PSA readings behind me I can again become considered healthy and obtain insurance. I can't wait to become his policy holder.
Ron Tonkin is president of Ron Tonkin Automobile Dealerships in Portland, Ore. He is a past president of the National Automobile Dealers Association.