Candid Confessions of a Cancer Survivor – Part One: Radical Prostatectomy – An Unnerving Experience

You consider your options very seriously when you’ve been told that you have cancer cells in that walnut sized organ, the prostate. To the average person, having prostate cancer is considered to be a matter of fact situation. “Oh, prostate cancer is one of the most easily treated cancers”, say the overly optimistic friends. With these expert’s encouraging words, it’s easy to go into self denial, but you soon realize that the medical experts don’t take it that lightly and think you should act, sooner rather than later. More serious now, you do research and learn of the ramifications that the conventional treatments may result in, including but not limited to incontinence and impotence. As scary as losing bladder control is, it’s nothing compared to the threat of impotence. So being aware that only a relatively small percent of prostate cancers will actually become aggressive (metastasize) and kill you, you feverishly start to Google for alternate, less invasive therapies. There is the holistic approach, laser treatments and HIFU, but in the end I opt for going with what I consider the most likely procedure to result in the eradication of the problem; a radical prostatectomy. My primal instincts have kicked in and survival has risen to the top, superseding even the need for sex. After having weighed the pros and cons for some time, one achieves a certain amount of peace, having finally made up one’s mind. Still there is a considerable amount of apprehension as the day approaches. Not only are they removing something situated in the lower regions, perched below the bladder and next to the large intestine (almost close enough to the back door to see daylight), but they are extricating the very essence of ones manhood.

Prior to this stage you’ve already been exposed to some fairly inhumane treatment. The urologist suspects that you have cancer due to an elevated PSA value, but he has to confirm his suspicions with a biopsy. All men over 50 have had the fun of the famed finger exam. Well that’s nothing compared to a prostate biopsy. First an ultrasound probe is inserted into the rectum to determine the size of the culprit. This is followed by a gun that shoots darts into the prostate to take samples. So when the time comes that you hear the dreaded “C” word, you kind of think, “How much worse can it be”? If you only knew what surprises lay ahead!

The first step is an appointment with a nurse navigator. I always thought this was a term pertaining to guiding a vessel through a dangerous waterway. Come to think of it, there are some analogies that could be made to the matter now under consideration. Anyway, the navigator is there to lay out the alternatives that are available to deal with the cancer cells. First there is plain old radiation therapy. Radiation is fired externally in the general region of your prostate. They’ll kill the cancer cells all right. They also kill any healthy cells surrounding the prostate. In fact, the oncologist said the area would look like a “bomb site”. Not in my opinion, a strong recommendation for the procedure. Then there is a specialized radiation treatment called Brachytherapy. Here, radiated pellets are shot through your perineum into your prostate. But this procedure only works with a small prostate. If one’s prostate is too large it must be shrunk with hormone therapy, which removes all testosterone from your system. You have to wonder if shrinking your prostate will cause collateral damage to other areas also involved in sexual function. Shrinkage notwithstanding, some other nasty side effects are obesity, lack of energy (including but not limited to lack of desire), an increase in vocal pitch and the development of the mammary glands which I believe are non functional. After hearing all this one begins to think, “How soon can I go under the knife”? But the surprises are just starting. First there’s the little problem of incontinence. Most men, you are assured, given enough time become more or less continent. The navigator moves right on, wanting to save time for a more glamorous subject; the delicate matter of impotence. Delicate for me of course, but not to the navigator who has done this a hundred times before. She, smiling radiantly, describes the procedures, should the need arise (bad choice of words) for external forces to be applied to the member in question to achieve adequate results. One is presented with two options, neither of which seems particularly appealing.

