Every Journey Begins with A Single Step, Part 2: Decisions

It’s been said over and over that every man’s journey to defeat prostate cancer is different. This is so true. Some cancers are so slow growing that active surveillance is most appropriate. Many require a more immediate approach. A man can choose from a wide array of different types of radiation, brachytherapy, chemotherapies, or surgery, just to name a few of the treatments that are out there. There are, however, some similarities.

The first, obviously, is that cancer is present. Second is that it does totally change one’s way of thinking about his own existence. Immediately after receiving my diagnosis in May 2011, I was forced to face the harsh reality that deep inside my lower abdomen I was harboring something that could potentially kill me unless I killed it first. It was an intruder capable of unspeakable horrors that I refused to acknowledge as the possible cause of my imminent demise. I accept that we all must go at some time, but I decided I wasn’t ready to go and I refused to go quietly.   At least, not yet. My training in the U.S. Army taught me to fight to the bitter end, that mental toughness is necessary to survive. Sherry, my wife of more than 31 years as I write this, knows this and told me point-blank “We are going to face this thing head-on and we are going to fight to beat it.” Note that she said “We.” I believe in that moment, she recognized the fear I was faced with and I needed her to be my source of strength to fight. She is, along with my three children, the source of my mental toughness and my reasons for going on.

On the day that I met with my urologist a week after my second biopsy and was given a diagnosis of Gleason 3 4 prostate cancer, we began an even more open dialogue. Specifically, about treatment options. That day was probably the longest amount of time I have ever spent talking to a physician during an appointment. He didn’t go straight to the “let’s cut you open and yank it out” kind of discussion. What he did say was there are numerous options out there to treat aggressive adenocarcinoma. He gave me the resources I could use to make an informed decision about how I wanted to confront this demon. He then proceeded to tell me how he wanted me to go home, take a deep breath and just think. Do my homework. Research the internet, go to online chat rooms he told me of where a man can ask questions and get reliable input from other men battling prostate cancer. Gather all the information I could to make an informed decision on the treatment that would be best suited for me, and me alone. He also suggested I see someone else if I felt it necessary to get a second opinion.

I didn’t seek a second opinion, though, because the evidence was right before my eyes in black and white. The biopsy report made it very clear that I had cancer. In the meantime, before meeting with him again, he had his staff set me up with appointments to see a radiation oncologist, a chemo oncologist and he ordered other tests to quantify the severity of the tumor. He did state that the tumor did seem to be rapidly advancing when taking into consideration that a first biopsy was inconclusive and a second biopsy revealed aggressive cancer, along with an upwardly trending PSA. He stressed to me that time was not much of an ally and that we needed to start treatment beginning sooner rather than later. His sense of urgency did not go unnoticed. His fear was that this ghastly intruder would begin to transform into a metastatic cancer if I waited too long. He explained to me that being diagnosed at 49 meant I was relatively young to be developing prostate cancer, and in younger men prostate cancer tends to be much more aggressive than in men in their 60’s and older due to the presence of higher testosterone levels.

In retrospect, I can recall being as composed as I could ever be, while my inner child was wanting its mommy. Since I now work in health care and have seen so much, I guess I truly thought I was ready to get the news, but I was just numb from hearing the words I expected but didn’t want to hear. “We did find cancer, and it appears to be aggressive” is a statement that hits you like a brick, no matter how prepared you think you might be. When faced with your own mortality, you begin to find an inner strength you previously didn’t know existed. You quickly find out that the old saying “Whatever doesn’t kill you only makes you stronger” does ring true.

In the end, I chose an old-school method of treatment to eradicate cancer from my body. I decided on a procedure called Open Retropubic Radical Prostatectomy. How I came to this decision required many hours of researching, thinking, asking questions, stressing and praying for an answer.

I recall my appointment with a radiation oncologist in Lexington, KY. At this point in my journey, I was strongly considering going the radiation route. I wasn’t very receptive to going under the knife if there were other options. Specifically, I was leaning toward cyberknife radiation. I had for the most part made up my mind. While discussing the radiation procedure, I asked the doctor his opinion about options if cyberknife failed to get all the cancer. Could I then have surgery to remove the prostate? He frankly answered no, telling me that surgery would be off the table at that point and I would be facing more radiation and possibly chemo, as well. The one single discussion that had possibly the greatest influence on me to forego radiation in favor of surgery was an online conversation I had with a gentleman who had been through treatment. He asked me how old I was at the time, and when I said I was 49, he gave me some advice I felt to be profoundly relevant to me. He said “At your age, you shouldn’t be looking toward survival beyond five years. You should be setting your sights on survival beyond 20, 30, 40, years or more. No matter what method of radiation you choose, there is always the possibility of collateral damage. Another 40 or 50 years is a long time for irradiated organs to hold up. You need to take that into consideration, as well.” The more that I thought about his advice, the more I thought it made sense related to my own personal situation. It was a moment of clarity. If I chose radiation and it didn’t kill all the cancer, or if in a few years the cancer returned then I would be faced with more radiation; salvage radiation, as it is referred to. I needed to get this thing out of my body. I have always been the type who needs to see the world in black and white, and grey areas are not an option. It became very clear to me that I needed a means of fully quantifying the severity of the adenocarcinoma growing inside me and the only way to do it was with a pathology report. The only way to get such a report is to remove the offending organ and have it examined. It was at this point I made the decision to have surgery. Despite the risks, despite the side effects, despite the recovery time, I thank God for the skilled surgical team that helped me through a very difficult time in my life and I don’t think I would do things differently if I had the chance.

When I received the post-operative pathology report I was then able to fully comprehend the severity of the cancer that had been removed. I had dodged the proverbial bullet. I was relieved in knowing that the cancer was still confined to the capsule that surrounds the prostate. There were clear margins noted, meaning the cancer was still contained within the prostate and there was no involvement with the seminal vesicles or the seven lymph nodes that had also been removed. This meant the cancer had been caught early enough that it hadn’t yet begun to metastasize and spread to other areas. This also meant that from a statistical standpoint, I had a greater than 99% chance of living past the five-year milestone.

Now, almost seven years down the road my PSA is still undetectable, and I remain cancer free. I’m free to work. I’m free to advocate. I’m free to spend more time with my family. I’m free to continue my journey.

Read Part One of Ray's story here.