A Survivor’s Journey

Damon Vocke [00:00:00] I got my physical 4.01 on PSA, MRI was advised, some indications of equivocal, and then I went through the biopsy process and always thinking this isn’t gonna be real, this is just conservative physicians. But once I got the diagnosis, it was mostly low-grade pervasive prostate cancer with a couple spots of moderately aggressive. And it was a bit of a shock concern because it was the whole area that I was unfamiliar with. And I wanted to jump on it. So, I jumped on the internet before I even heard from my urologist. I started searching for high-end physicians that do the surgery and radiation and the like. And my overarching consideration was I want to treat and eradicate the cancer. The side effects were secondary, in my opinion. I want live long. The other things that can happen, I wasn’t so concerned about it. But it was really just dealing with the cancer and making sure I could do that effectively. So, the three options that were presented were monitor and then have to worry about it, do continuous biopsies and the like, which are not super pleasant for males. And then the second was the radiation. And I was a 61-year-old male in good shape and thought I could tolerate surgery very well. And there’s a lot of treatments involved in the radiation, so I wasn’t super interested in the radiation option. And really, the focus again, the word eradication for me was the optimal decision was to try to just get rid of the cancer and then hope and pray that there were no residual effects of cancer with regard to lymph nodes. One thing that I discovered I wasn’t quite clear on was that when you get your prostate removed, you will get a pathology report that accompanies the outcome, and fortunately mine showed zero margin, meaning nothing in the lymph nodes, and you have follow-up blood tests to check for PSA, and you want to get non-detectable. Which fortunately I’ve received. But it was really, it’s not one size fits all, which I think is clear from the preceding comments by the physicians. You have to take into account your age, your resiliency, your fitness level, your ability to tolerate the surgery if you can. And what are your ultimate objectives with regard to the diagnosis that you have? And again, for me, the overarching objective was eradication and hopefully ridding myself of this issue and not worrying about it. And I would also say in my mind, I’m an active person, I like to do a lot of different things, was a quick recovery. So, one of the things that was appealing to me about the robotic surgery was the recovery period was about four weeks where you could walk, and you could work with increasing distances and after four weeks you could begin to resume normal activities. And that was very appealing to me because I didn’t want to have a long recovery period. But you know, you take into account for me, the precision of the robotic surgery and preservation of the nerves surrounding the prostate was important with regard to erectile dysfunction and continence and the like. And it was kind of you do a risk assessment, at least I did, of what’s the best possible option for someone in my shoes. And I personally, my preference was just, let’s just rip the band aid off. Let’s get the prostate out and we’ll deal with the consequences. But if that can eliminate the cancer, I’m all for that and I’ll deal with the side effects. And fortunately, I’ve had a very good story to tell with regard to the side-effects, which I think are a combination of preparation for the surgery. I did a lot of fitness, I always have. Um, I was mentally prepared. I came up with things in my mind to just accept the fact that I was going to have to go through this process and, uh, look at the, at the end goal and not so much the sort of short-term inconvenience. And, um, I’ve also known other cancer patients in my immediate family that have had far worse, uh cancer situations. And so, I thought this is relatively simple compared to those with stage four and other things that the prospects are not very positive. So, for me, I just try to keep my chin up, stay focused, remember all the great things in my life and look at those as the ultimate objective and just get rid of it. So, I went and I did my consultations. I spoke with loved ones who gave me input advice and the basic advice was mostly from my daughter’s dad, just get of it and that was very persuasive. Uh, and, um, I just wanted to move on and try to address it head on the radiation to me, I know that’s a good option for many people but given that I was 61 and in good health and had resiliency, I believe to withstand the surgery, it was more appealing to me to do the robotic surgery. And, uh, again, I’ve read some very good things about the precision by which it can be done and preserve the nerves as much as possible to minimize incontinence and maximize functionality with regard to sexuality. So those were the considerations in my mind. And again, it’s not one size fits all, but I think a risk assessment and then a focus on what are your ultimate goals are critical for the patient and also getting input from those around you that love you and care about you of what is their opinion about the best course of treatment. 
 
Phillip Koo, MD [00:06:02] I think that’s really helpful to sort of see you frame it with regards to your primary goals is eradicating the disease. Because I will say there are certain patients that come in and say, hey, my primary goal is to make sure I don’t have incontinence or I don’t have sexual dysfunction afterwards. And I think sometimes that starts you down a different path as opposed to patients who have a different goal in mind. So, walk us through how you sort of went about making, I imagine you saw at least one urologist, you saw Dr. Hu, did you see others? Did you also see a radiation oncologist? 
 
Damon Vocke [00:06:39] Yeah, so when I saw the diagnosis, which again was a bit shocking seeing the word carcinoma, it’s like having somebody spill a big cup of hot coffee in your lap because you go through it and you just think doctors are being conservative and they want you to go through all these tests and you’re fine and then you get it. It’s just shocking and you have to tell your friends and family, like, look, I have cancer. It’s still hard for me to say that. And then it is, okay, then you switch to, what do I do about it? I did internet research on what the diagnosis meant with my Gleason scores. And it was mostly, you know, low-grade cancer, but it was pervasive. And I had a couple of spots of moderately aggressive. And I found Dr. Hu on the internet, a prominent physician in this area. I did consult with a radiologist about it, given my circumstances. And then the monitoring thing really was dead from the very beginning because I just didn’t want to have to live with the notion that this is in my body, it’s not going away. It’s gonna increase over time and why live with the fear of having to deal with it. So, I had a very good consult with Dr. Hu. My urologist was good, but Dr. Hu does this. I asked his nurse, how many does he do a week? And it was, I think it was 10 to 12 a week. And they knew right then, this is what this man does. He’s very good at it. And he was just very incisive about what I should be considering. Never told me what I should do. He recommended I see a radiologist in this area and, but he explained the risks, the advantages and the disadvantages of doing the robotic surgery and then told me if, you know, you want to consult further, let me know. But, um, I kind of had my mind made up from that consultation, but I also spoke to a few survivors who told me you’re going to get options and you’re gonna have to weigh out the risks of all the options. And one thing that made me feel more secure is it’s highly treatable. You know, doing nothing to me is not a good option. To be proactive would be the advice I would provide to people, but everybody’s got to decide for themselves, but it doesn’t go away, it’s going to grow over time. And the consultation was very helpful. The fact that a robot was going to go into my body and make I think it was five incisions was startling to me that that could be done. I have very, very small little, little staple scars on my abdomen from it. It’s not like, you know, somebody I used to know, my grandfather had appendicitis and had a big scar and all that it’s kind of an oxymoron. I thought when with the terminology it’s radical, prostatectomy, minimally invasive, and I always thought, how does that come together? That sounds pretty bad, but I know that I think the radical means it’s gonna remove the entire prostate, but it’s minimally invasive, and the recovery period was shockingly easy. I never took one painkiller. I took some aspirin for a day or so, and that was about it. And again, I was walking on the first day I was released from the hospital after an overnight stay. And within two weeks I was walking’ five to seven miles, and four weeks I started to resume my normal activities. You can’t go out and play 36 holes of golf, but your recovery period can be fairly aggressive in my experience. You gotta be careful, but those were my considerations is just how quickly, how can I get rid of this problem? Hopefully, knock on wood. And then how do I move on and resume my normal lifestyle?