Pioneer and Leader in Laparoscopic Radical Prostatectomy

Bob Patten, Littleton, Colorado

[In August, 2004, at the United States Masters Swimming long-course national championships in Savannah, GA and coincident with the Olympic games in Athens, Bob Patten broke the world 200m breaststroke record for men age 70-74. Bob set the world record 100 days after radical prostate cancer surgery. This is his story.]

In March of 2004, at age 69, I thought I was in perfect health. As a dedicated US Masters Swimming competitor, I had not gone more than three days without a workout since 1981. But now I was in total disbelief. For most men my age, a PSA level of 4 ng/ml would not be a huge concern. However, the elevation from 2.7 a year prior caught the attention of the doctor. A biopsy had confirmed it: I had prostate cancer.

With limited knowledge of the disease, the search for the best treatment began. At first, the process was not a rush because a lot of information available describes how prostate cancer is slow moving and I quickly learned that "watchful waiting." is often considered a reasonable standard of care. While contemplating the options a friend asked if I would like to visit a friend of his that was diagnosed with prostate cancer that had opted for watchful waiting. This sounded great until I learned that his friend was in the cemetery.

What to do? Radioactive seeds, cryosurgery, radiation, or radical surgery? I believed that there would be no easy solution and began a more realistic quest for treatment. In the first meeting with the urologist the Gold Standard of Care was described as radical prostate removal. Seeds were also considered a good option. Radiation was an option but low on the list while cryosurgery was considered too new.

The urologist believed that surgery was the best option especially given my good physical condition. To me, the thought of ripping through my stomach and abdominal muscles to remove the prostate was enough to scare me away from the procedure. I could not imagine how I would ever get back into shape after the estimated eight-week recovery time. Additionally, a nephew of mine recently had open prostate surgery and nearly died from complications of blood transfusion.

Seeds were sounding pretty good. Then within a matter of a week I met more than five men who had had complications with seeds. Surgery seemed ugly, but better than watchful waiting or seeds.

My son Rick started researching surgery and came across a surgical technique not performed in Colorado: Laparoscopic Radical Prostatectomy (LRP). After several hours of research, Rick and I realized that the name most closely associated with LRP is Arnon Krongrad, MD, in Miami. At about 1:00 am one morning, Rick sent an email to Dr. Krongrad explaining the fact that his father was diagnosed with prostate cancer and as a serious master swimmer he could not accept the damage that open surgery would do. Rick also shared my concern over the complication of prostate surgery that nearly killed my nephew. It was an email sent on a long shot.

Within 3 hours, Dr. Krongrad personally responded to the email. In an amazing small-world case, it turned out that Dr. Krongrad was also a master swimmer. In an even more strange and wonderful twist of fate, Dr. Krongrad put the last name and sport together and asked if we were related to Bobby Patten. Bobby is my son and Dr. Krongrad's former swim coach from Dallas.

After discussions with Dr. Krongrad and the local doctor and urologist, I decided to travel to Florida for surgery. During the next few weeks, I decided to get in one more short-course meet in Indiana, wondering what things would be like if I had surgery. At this meet, I mentioned a possible trip to Miami for LRP to one of my swim buddies from Littleton. He mentioned that his dentist, located in the same building with my son Rick, had just returned from having LRP with Dr. Krongrad. All the connections formed an unexplained sense, a feeling that a direction was being irreversibly set.

What followed next can only be described as an insurance nightmare that ran 24/7 for over a month. My insurance company promptly denied the primary care physician's request for authorization to have Dr Krongrad perform LRP and redirected the referral to University Hospital in Denver. Great news, I thought. I would not have to travel and I could get the same procedure. Upon trying to set an appointment with the University Hospital Urology Department I learned that University Hospital had never performed LRP, but was trying to get a program started. I did speak with a urologist associated with that hospital, and he graciously endorsed the decision to go to Dr. Krongrad.

When we notified my insurance company that University Hospital did not perform the procedure, they took the referral under advisement with their parent company. After a couple of weeks of review, my insurance company denied the referral because a outdated third-party document that they had retrieved said to. With a full out bombardment of emails, faxes, studies, and reports, my insurance company refused to cover the procedure. The only alternative was to file an appeal with CHDR, which oversees Medicare supplemental insurance companies like mine. While the battle raged on, Dr. Krongrad's staff continued to keep in contact with information, answering questions, and even keeping the surgery date.

