Ralph

Around the year 2000 I had an enlarged prostate and a PSA that ranged from 5.7 to 9.5 for several years. My urologist said this was an expected PSA because of my enlarged prostate. Twice a year I had a PSA and digital rectal exam to monitor any changes. In 2003 I began having urinary flow problems and I was put on Flomax and later on Proscar. These drugs worked for me and I began getting up only once at night.

Why did you have two prostate cancer biopsies?

In July 2006, at age 65, I retired after 37 years as a pastor here in Lancaster, Pennsylvania. The next month, in August of 2006 I had a PSA of 7 but since I had already been on Proscar that meant my real PSA was about 14. I had my first biopsy of 12 cores and it was negative. However, my PSA continued to be high enough that my urologist wanted to do a second biopsy. So four months later, in December of 2006, I had a second biopsy. While the digital rectal exam was smooth with no nodules the pathology report showed that 1 out of the 12 cores had a 12% cancer volume and another core had a pre-cancerous indication. My prostate cancer stage was rated at T1c. At that time I didn’t realize that I was relatively fortunate.

What was your reaction to the diagnosis of prostate cancer?

The diagnosis of cancer was a shock. I grew up on a dairy farm, working hard, eating from the garden all year round. Most of my life I have been very active, jogging regularly and running in 5K and 10K races. Since the 1970’s I’d been eating healthy and exercising regularly. I was in shock.

What were you told about your prostate cancer options?

I learned that my prostate cancer had been detected at an early stage, was confined to the prostate and was not aggressive. My urologist said the low level of prostate cancer meant I had the option of taking time to explore the options. He didn’t push for any specific treatment, but explained the downside to surgery or radiation. He encouraged me to get a second opinion. Whether buying a car, dishwasher or puppy, I tend to go overboard in researching options.

The shock of prostate cancer made me even more fastidious. My wife said I got married to my computer for several months, researching prostate cancer. I did see a local radiologist in January of 2007 but he had a poor “bedside” manner and I was not comfortable with him. About that time I learned that there were “centers of excellence” or facilities that had earned strong, positive national reputations and often one had to travel to get to such a “center of excellence.” I decided that I would do that for whatever treatment I finally chose.

During my research, I read an article titled “How Prostate Cancer Can Extend Your Life” by Gary Driggs. The author had a diagnosis similar to mine and was on Active Surveillance. His overall health improved greatly when he did all the healthy things one should do as the active part of Active Surveillance. That article focused my attention on Active Surveillance and I decided it was something I would like to do.

I had two friends, Bill & Ben, both Us TOO leaders of the Lancaster chapter. They shared their prostate cancer stories with me over breakfast. They were both being treated with great satisfaction by an oncologist in Virginia, Dr. Charles Myers. With their encouragement, I made an appointment. My first visit was the end of February 07. His office is about 300 miles from where I live. In my visit with Dr. Myers he confirmed that AS was appropriate for me and he provided a program for me to follow.

What was your Active Surveillance regimen?

The prescription medications I was taking were Avodart and Uroxatral.

I followed a low fat Mediterranean heart healthy diet often with chicken breast, salmon or sardines and non-fat dairy products.

My vitamins and supplements included Vitamin D3, 10,000 IU daily, pomegranate extract capsule, lycopene and soy isoflavones, fish oil, reveratrol and curcumin, and quercetin.

Each day I did 30 minutes of aerobics and three times a week I did resistance training.

Although I’ve always been physically active and eating healthy, prostate cancer focused my attention and I was diligently eating and running to positively benefit my health and not just to feel good. Since beginning this program I lost 20 lbs of fat and gained 10 lbs of muscle. Dr. Myers encourages us to indulge in three sins—coffee, red wine and dark chocolate. I follow his orders with great dedication. Now I feel better physically than I have for many years.

How would you describe the Surveillance part of your program?

I have a blood test every three months. The blood is tested for serum PSA, now around 2.0 which is good for me. The Free PSA is now at 16.2% and needs to be above 20%. My dihydrotestosterone (the bad stuff), is now at 2.7 which is very good because it needs to be below 5. The serum testosterone (the good stuff), is now at 720, which is very good. Vitamin D, now at 80, is also at a good level.

I see Dr. Myers once a year in October. He does an overall physical with a digital exam. He indicates adjustments to supplements and confirms the direction of my program. Between my annual visits, he monitors the regular blood tests and makes adjustments to drugs or supplements as needed via phone call or email.

Upon Dr. Myers recommendation, every April I have a High Resolution Harmonic Color Doppler Ultrasound with Dr. Duke Bahn in Ventura, California. (I try to resist telling my wife how wonderful it is to visit this beautiful seaside resort city every year for a one-hour medical appointment.) Dr. Myers believes that this surveillance tool or something similar is essential so that he knows precisely what is happening with my cancer. A PSA test by itself is not enough and a biopsy does not give a sufficiently complete picture of the possible development of prostate cancer.

Every year Dr. Bahn has reported that my PC continues to be confined and remains at a low-risk disease level. He confirms that AS is still appropriate. He says that because of my continued prostate inflammation and prostatitis (with a large Gland volume at 71 cc) I will continue to experience significant PSA fluctuations. I also have significant calcification, which also results in PSA fluctuations.

How would you sum up your experience with Active Surveillance?

For four years I have maintained the Active Surveillance program that I started in February 2007. It’s the low fat Mediterranean diet (olive and avocado oil) with plenty of plant based food plus fish, occasional chicken breast, exercise and Avodart (I stopped taking Uroxatral a year ago). I continue to take Vit. D3, fish oil, Quercetin, Pomegranate, Curcumin and Resveratrol.

My last Color-Doppler results (April, 2011) shows the area of my prostate cancer as unchanged and the area of latent malignancy slightly reduced with no new lesions in the prostate.

Prostate cancer and all cancer is still mysterious and there are no guarantees, only probabilities. Certainly, there is no cure yet. Every man is different in genetics, psychological make-up and type of cancer. Even though I am very satisfied with AS and am healthier now than before the discovery of prostate cancer, a year from now my story could be different. Every blood test and every visit is a time of anxiety. Is my PC still arrested or did it manage to break out despite all my best efforts to contain it? Even though these concerns exist, I am confident in the guidance of my oncologist and very positive about the future.

I want to emphasize the importance of having an oncologist to guide a treatment plan that is appropriate for the individual. Dr. Myers says I will die with PC not because of it. I have a strong motivation to fastidiously follow the Active Surveillance regimen, not just because it is apparently arresting my PC but because my overall health has improved. I’m now 71, still running 5K’s. Nothing hurts and I feel great.

Disclaimer: Individual patient regimens may vary and any information provided by a patient should be used to expand your knowledge for discussion with your own physicians and others and should not be considered as actual medical advice

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