Ok, it has been a month and a half. We (Jody and I) have found the YANANOW site a very valuable resource. We think that a brief past history of my health is of import to this blog. We will compile this later on. However by way of introduction please find the following google doc links. Images and other links to be added.
A brief personal history is of importance to the prevention of Cancer. The medical industry focuses on the diction and cure of cancer as a profit center. OHSU takes a passing interest even in my past or current diet or activities. In other words, Cancer treatment is not from our point of view personal.
We (Jody and I) are rather disturbed about this. Interview - "The Secret History of the War on Cancer" gives a view of why prevention is of such importance. If you want to prevent the return of Cancer gets the audio-book. The scope of the book is incredible it's a long read. We suggest the audio-book. It is available for free through you local or not so local library.
Interview with the author - https://www.youtube.com/watch?v=uKsf6WtvxEE
Before the Cancer diagnosis, we listened to "the emperor of all maladies" audio-book. The history is as gruesome as it is interesting. Winner of the Pulitzer Prize, and now a documentary from Ken Burns on PBS, A must see if you have Cancer of any type.
We feel it's important for people with Cancer to understand the history. We have found the current state of treatment of Cancer is only a little better now as in the past. The general prostate Cancer treatment is to kill it by cutting, sunburn, or cooking it.
The links to the medical documentation:
PSA History graph:
You can see the jump in the PSA. I was lucky to get an MRI done before a biopsy was done. The MRI-guided the biopsy. If I had not had the MRI images cancer would not have been found at all. See a description of biopsy below the MRI report.
The detail report from the Magnetic Resonance Imaging MRI with a rather large coil / antenna in my rectum. Using meditation I was able to not move a twitch resulting in very good images.
It is of great importance to learn how to read and understand this report. Below is a copy of my MRI. One of the things to important to notice is the Cancer is in only one location. It seems to start in my right nerve bundle and is moving out from that location. This means it most likely is caused by industrial exposure cadmium over 30 years ago.
A large tumor was found it turned out not to be Cancer. However I was lucky again if the tumor was not found the biopsy would not have been done. Wow...
- EXAM: MRI Prostate with and without intravenous contrast.
- HISTORY: Elevated PSA=9, evaluate for prostate cancer
- COMPARISON: None.
- TECHNIQUE: Endorectal multiparametric and multiplanar MRI of the prostate
- performed, including axial T1 images of the pelvis and high resolution axial
- T2, diffusion, and perfusion pre-and post dynamic intravenous gadolinium images
- of the prostate.
- The prostate measures 5.7 CM transverse by 4.9 CM anteroposterior by 5.9 CM
- craniocaudal, giving a gland volume of 85 mL . No post-biopsy hemorrhage noted
- on T1 weighted images.
- A dominant tumor focus is identified in the right anterior central gland,
- measuring 1.4 CM transverse by 2 CM anteroposterior by 2.6 CM craniocaudal,
- giving a tumor volume of 3.8 mL . The tumor demonstrates:
- Low T2 signal: Yes, mildly heterogeneous.
- Restricted diffusion: Yes, mildly heterogenous hypointense signal .
- Early enhancement: Yes.
- Delayed washout: No.
- Overall Pi-RADS classification:
- 4, based on the T2 and ADC heterogeneity.
- With respect to tumor stage:
- Likelihood of right-sided extracapsular extension: Absent (0-20%).
- Likelihood of left-sided extracapsular extension: Absent (0-20%).
- Likelihood of right-sided seminal vesicle invasion: Absent (0-20%).
- Likelihood of left-sided seminal vesicle invasion: Absent (0-20%).
- A peripheral left central gland focus at the base of the prostate with
- heterogenous diffusion restriction and washout is encapsulated and compatible
- with a BPH nodule. Urinary bladder trabeculations are noted secondary to
- chronic bladder obstruction. No lymphadenopathy, suspicious bone lesions, or
- other abnormality identified.
- 1. Dominant right paramedian anterior central gland PI-RADS 4 focus, suspicious
- for malignancy. This is amenable to direct of fusion guided biopsy.
- 2. Moderate prostatomegaly, with changes of benign prostatic hyperplasia.
- Recent literature on likelihood of prostate cancer by scenario:
- Repeat biopsy positive in 5 of 112 patients (4.5%) with negative MRI and prior
- negative TRUS biopsy (J Urol 2014; 192: 60-66).
- Repeat biopsy positive in 47 of 58 patients (81.0%) with positive MRI and prior
- negative TRUS biopsy (J Urol 2014; 192: 60-66).
- Biopsy positive in 33 of 151 (21.8%) low risk biopsy naive patients (PSA < 10
- and negative digital rectal exam) with negative MRI (J Urol 2013; 190: 502-8).
- Biopsy positive in 23 of 43 (53.4%) high risk biopsy naive patients (PSA > 10
- or positive digital rectal exam) with negative MRI (J Urol 2013; 190: 502-8).
- Biopsy positive in 53 of 94 (56.4%) low risk biopsy naive patients (PSA < 10
- and negative digital rectal exam) with positive MRI (J Urol 2013; 190: 502-8).
- Biopsy positive in 48 of 63 (76.1%) high risk biopsy naive patients (PSA > 10
- or positive digital rectal exam) with positive MRI (J Urol 2013; 190: 502-8).
Attending Radiologists: JOYCE MHLANGA, MBBCH
Author: APURVA BONDE, MD
I personally reviewed the images and, if necessary, edited the report. I agree with the report as now presented.
An MRI should be a standard procedure done before a biopsy. I would have had the typical 12 core biopsy that leaves the lower section (hard to get at) unsampled. So I had a 19 core biopsy (7 more cores lower that a typical biopsy was taken) or cancer would not have been detected.
