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  R.I.P.     PLATINUM  
This is his Country or State Flag

Aubrey Pilgrim lived in California, USA. He was 68 when he was diagnosed in February, 1992. His initial PSA was 10.20 ng/ml, his Gleason Score was 5, and he was staged B2. His choice of treatment was Surgery (Retropubic Prostatectomy). Here is his story.

Aubrey has written a book which sets out his story and which gives very valuable advice for anyone diagnosed with Prostate Cancer. You can read the entire book, A Revolutionary Approach To Prostate Cancer online. It has been made available free of charge. Well worth reading, it covers all the key issues.

Here is an extract of his diagnosis in Chapter 2:

I was almost 68 years old. I had been having trouble urinating for some time. I had a very small stream. Even after I had urinated I often felt like I still needed to go. I had to get up frequently at night to urinate. After I urinated, I could stand there and shake it for five minutes. But the second that I put it back in my pants, it would dribble all over me. It was quite embarrassing. I also noticed that I was having more trouble having sex. My wife died in 1986 after over 42 years of marriage. I have not re­married, but I love sex, so I have a lady friend.

Digital Rectal Exam (DRE)
I finally went to see my doctor, a HMO internist. He did a digital rectal exam (DRE) and said that my prostate seemed a bit enlarged, but he didn't seem to be too concerned. I had heard about the prostate specific antigen (PSA) test and asked him if I should have one. He said that test was for suspected cases of prostate cancer and didn't seem to think that I needed it. He also said that the HMO would require that a urologist order that test.

PSA Test
I insisted on having a PSA test so he referred me to a urologist. The urologist did another DRE on me and said that my prostate was about four times larger than it should be. He seemed to be concerned and sent me to the blood lab for a PSA test.

Urine Retention Test
The urologist also sent me to have a urine retention test. This test checks to see if all of the urine is voided from the bladder each time you go. The prostate has a tough capsule that surrounds it. The prostate may grow so large that it squeezes and closes off the urinary canal that passes through it. One may not be able to completely empty the bladder and urine may be retained in the bladder. Depending on the amount of retention, it can cause kidney problems, bladder infections and other problems.

To check for urine retention, I was given a drink that had a dye in it. The dye can be seen with X­rays. After a period of time, I was asked to void, then an X­ray was taken of my bladder. It proved that I was retaining a large amount of urine.

BPH
The doctor said not to worry, that it may only be benign prostatic hyperplasia (BPH) growth. (It is sometimes called hypertrophy instead of hyperplasia. Hyperplasia is the better term since it means excessive growth or proliferation of normal tissue cells. Hypertrophy means excessive nourishment.) It was easy enough for him to say "Don't worry".

BPH occurs in most older men. The BPH growth is made up of non­cancerous cells. It is a fairly simple operation to perform a "Roto Rooter" procedure to ream out and open up the urinary duct. The device is inserted into the urethra in the penis and some of the obstructing tissue is trimmed away. They can also use laser and other procedures to trim away prostatic tissue and open the urethra. I was hoping very much that my problem was only a BPH growth. [This subject is discussed in depth in Chapter Four of Aubrey's book.]

I went back a week later for the PSA results. It was 10.2 ng/ml. The normal figure for my age would be less than 4 ng/ml. I don't have to tell you that I was a bit worried. My urologist is not very communicative. He set up an appointment for a biopsy. I asked a few questions, but I just couldn't force myself to say the word "cancer". So I went home and worried. And worried.

Biopsy
I went back a week later for the biopsy. It is a relatively painless procedure. A device with a spring loaded needle is inserted into the rectum. The needle pierces the rectal wall and into the prostate gland. A few cells are picked up by the needle. He took two samples of tissue, one from each rear lobe of the prostate. The samples were sent to a laboratory for analysis by a pathologist.

The needle can miss some cancers, especially a smaller tumor. Some doctors may take six or more samples just to make sure.

Ultra Sound
Some doctors may also use ultra sound instruments to view the prostate. Even very small tumors that can't be felt can be visualized with ultra sound. They can use the ultra sound to guide the biopsy needle precisely to the tumor. Since my prostate was so enlarged, my doctor didn't think it was necessary to use ultra sound on me.

Bleeding During Sex
He told me that after the biopsy I might have blood in my urine for a while so I wasn't too surprised when I saw the blood. I didn't see any more blood in my urine after about a week so I had sex. I was anxious to have as much sex as possible because I was afraid that it might be my last time.

After we had sex, my lady friend went to the bathroom. There was blood all over her. She almost panicked. I didn't feel too good about the situation either. But mylady friend was very concerned that the blood might have cancer cells in it, which might somehow infect her. Such a thing is absolutely impossible, but I could not convince her. She refused to have sex again for some time. I was terribly hurt and disappointed that she felt that way. But I could not convince her. I could only think of the many times when I could have had sex that were lost forever.

