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Patients speak about prostate cancer and laparoscopic radical prostatectomy

Jim Borgmann, Miami Springs

“Jim, you have cancer.” These words will make you faint, especially if your name is Jim.

In my case, however, they did not. Yes, my prostate biopsy showed that I had prostate cancer, the number two killer of men in America. For some reason I was not afraid. The good news was that I had caught it early, thanks in no small part to my brother. When he received his bad news ten years ago, it immediately put me on alert.

Prostate cancer has a significant hereditary link. If there is a family history, especially a brother, your prostate cancer risk increases dramatically. For that very reason, I received a prostate PSA test every year. PSA stands for Prostate Specific Antigen, a chemical marker in the blood that indicates the possibility of prostate cancer.

For years I had gone merrily along with a PSA below 2.0 ng/ml.  This June, though, it jumped to 4.7. My primary doctor recommended we do the blood test again just to make sure the lab got it right. This upset me more than the PSA number since I hate the sight of blood and needles! When the second test came back at 4.7, we knew it was time to take action. I had no prostate cancer symptoms and no sign that anything was wrong. No pain, no frequent trips to the bathroom, nothing. Nada. Zilch. Only the PSA.

This is how it is with curable prostate cancer: no symptoms. You need a physical and PSA to know you have it.

On July 5th, I went to my urologist, who performed the biopsy in his office. It was a very painless procedure. I can only describe the “pain” as if you snapped yourself with a rubber band on the back of your hand lightly twelve times once a minute. He took a dozen samples in about fifteen minutes in his office. 

Several days later I got “the call” in my office at Miami Springs City Hall, where I am manager. “Jim, three of the twelve biopsies were positive for cancer.” It took me by surprise, but like I said, I wasn’t mortified.

That afternoon my wife and I went to the doctor’s office to discuss prostate cancer treatment options. The first option, which is not an option at all, was to wait and see what develops and do nothing at the moment.  I don’t think so! 

The first real option was a procedure called radiated seeding.  In this process the prostate is implanted with radioactive seeds, and the radiation destroys the cancer cells, leaving the prostate intact. This process may be followed up by external beam radiation treatment.  I have friends who have had just the seeds and others who had the seeds with the external radiation. My brother is in the latter category and has had many related medical problems ever since as he was apparently over-radiated during one of his treatments.  Scar tissue and nerve damage have left him in constant pain.

The second option was an open radical prostatectomy. My friends, this surgery must be from medieval times. The surgical cutting is horrific. Two units of blood are required as is morphine for the pain. Your hospital stay will be at least a week. You will be back to work in 4-6 weeks. Okay, these options are not saying anything good to me at his point. 

“Jim, you are a perfect candidate for a laparoscopic radical prostatectomy.” LRP is a surgery similar to arthroscopic surgery on the joints. This the procedure involves making five tiny incisions in the belly. These incisions allow the doctor to insert a camera, cutting tools, clamps and a drain. The doctor performs the actual surgery robotically as he views a monitor. The prostate is placed in a plastic bag, sealed up, and then extracted through the incision in the belly button. Pain is minimal and you go home the next day. Now we’re talking!

Dr. Arnon Krongrad brought laparoscopic prostate surgery to the United States in 1999 and he just happens to practice in Aventura. As I told friends of my situation, it was incredible how many of them knew of Dr. Krongrad. Everyday someone else said, “Go see Krongrad, go see Krongrad”.

I looked up Dr. Krongrad and read some incredible stories from other patients that had this form of prostate cancer surgery: broadcaster Pat Robertson, baseball great Ken Griffey, Sr., Pittsburg Steelers linebacker Robin Cole, former Miami-Dade County Manager Merrett Stierheim and hundreds more had successfully gone through this. They come in from all over the country to have Dr. Krongrad operate on them. One 70-year-old man, a devoted athlete, had the surgery and 100 days later set a Masters Swimming record for men 70-74!  What really sold me was a 71-year-old pathologist with prostate cancer who aptly put it that he has seen too much cancer and if it could be completely removed in a relatively painless way, that’s what he wanted. That was all I needed to read.

I was very lucky. All of my follow-up tests after the biopsy showed that the cancer had not broken through the prostate capsule, which meant I was dealing with early stage prostate cancer. The bone scan and CT scan were both negative. Dr. Krongrad reviewed all my charts and tests and concurred that his surgery was right for me. He explained the whole 90-minute procedure and told us about potential side effects and things he might have to do if he saw any additional problems once inside me. We were ok with all of this. So we set a date of September 19 for the surgery.