One of the things to important to notice in the biopsy below is the Cancer is in only one location. It seems to start in my right nerve bundle and is moving out from that location. This means it most likely is caused by industrial exposure cadmium over 30 years ago.
1. Have an MRI before a biopsy ... force them to... it should be standard procedure.
2. The standard 12 core biopsy is missing early cancer. Have a 19 added lower than the standard procedure. This has really saved my life ... I am very lucky. Important contamination / small particles /toxins enter the pancreas by traveling down the nerve bundles.
3. Learn how to read your biopsy and keep track. We found doctors report that stated a 3-4 condition when the biopsy stated a 4-3. Its a big difference. We have had to correct doctors mistakes several times. You must take active care of your self.
A strong immune system kills cancer. If the immune system is damage Cancer can exist. however Cancer can only grow if the testosterone promotes growth. It allows the cancer to grow blood vessels (this is called angiogensis). Turning off the blood vessel growth can be done by diet. Angiogenesis inhibitors / anti-angiogenesis food prohibit cancer from growing blood vessels. I have had for several years an anti-angiogenesis diet. Thus its a good bet the Cancer I have has evolved to promote its own growth in response to my diet. Citations / links for the above claims in next update.
Please excuse the long length of time before checking in. Right off, I want to say that Yananow was absolutely primary in my being able to make the right decision for me. The database comparison is brilliant and the reference material invaluable. The candid personal histories and sharing are so incredibly supportive … I can not thank you all enough.
Here is a summary of my results:
After lots of research, especially by my loving partner, we almost chose Calypso radiation therapy, until we were told it would be in conjunction with hormone replacement therapy. I did not want to go that route, because I have had some heart issues which I have stabilized through diet and exercise, and HRT seems risky for the heart from various research we read.
Consequently, I was fortunate to be the patient of Dr. James Porter at Swedish Urology in Seattle, WA, for the DaVinci robotic surgery to remove my prostate and hopefully the cancer. BTW, check out propublica.org. This site rates US surgeons and hospitals effectiveness on various procedures from public Medicare data, for example - return rate due to complications.
I had a PSA of 9 with a 4+3 prior to surgery. My prostate was 90 grams, the cancer was 3 grams. The cancer was in the lower right below the pelvic bone near the nerve bundles. The cancer was not near the margins of the prostate. Dr. Porter was able to spare my nerve bundles. The pathology report after surgery downgraded me to a 3+4. PSA levels are now undetectable.
The normal pattern and position of a 12 needle biopsy would not have found my cancer, because the cancer was located much lower. An additional 7 needles were added to the 12, and consequently cancer was detected.
7 additional needles were used, because an initial MRI had been taken and it showed a tumor in that area. However, the tumor was a benign fibroid tumor. I should add that an MRI prior to biopsy is not usual, but my wife and I were leaving the US indefinitely for our home in Chile in a few days. So, my doctor ordered an MRI before we cancelled our tickets.
So it was indeed a great deal of luck that my cancer was found.
As far as urinating goes: I have had control as soon as I removed the catheter. This I am told is unusual. I was surprised that I did not have more trouble. I wore light pads for 2 months anyway. There is a feeling of urgency, and there were two times in which I lost some control and dribbled a little.
As far as sexual climax goes, I have not tried any devices or drugs. I have had erections starting in the third week. With the prostate gone, there is no ejaculate. Oral stimulation to reach a climax works well. The first one was like an electrical shock and was painful. The second was better. A few months later, with a little creativity and flexibility, sex for both of us is very satisfying but a somewhat different experience. I am very fortunate to have a best friend and lover of 50 years.
As far as the recovery pain. The first three days were really bad. Dr. Porter said narcotics would slow the healing process, so I took Tylenol only to go to sleep for several hours, then wake up from pain. Next two hours walk around but not too much, sit down, eat just a little; easily digestible food is necessary. Empty the bag, wait for the pain meds to work, go to sleep. The fourth day, I was able to sleep a full 8 hours and have a normal day.
The first couple days, there was a great deal of reference pain in my shoulders from the CO2 gas used during the operation. This was a total surprise to me. The pain in my shoulders was very intense. I had not heard about the use of CO2 gas to inflate the body for laparoscopic surgery.
For me, there was no pain / burning from the catheter, though I have heard that is often the case.
Ok the big big surprise. It seems that the 90 gram prostate was perhaps causing problems with my intestinal process. I was leaking or weeping. That has stopped entirely. I had had a 16 mm kidney stone removed. My chemical balance was great, but I was passing only half the fluid I should. I had problems forcing myself to drink enough water. Now I can drink 8 glasses of water with no problem. It remains to be seen but perhaps the kidney stone problems will be no more and were caused by my enlarged prostate.
Ok what are we doing now. I was told not to lift over 15 to 16 pounds for the next 6 months. Well, we have moved back to Chile living in a small cabin in the Andes mountains. It is heated by a wood burning stove. Splitting wood to keep us warm and cook food. I think I have lifted 25 to 35 lbs but not carried such any distance. I do physical work most of an 8 hour day. It is work of my choosing, and I rotate from one task to another depending on how my body feels. Split a little wood, dig a little trench, saw a little wood. Repair a little siding, Take apart old wood, make wooden handles for all the tools without handles, set up large workshop and store wood inside the cabin.
A land of not so many toxins. In a month, you might see a contrail. The worries and pressures of politics are gone. The threat of nuclear war in this area is remote. Food security is good. The air is clean. The water is clean. Most importantly, we are privileged to care of a small native forest.
At 72, we are looking forward to our garden in the spring and living a lot longer here. Chile is a long long way from a lot of things.
Thank you YANANOW!
Carl's e-mail address is: carl AT applied3d.org (replace "AT" with "@")