The Biopsy Results, Cancer
It took about two weeks to get the biopsy test results. I worried myself sick while waiting. When the doctor came in, he didn't have to tell me. I could see it in his face. He said, "I'm sorry, but you have prostate cancer."

I had suspected it for some time. The biopsy was positive for cancer with a Gleason Score of III + II, or 5. My doctor didn't bother to tell me what that meant. I found out later that the pathologists examine the cancer cells taken for the biopsy and give them a Gleason score from 1 to 10, with 10 being very aggressive and dangerous. (PSA, biopsies, Gleason Grade and Stages are discussed in more detail in later chapters of the book.)

Bone Scan
He set up an appointment for me to have a bone scan. When prostate cancer starts spreading, it often goes into the bones. In a bone scan, the person is injected with radioactive material. Then the movement of the radioactive material can be monitored with an X-ray. The radioactive material concentrates more in cancerous areas. If cancer is present in the bones it will show up as a dark spot on an X-ray. It is a fairly good test.

Thankfully, my bone scan was negative.

Prostatectomy And Impotence
It appeared that my cancer was localized. The doctor suggested that I have the prostate removed immediately. But I had heard about prostate surgery and impotence. I asked him what the chances were and he said about 50% of the men are usually impotent or unable to get an erection for about a year or so. Some are never able to regain the ability to have an erection. This happens because the nerves that control the flow of blood into the penis may be lie along the sides of the prostate. Until a few years ago, they were automatically removed along with the prostate. But an experienced doctor can peel the nerves and blood vessels, the neurovascular bundle, away and save them if the cancer has not spread to the nerves. Even if one side has been invaded, the nerve on the opposite side can often be saved so that erectile function can be preserved. (There is much more said about nerve sparing in later chapters of the book.)

Many people think that a 68 year old man should not be too concerned about or interested in sex. I was married for over 42 years before my wife died. We had sex almost every day, in my younger days, sometimes twice a day. I now have a lady friend. Unfortunately, she is rather prudish and doesn't like sex as often as my wife did.

I didn't feel like a 68 year old man. When it came to sex, I felt just about the same as I did when I was 20 years old. It is true that I slowed clown a bit and I felt a few aches end pains now end then. But the pleasures of sex were every bit as good or better than they were 20 years ago. Another thing, 20 years ago, I could not last very long. Now I could enjoy it for half an hour or more. A 50% chance that I would no longer be able to enjoy sex was not the kind of odds that I wanted to chance.

When I was in the Navy in World War II, I was stationed on a small jungle island in the south Pacific. Almost everyone on the island got "jungle rot", a fungus, on their hands and feet. One poor guy got it on his penis. The Medic looked at it and jokingly said, "If we can't clear this up we may have to amputate it." The guy was terrified. He said, "Doc, if you have to cut on that, you may as well make the cut right here", and drew his finger across his throat. I felt about the same way.

[Aubrey describes his surgery in detail in his book in Chapter 2 and concludes with these paragraphs:]

At Four Years
I am still impotent, but my PSA is still zero. I still get depressed when I think about not being able to have a good erection. And not being able to enjoy the same type of orgasm and ejaculation that I had before. If I had it to do over again, I would definitely do more study end research. The doctor who did my surgery was inept and inexperienced. But I did not bother to look further because all expenses were covered by Medicare and an HMO. If I had it to do over, I would look for a better doctor, even if I had to pay for him and it took every penny I had. Compared to what I am missing and my lessened quality of life, money is insignificant.

If I were to choose today, I would choose the seed implants. But of course, not many doctors were doing seed implants in 1992. It appears that seed implants are even better for some types of cases than even surgery. And the impotence rate is much less. More about seed implants or brachytherapy later.

Another option that I would consider is using antiandrogen hormones to block the conversion of testosterone to dihydrotestosterone (DHT). Prostate cancer thrives on DHT. New studies being conducted at this time indicates that it may be possible to treat localized cancer with these drugs. They allow you to still have your circulating testosterone and libido and have very few side effects.

[Aubrey was very active in the Prostate Cancer World and his PSA remained undetectable. In May 2008 he wrote to say:]

I have been told that I have a Grade IV Astrocytoma Glioblastoma in the Parietal Lobe with extrusion into the right Parietal Lobe. It is a huge mass. The doctor said that I had about 4 to six months to live. I am supposed to start chemo therapy on Tuesday.

[Regrettably this tumour did what his prostate cancer could not do and Aubrey passed on in July 2008. He is sadly missed by the prostate cancer community.]


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