At 6:30 AM on the 19th, we arrived at Aventura Hospital for the surgery. By 7:00 AM I was on my way to the operating room and at 11:30 AM I opened my eyes in the recovery room. Surgery was over. I felt a little pain in my belly, but it was very tolerable. By the way, the recommended pain relief for this surgery is two Tylenol! I took my two about fifteen hours later because my back was killing me from lying in bed! About that same time I was up walking around the hospital with the nurse. I did not walk this well for at least a week after my hernia surgery fifteen years ago. It was amazing.

Dr. Krongrad came by the next morning to discharge me with excellent news:  although the prostate was showing signs that the cancer was trying to break though, it had not.  He had gotten it all. Praise God!

Even better is the fact that even though I still have to have my PSA tested, I do not have to face chemo or radiation. I feared that more than anything to be honest with you. Chemo always seemed to me the poster child for the expression “the cure is worse than the illness.”

Most men want to know about the potential sexual side effects of the various treatments for prostate cancer. I was informed that there should be no reason why anything should change in that arena, except for the lack of fluid, which is produced by the prostate. One can also expect to have some degree of bladder control issues after a catheter is in for ten days, but that will go away eventually, depending on your age and physical condition. In my case, two weeks out and the control is coming back strong.

Other issues such as erectile dysfunction may already be affecting men by age 50, so that is to be expected. So, like the ad says (and Elvis has to be spinning in his grave), “Viva Viagra!” 

Seriously, though, I have some comments for men who ask this question.  There are other options out there such as seeding and cryotherapy (freezing the cancer cells) and even an ultrasound process not available in the USA. They too are associated with erectile dysfunction. I don’t know what the sexual side effects of those are.  I do know that since I had cancer in my body, I wanted it OUT of my body. So I made the choice I made, regardless of the potential side effects. If that is really an issue for you, I can only ask one question:  do you know any dead guys who are still having sex?

On Monday, October 1, less than two weeks after my surgery, I returned to City Hall and put in a full week. It’s nice to be back. Thanks to so many of you who sent cards or plants or fruit baskets during my recuperation at home. Your prayers and good wishes certainly helped speed my recovery. Of course a special thanks to Karen, my wife of 33 years, whose vows of “in sickness and in health” were really put through the acid test this time.

By the way, for those of you who think this is an old guy’s disease, Dr. Krongrad’s newest patient is 37 years old.

-- Addendum December 31, 2007

Fabled newscaster Gabriel Heater always started his broadcasts with the phrase “Ah, there’s good news tonight.” Although some of what I am about to write is sad, the good news is that men are finally starting to talk about prostate cancer. I have never been afraid or embarrassed to talk about my experience with it simply because I am a very open person.  My career in government has almost demanded such openness.

This past week, however, has given us all a glimpse into the world of entertainment and how prostate cancer knows no boundaries. One of my favorite singers from the seventies, Dan Fogelberg, died just before Christmas from this hideous disease. He had been diagnosed too late for any treatment to be effective. The scary part is that he was only 56, a year younger than me. On the home page of his website are two writings. The first speaks of his death, a horribly painful death. The second writing is entitled “and now the sermon,” a fitting cry out to men to get regular PSA blood tests and digital rectal examinations.

From my experience speaking with men about this topic, the digital exam is the part they don’t like. My only comment on this “fear” is that the procedure is far less painful than the battle with a disease that can and will eventually kill you if left untreated. Slowly.  Painfully. All for a few seconds on discomfort? Come on, guys!!

Frank Capra, Jr., also fell to this scourge around the same time. Under Capra's leadership, EUE Screen Gems' credits include several major motion pictures, including 28 Days, The Divine Secrets of the Ya-Ya Sisterhood, Domestic Disturbance, Black Knight and A Walk to Remember.

Lest we forget, prostate cancer also took the life of Frank Zappa in 1993.

Fresh on the heels of Capra and Fogelberg’s deaths came the news that Stephen Stills (Buffalo Springfield, Crosby Stills Nash and Young) had also been diagnosed. The GREAT news is that he was diagnosed early enough to do something about it. He is scheduled for surgery in early January and our prayers are surely with him. What is the lesson here? Stephen was not afraid to be tested regularly. He understood the consequences of not being tested. 

When blood relatives have prostate cancer, your chances increase dramatically. I have had an annual test ever since my brother’s diagnosis ten years ago. I was diagnosed in July 2007.  My choice of treatment was a laparoscopic radical prostatectomy, which was performed in September. 

Two of the side effects associated with prostate cancer surgery are bladder control (incontinence) and erectile dysfunction. I am happy to report that three months after surgery, I have regained complete bladder control. With the help of available wonder drugs, I am regaining much of my old self in that latter category, too!