Month: January 2015

Factors that a urologist with prostate cancer used to make his ” Decision.”

I am not advising that you make the decision I did. (That is the difference between this book and many others about prostate cancer.) I am advising that you make your decision the way that I did. It has to be done based on things and factors specific to only you. I know, I know, I am a surgeon and you think I am biased toward surgery. Well, you are wrong. I am biased toward surgery in a certain subset of the prostate cancer patients, namely someone with the ” who are you” factors similiar to mine, but not regarding the management of prostate cancer across the board.

I do not have ” a dog in this fight.”  Use my system and McHugh Decision Cheat-sheat to help you clarify your decision and share with others to help them.

In the picture above is my garage and my 1986 Toyota truck, my first air-conditioned car that I bought in residency in Augusta, Ga to use to moonlight in Millen, Ga for extra money. On the truck are our three cats, in order from right to left, Kitten, Annie, and Kibber. On the hood is Penelope as a puppie. Penelope is there to eat cat food. My wife had the habit of feeding the cats their” three cans of “stinking can” cat food on the hood of my beloved truck.  When I would come home at night, if I walked by the truck, the cats would congregate there hoping to be fed. Penelope loved the canned cat food as well and that explains why she is there. Sadly, Kibber and her daughter Annie have passed away since this picture was taken. The picture says so much however about my life at the time…

burn me once… shame on you…burn me twice…shame on me

• When tumors are described by way of its differentiation, i.e. well differentiated, poorly differentiated, what they  are talking about is how close or how far away is from a normal one.
• In prostate cancer the Gleason’s score  is a way to describe how a cell is differentiated.
• A Gleason 6 is a well-moderately differentiated cancer.
• A Gleason 8 or above is a poorly differentiated cancer.
• A well differentiated prostate cancer is harder to call for the pathologist than a moderately differentiated cancer because the well differentiated cell more closely resembles the normal prostate cell.
• A poorly differentiated prostate cancer cell is  an easy to call for the pathologist because its architecture is so far removed from how a normal cell looks…it is sometimes described as “bizarre.”
• A poorly differentiated cell however can be tricky for the pathologist because it can be so bizarre looking that…

After the prostate is removed the male depends almost exclusively on the external sphincter for the control of urine. The male’s body has  to “relearn” how to control continence. How much one will leak, how long one will leak, and to  what degree one leaks, cannot be predicted. The fear of incontinence along with the fear of impotence are primary factors in the “Decision.” These two factors often are more important to the male than concerns about the “best thing to do to cure the cancer.” Prostate cancer is unique in this way.

Dirty little secret: I don’t think doing Kegels have anything to do with the return of continence. Don’t get me wrong… they don’t hurt anything. I think continence starts with the prostatectomy being performed well, and then…luck. Why it is that I can remove a prostate the exact same way in one patient (and he is dry day one…

If nothing is going right….go left.

If you have obstructive voiding symptoms (slow stream, hesitancy, getting up at night, stop start stream, decrease in caliber  of  stream) and want to do radiation as your treatment of your prostate cancer it is okay to have the prostatic urethra opened by the Greenlight laser before the treatment to prevent exacerbation of your voiding symptoms after radiation. It is not advisable to do any surgical treatment of the prostate after radiation treatment of the prostate. Trust me.

It is better to cure at the beginning than at the end….my friend.

John…nothing you drive has an airbag…a lot of people depend on you…buy a new car!

The Five Reasons:

1. You don’t have radiation in your body the rest of your life.
2. You don’t have radiation in your body the rest of your life.
3. You don’t have radiation in your body the rest of your life.
4. You don’t have radiation in your body the rest of your life.
5. You don’t have radiation in your bodythe rest of your life.

Tomorrow: Five reasons not to have your prostate removed…see…I am not biased, I am not biased, I am not biased…