A patient faces difficult decisions in a battle to survive prostate cancer.
Waldman was also fit, trim and running marathons when he saw his primary doctor for a urinary problem 10 years ago. The prostate is below the bladder, and the increased tissue mass of a prostate cancer tumor can press against the bladder and cause urinary problems.
So to be cautious, his doctor did a Prostate-Specific Antigen (PSA) test to see if the antigens produced by the prostate were high.
After two PSA tests measured elevated levels, a urologist did a biopsy. As feared, the biopsy came back positive: Waldman had cancer.
Waldman said he was shocked. Reflecting his own thoughts at the time, he recalled a friend saying, “How did you get cancer? You’re in such good shape.” Waldman didn’t have any family history of cancer either.
After the initial shock, Waldman’s positive attitude kicked in. He thought if a man is going to get cancer, prostate cancer is the one to get. If detected early at the low-risk level — as his was— studies show it’s curable.
Cathy Wittig, his girlfriend at the time and now his wife who lives with him in Newtown, Pa., came over to Waldman’s house after she heard the news. She said Waldman was calm and focused on what he should do next. Together they researched his options.
Two common treatments for low-risk prostate cancer are watchful waiting, seeing if the cancer actually gets worse, or a radical prostatectomy, removing the prostate surgically.
Wittig went with Waldman to his next urologist appointment, and carried a notebook with their questions about the options. But before they could ask a question, the urologist advised Waldman to get his prostate removed. The doctor said there was a 50 percent chance that the cancer would grow within the next 10 years. Waldman would also recover better from surgery now because he was younger and healthier than he could possibly be down the line.
Waldman, an engineer by trade, said a 50 percent chance that the cancer could get worse, and in unpredictable ways, was too high of a risk for him. He asked the urologist who he recommended for surgery.
Waldman wanted his prostate removed robotically. Robotic surgery is practiced widely today, but back in 2003, Dr. David McGinnis of Bryn Mawr Hospital was the only urologist in Philadelphia doing this surgery.
Robotic, or computer-assisted prostate surgery, is less invasive because it is more precise, said McGinnis during a recent interview. Back then a one-armed robot held a telescopic camera so that doctors were able to see more during surgery. Today, doctors command a two-handed robot to do the actual surgical incisions without the tremors of even the most skilled surgeon’s hands.
An appeal of robotic surgery for Waldman was the shorter recovery period. Instead of the usual four days in the hospital and six weeks away from work, he’d be out of the hospital the next day and back to work in three weeks.
After researching about and meeting with McGinnis, both Waldman and Wittig believed McGinnis would provide the best outcome. In addition to McGinnis’ skill, Wittig said they appreciated how McGinnis listened to them and accommodated their needs.
The good feelings were mutual. McGinnis said, “Every surgeon’s favorite patient is the guy who takes care of himself, is nice and trim and physically fit.”
Because of Waldman’s marathon running, his body was ready. McGinnis said patients with a positive attitude — which Waldman has — tend to recover better.
To help them stay positive, Wittig said, “We certainly didn’t feel alone. We have a good network of family and friends.” Friends of friends connected Waldman with two people who had already undergone prostate surgery. Waldman contacted them to get a better sense of what to expect.
Surgery took place at Bryn Mawr Hospital on a Friday. The procedure was approximately four hours and Wittig stayed with Waldman at the hospital Friday night, just in case he woke up and needed something.
The following evening, they discharged Waldman from the hospital. He stayed at Wittig’s house, and by Sunday morning he was walking up and down her driveway.
Waldman said within a week he was doing most of his regular activities except for running and lifting. He resumed these activities after six weeks.
McGinnis said two standard risks for both open and robotic prostate surgery are incontinence and impotence. Incontinence is a risk because the entire prostate is always removed during surgery, and about half the muscles that control a man’s urinary system are embedded in the prostate. As a precaution, Waldman left the hospital with a urinary catheter inserted so that his remaining control muscles and bladder could have a rest. After a week, the catheter was removed and Waldman was continent.
Impotence is a risk because the nerves important for sexual functioning are about a milliliter away from the prostate, said McGinnis. Surgeons tiptoe around these nerves and do their best to leave them alone, but they typically shut down after surgery, and can take from weeks to two years to bounce back.
Wittig recalled McGinnis telling Waldman that he could resume sexual activity a couple of months after surgery, but it actually took six months for Waldman to be fully functional again. McGinnis supported Waldman’s assessment that he needed more time simply because he wasn’t physically ready yet.
McGinnis said when he was in medical school, erectile dysfunction after surgery was usually diagnosed as a psychological problem, caused by issues like performance anxiety. But from what is known today, the causes of erectile dysfunction are physical for the majority of recovering patients.
After a six-month checkup following surgery, Waldman goes to his primary doctor for a PSA test once a year, and to McGinnis for an annual checkup. Since surgery, Waldman said his PSA level has stayed at zero, and McGinnis always tells him he looks great and he’ll see him again next year.
As a result of the experience, Waldman said he’s more aware of cancer. He’s become even more proactive about getting all his yearly tests and checkups with the eye doctor, dermatologist, dentist. He also facilitates a prostate support group in Langhorne.
Wittig added that after the cancer scare, they’re careful to do things now while they’re still healthy and can enjoy them.
Wittig confessed that in the back of her mind, she worries that cancer is still in Waldman’s system and will reappear in another form. She has the example of her brother who was treated successfully for Hodgkin’s disease at age 26, but then, 34 years later, he died of stomach cancer.
McGinnis responded that while you can never say never, in terms of Waldman’s prostate cancer coming back, the more years he remains healthy since surgery, the less likely his prostate cancer will return. Right now Waldman has “less than a 1 percent risk of his cancer coming back.”
McGinnis said that having prostate cancer does not make Waldman a more likely candidate for others. He’s not of any higher risk than anyone else; unfortunately it just happens that some people are “unlucky, and they’ve had more than one kind of cancer.”
For final thoughts, McGinnis recommends annual PSA testing for the general population, beginning at the age of 50. He and Waldman argued against the recent recommendation by the U.S. Preventative Services Task Force that routine PSA tests cause more harm than good.
Urologists have also found serious flaws in the study that the Task Force used to make their recommendations.
“I just think they’ve lost their minds,” said McGinnis. “They’re completely wrong.”
Lynne Blumberg is a freelance writer who lives and tries to stay healthy in Philadelphia, This article first appeared in the special section of "Fighting Cancer."