My insurance company lost the appeal less than a week before the scheduled surgery and was ordered to provide LRP. In a final act of defiance, three days before the scheduled surgery with Dr. Krongrad, my insurance company agreed to cover the LRP procedure only if I went to University Hospital, where the procedure had never been performed. The insurance company medical director would never take or return phone calls. Their policy was clearly deny, duck, and delay. With three days left to surgery, I had no other alternative. I opted out of my insurance, which meant that my care would be covered under Medicare. Dr. Krongrad had requested my local doctor send my physical profile, and it was determined that I was a candidate for LRP.

Bobby and I flew to Miami and met Ruth and Hope; Rick joined us the next morning. After more than 10 years, Dr. Krongrad reunited with his old coach and my son, Bobby. Our meeting felt much more like a swimmers' reunion than a meeting with the doctor. Bobby presented Dr. Krongrad with a Dallas Aquatic Masters T-shirt, which conferred on Dr. Krongrad honorary membership on the team. In turn, Dr. Krongrad showed off a treasured T-shirt minted to commemorate the July, 1990 Lone Star Masters swim-for-distance workouts.

After the inevitable medical evaluation, I was somewhat tense. To help relieve the tension, Dr. Krongrad invited Bobby and me to that evening's Masters workout at the 50m outdoor pool at Florida International University. It was a beautiful evening, the sun gently setting over swaying palms. The water felt great and I was pleased that the effects of the bowel prep had vanished. I asked Dr. Krongrad not to overdo the training, and he kindly agreed. Also, being a good patient, I was careful not to swim too fast and unwittingly embarrass my surgeon the night before surgery. Bobby, who has set numerous swimming records, amused himself by trouncing the teenage swimmers who were in his lane.

On Wednesday May 5, 2004, I checked into the hospital at 6:00 am, for surgery scheduled at 7:30 am. I awoke at about 10:00 am and my first question was when surgery starts. The nurse advised me that the surgery was over.

At around 11:30 am, I arrived in my room. At around 12:30 pm, the I.V. was removed from my arm and I was free to move about as I wanted, with assistance from one of my sons, or a nurse. Liquid food was the fare for lunch, dinner, and breakfast the next morning. There was very little pain and I took no pain medications. I was discharged the next morning. A long-sleeve monogrammed shirt was offered, which inducted Dr. Krongrad into a secret honorary swimming society, and I was out.

Our next stop was a light lunch and then we went for a walk on the beach. We walked a total of about a mile and half, taking a number of breaks along the way. While walking I made up mind that I would go to the Long Course Nationals in mid August.

A couple of days later, at a post-op meeting with Dr. Krongrad before leaving, I learned that my cancer was organ confined and that the margins were clean. Great news. More recently, my PSA dropped to <0.1 ng/ml, as further validation that the cancer had been eliminated.

I continued to walk each day for the next ten days. On the tenth day, the catheter was removed and the biggest aggravation of the whole operation was gone. I had gone back to Colorado on May 10, and, with the catheter removed I was able to get back in the pool for light workouts. I found the pool to be a very comfortable place to be: no diving or hard pushoffs (doctor's orders). By mid June, workouts were back to about ninety percent of pre-surgery and I felt comfortable with the decision to compete at Nationals.

The rest of June and July workouts continued to improve, with timed repeats in early July equal to pre surgery. At one month after surgery, I found it hard to believe that I had major surgery, with so little pain, no visible scar, and no painkillers.

By the time Nationals arrived, I felt like I had never had radical cancer surgery. I find this hard to believe given that it had happened only 100 days before I competed. In any event, I went off to Nationals in Savannah, GA as a newly minted member of the 70-75 year-old age group. At this meet, in great spirits and great shape, I entered my favorite event, the 200m breaststroke. At the end, with my legs aching and lungs burning, I looked up at the clock. I had set a new world record for the 70 to 74 age group, breaking the old record by over 1.5 seconds.

I had seen the broadcast by Pat Robertson before my LRP and knew that quick recoveries were possible. However, as far any of us can tell, nobody has ever set a world record after radical prostate cancer surgery, let alone so quickly after prostate cancer surgery. Having gone through surgery and then setting a new world record was for me the most vital validation that all is well. In gratitude to all the men who were so open with me, I have spoken with others who were in the shoes I filled only four months ago. It's the least I can do.

Many, many thanks to Dr. Krongrad, a fellow swimmer, for supporting us in the ordeal with the insurance company, making us feel like family, providing a much-needed pre-op workout, delivering painless prostate cancer cure, and allowing me, within a few short weeks of surgery, the realistic dream of a swimming world record.