First there is the unsettling suggestion that one inject, yes, the penis, with a chemical substance that will cause an immediate response. Now that’s a titillating twist to foreplay! I doubt even sadomasochists have thought of that one. If one is too squeamish about needles in places that weren’t meant for needles you might try a vacuum pump. This involves placing the member into a chamber with a pump to create a vacuum that will draw in sufficient blood to cause an erection. I assume there will be a warning on the box that over pumping may cause permanent injury, seek medical attention immediately if… Once the desired state has been achieved a rubber ring is placed at the base to trap the blood in the engorged member. This procedure is reminiscent of that used to castrate calves on the farm by mechanically stretching a rubber ring over the testicles to cut off blood supply. Eventually the testicles shrivel up and fall off. One assumes there will also be a warning on how long it is safe to keep the rubber band on the penis. However you are given a “faint hope clause”. If the surgeon in his wisdom deems it safe to spare one, or if lucky, both nerves that run on the outside of the prostate, normal erections may occur over the course of time. This is fine for someone with the faith of an evolutionist who believes that given enough time anything can happen. Red-faced, hot and bothered, I leave. The still cheerful navigator awaits her next victim.

Finally after much agonizing and soul searching while clinging to the false, I mean faint hope that the surgeon will be able to use the nerve sparing procedure, the decision is made to opt for surgery. There is one more matter to deal with before surgery. When it comes down to the nitty gritty there is only one nasty outcome of a prostatectomy that really counts, and that’s loss of bladder control. Yes, that’s right, sex finally plays second fiddle. The cure all for this problem is becoming proficient with the Kegel exercise. Past experience has alerted the team to be proactive and not assume that all men are doing this exercise properly. Therefore they have trained a physiotherapist that you see before surgery, who is now the expert in the field of exploring the internal parts in the nether regions of the male anatomy, to determine the efficacy of the Kegel exercise you have been practicing. Most professional positions these days come with an impressive official title”; this one is ‘Certified Pelvic Floor Therapist’. Finally the fateful day of the pre-op arrives. You go through a series of tests and then you’re ready for the meet and greet with the therapist. To my surprise, it’s a woman. Why aren’t there more men in the medical profession these days? What would inspire a young, pretty woman to decide on a career specializing in this field is beyond my comprehension. It must have something to do with getting in on the ground floor. But everything is done with proper decorum. You are instructed to remove your clothing (nothing is said about keeping your underwear on), put on the gown and lie down on the bed on your back with your knees raised. Immediately a warning flag goes up (bad choice of words again). This in not the position one has become accustomed to during the routine digital exam that your GP uses, when you’re instructed to face the wall and get into a fetal position. How I yearn for the comfort of the fetal state right now. However, you muster up your courage and lie in a prone position adequately exposed, waiting for the Kegel expert. She comes in friendly and smiling enthusiastically. Again, she had done this a hundred times, but not me! This Prostate Protocol is a little tougher than with the GP who you can happily moon without having to look at him. She faces you as she puts her head next to your knee (on the outside, that is) and goes about her business. At this point eye contact is strongly not recommended. She instructs you to breathe deeply. When you’re off guard, zip, she’s in. That wasn’t too painful. One begins to wonder at this point if this really would be any easier if it were a man doing this procedure, strictly due to finger size of course. She begins to give instructions on what to do as she explores all those muscles on the pelvic floor to see if they are being activated adequately. Finally her examination is complete and she announces my rating of 4 out of 5. I’m not sure if that’s the Kegel’s score or the rating of my acting performance, feigning that this was routine for me too. Again she follows proper protocol and leaves the room while I am instructed to take my time in putting myself back together.

Take my time, no way. I’m up and dressed in no time flat. When I’m ready she comes back in cheerful as ever to give me last minute instructions and the possibility of future liaisons. She again stresses the importance of doing these exercises and doing them properly. Since I only got 4 out of 5, I guess she felt there was room for improvement. As an illustration she gave me a graphic concept the she hoped would stay with me; “When you’re doing your Kegel’s pretend that you are inhaling a pea through the end of your penis.” Well, you don’t forget that helpful hint immediately. It quickly becomes firmly embedded in… your mind. Then on my way out she hands me her business card, “Just in case you want to see me again”. Not likely. I’m out of there in a flash!

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