One more vivid reason to hate prostate cancer

An old acquaintance of mine died this week of prostate cancer. He was about 68. We were not friends, but he was a vivid figure in my life and his wife, who is a friend, notified me of his passing.

Five years ago, when he was diagnosed, she sent an email. She remembered that I was a prostate cancer survivor. After a diagnosis, a man is presented options. Surgery, radiation, or "wait and watch." Her husband had to make a choice, and she asked for my advice. I gave her the same advice I would give you.

Without hesitation, I emailed back: surgery, a radical prostatectomy to remove the entire prostate. Background: the prostate is a gland, the size of a walnut, and through it pass the urethra, on its route from the bladder to the urinal, and the seminal vesicle, on its route from the testes to an orgasm. Older men may encounter two kinds of trouble with the prostate: enlargement, or cancer. Mine was cancer.

I am not an advocate for surgery. Consider this nothing more than information. Every man's decision is personal, driven by personal reasons and medical percentages, both of which can be confusing. A report released last year concluded "nobody can tell (men) what type of treatment is most likely to save their lives."

When my diagnosis came down in January, 2002, I was driven by personal reasons that made my decision relatively simple. Twenty months earlier, in July, 2000, my wife, Meredith had died of breast cancer. Now I had the damn disease, and I was pissed, and still combative, if not outraged. I was going to have to drive down the same freeway to the same hospital that I had driven her down so many times for treatment of her version of the disease.

I met with a urology nurse, who was a sort of triage counselor, who explained my options. I decided I was too young – 59 – for "wait and watch." Prostate cancer is relatively slow-growth, and a man diagnosed in his 70s or 80s may die of other causes before he dies of prostate cancer. I rejected radiation. I remembered what radiation did to my late wife's breast and armpit in her losing battle with breast cancer in 1998-2000, and I did not want any effects of that kind down there where prostate cancer grows.

That left surgery. I would have chosen it anyway. The counselor addressed side effects: impotence (of course), which at 59 didn't matter to me; incontinence, which did matter; and erectile dysfunction, which mattered also. She gave percentages of likelihood, and she described a "nerve-sparing" procedure that improved a man's chances of getting it up afterwards. Not all the way up, but 80 percent. Drugs like Viagra would provide the other 20 percent.

Many men are repelled by those risks and realities. I read the opinion of one man who said he would rather die than live like that. Not me. Regarding the medical percentages, mine was a basic decision. Medical science is way more likely to figure out what to do about incontinence and erections, than it is reversing death.

So a surgeon and the urologist went in, snipped out the prostate, pulled my urethra across the inch gap where the prostate had been and stitched it to my bladder. They used the "nerve shielding" process that gave me the best chance of obtaining future erections, which would be an inch shorter because of the urethra-pulling. Fun, eh?

The nine months after surgery were tough. I leaked profusely, my sex member was as lively as a frozen hotdog, and I had a couple of bladder infections, which present a man with pain that challenges the imagination (friendly hint: keep a supply of Cipro on hand). Then the hotdog started to thaw, and even tingle sometimes. The urologist fixed the incontinence by breaking and stretching scar tissue (where urethra was stitched to bladder) with an hilarious albeit humbling procedure involving long, blue, flexible rods resembling knitting needles. A nurse, setting me up (so to speak) for this procedure, was fiddling around down there and suddenly asked, "You're Michael Grant, aren't you?" The moment made my entire media career hyper-worthwhile. "You know everything about me now," I told her and we laughed, which had benefit for the occasion.

With my advice five years ago, I advised my friend of these side-effect adventures and the slow but steady progress that had followed up to that point. Her husband decided to go a route that spared the prostate. She said he chose "cryosurgery, resulting in freezing just the section that was cancerous." Last November, she notified me that the cryosurgery "didn't work. After 5 years, it has metastasized to bone cancer. He tried two different types of horrific chemo."

Then, this week, came the report that he had died. I can still leak a couple of drops if I sneeze wrong, and I hate that. I have to plan my sex life around Levitra, and I hate that. I hate all ED commercials and their impossibly goofy men, and I hate it that I can only spring to 80 percent attention when I am in the shower with my wife.

But she and I just got back from an hour-long walk. And a vivid, robust man I knew and admired is gone. I hate that most of all.