By Colin Campbell May 2001 When I retired in 1982 at the age of 62, I was in good physical health although mentally somewhat fatigued from my experience of teaching at high school level. I was glad to be retired! In the years since then, my wife of fifty-eight years and I spent part of the winters in Alabama, to escape part of our Ontario winter! We had a small motor home and parked in beautiful Gulf Shores State Park on the Gulf Coast. I found it very relaxing to have a bicycle and cycle quietly within the Park. I was listening to a TV talk by a prominent Harvard Medical School urologist, whose name I cannot recall, and who had invented a new kind of cycle seat: Winter 95! This seat removed the pressure point of the conventional seat, which is directly below and about two inches away from the prostate gland! He pointed out that, with the usual seat, the prostate gland was subject to possible damage when riding over rough ground or bumps, which could contribute to subsequent prostate problems! I resolved that, when I got home, I would have a prostate check-up by my doctor. My doctor found a nodule on the gland and sent me to a urologist. I discovered this test called PSA for the first time, but the number 15.0 didn’t mean anything to me! It did to my urologist, however, and so I had my first biopsy and subsequent bone scan. The biopsy confirmed prostate cancer. I then discovered the term “Gleason Score”; my score was 6, and I had Stage T2b cancer. The urologist suggested a three-month period on Androcur at six pills per day. He suggested that the preferred treatment following the hormone therapy would be external beam radiation over a period of six weeks and about thirty treatments. He explained the probable side effects of the Androcur, i.e., impotence, and the likelihood that, following radiation, I would remain impotent. He said that radical prostatectomy was not an option given my age. Another option was “Watchful Waiting,” which he did not recommend and which, in any case, did not appeal to me. No other treatments were mentioned, and, in the absence of any support group in this area, I had no one with experience to talk to. I went ahead with the run up to radiation by going to the London Health Sciences Centre for preparatory “simulation.” This consisted of being disrobed and placed on the linear Accelerator and carefully positioned with the use of the equipment to mark the location of the prostate so that the beam could be focused precisely on each treatment. This was accomplished by injecting a radioactive fluid via the penis and then photographing the position of the prostate relative to marks pinpointed on my body during the simulation, which were indelible and would be the reference points for subsequent treatments. By the time the radiation treatments commenced some four months after commencing the Androcur, my PSA had dropped to 0.1, which was normal following the Androcur. This had shrunk the tumour which improves the chance of a successful outcome to the radiation I consulted another physician with whom I was personally friendly, and, following his exam, he suggested waiting, since he was concerned that radiation would cause collateral damage. After some consideration, and lacking any other source of information, I decided to accept my urologist’s recommendation, and proceed with radiation. He pointed out that there was a relatively high possibility of failure, which I chose to ignore. My radiation commenced in July 1996 and concluded after 31 treatments in August. I monitored my PSA for the next three years with the following results. Feb 97 0.6 Aug 97 0.3 April 98 0.4 Sept 98 1.1 May 99 1.6 Aug 99 2.6 Dec 99 3.6 At this point, I consulted my urologist who agreed that a biopsy was indicated. This was done very promptly with the result that the pathology was positive. The Gleason Score was now 7, which was an increase from the pre-radiation score of 6. I was prescribed Androcur again but at a reduced dose pending further arrangements. I discovered The Crittenton Hospital in Michigan via the Internet and their work in cryosurgery using equipment by Endocare Inc. I obtained a video of the procedure from Endocare, which really impressed me. If I had been aware that such a procedure was available when I was first diagnosed, and if I had been aware of the relatively high failure rate of conventional radiation, I would never have opted for such radiation but would have sought cryosurgery. To my surprise I discovered that this procedure had been carried out at the London Regional Health Sciences Centre by Dr Joseph Chin, Head of Urology and Professor at University of Western Ontario, since 1995. Dr Chin accepted me as his patient in May 2000, and, on completion of the course of Androcur and a PSA of 2.8 in Sept 2000, I had the cryosurgery at University Hospital in London, Ontario. I went into hospital at 11 am Sept 25, had the procedure very expeditiously with a general anaesthetic, and was released at mid-day the following day. I had a “Supra-Pubic Catheter,” which would remain in place for three weeks, at which time I had to return to see Dr Chin. (The ultrasound examination that was conducted prior to my discharge was satisfactory.) I saw Dr Chin after three weeks and had the catheter removed without incident. He indicated his satisfaction with the proceedings and arranged for a TRUS biopsy in six months time, which was on April 25th 2001. The pathologist’s report stated that there was no evidence of cancer!! My PSA as of May 2001 was 0.7. The TRUS ultrasound, to quote the doctor who performed it, was “just the way we like to see it.” I had to urinate frequently for the first month following removal of the catheter, and there was a minor attack of faecal incontinence, which soon vanished. I had considerable discomfort for about a month following the procedure especially when seated! It was pointed out to me that frostbite was extremely painful to the extremities and it must be just as painful elsewhere! It passed within a few weeks, as did the frequent trips to the bathroom. I am back to what I would consider near normal with one exception, which was expected, impotence. We have no problem with this since, at 81 years, we can consider sex as an overrated pastime. We have three sons and sixteen grandchildren! In conclusion, I can say that I would not hesitate to recommend cryosurgery, and would be prepared to do it again, if necessary. I am just sorry that I had to go through the extended course of radiation, with its side effects, only to find that it had failed. Colin Campbell Chairman, Owen Sound Prostate Cancer Support Group 1250 13th Ave East Owen Sound Ontario N4K 6L8 PS: Much better results have been obtained with “conformal radiation” but while done extensively in the USA, I am not sure how available it is in Ontario. Regardless, I would still prefer “cryosurgery” because, unlike radiation, it can be repeated, and I believe at substantially less cost, both in money and in time taken.