I am Andrew Sikes and I have Prostate Cancer. I'm 40, I surf, build wooden surf and Stand-up Paddleboards, sail, race mountain bikes, teach SCUBA, and work as a Fire-fighter/Paramedic. Needless to say my general health is excellent.

I received my diagnosis on Monday September 21 and am scared shitless. You probably need not guess that I've been awake most of the night...

Things started with a PSA test during my annual FD physical in March. The doctor and I decided to do a PSA screen due to my age and close family history (father had PCa). My PSA was 1.7, I was referred to a urologist and re-tested in July after a circuit of antibiotics with a result of 1.4. DRE.(s) are normal. Biopsy on September 15, results on September 21 revealed Gleason = 6 in one of 12 samples, not yet staged. Samples were sent to Johns Hopkins for re-analysis. RLRP (Robotic Laparoscopic Radical Prostatectomy) is recommended, I meet with the surgeon on Monday.

What scares me most is not the surgery, I survived emergent brain surgery for intracranial bleeding in 01/06, I can certainly survive this. I was privileged to witness a robotic nephrectomy when I was in Paramedic school, and am not unfamiliar with operating rooms. It's what happens after that I'm worried about.

I'm not sure what I expect from you, actually I really don't know what to expect from any of this. The past two days have been an emotional rollercoaster. Now I'm just trying to educate myself and accept that I have prostate cancer at 40.

Later: First, I would like to express my appreciation to all on the YANA site for sharing their stories and experiences, good and bad, and for those who contacted me with words of encouragement and advice. I especially would like to mention Terry Herbert, Bob Evensen (whose story so closely parallels mine), John S, and Mrs K**** G****** for sharing her husband's story. You have all made this experience significantly less scary, your words provide much needed solace in this time of fear and doubt. The resources here are far more informative and (more importantly) personal than any book or literature I've read since my diagnosis. Your bravery is contagious. Thanks to All of You.

Now for some good news!

I met today with Dr Scott Burgess of Hampton Roads Urology. He's an enthusiastic young Urology Surgeon (38) but has an immense amount of experience with RLRP. For the past five years, He has performed Da Vinci procedures at Riverside Regional Medical Center in Newport News and does around 300 procedures a year. His first comment was "...what's a guy like you doing with prostate cancer..?"

My 12-Core biopsy on 09/15 showed 2% Gleason-6 in only one core. To Dr Burgess, this discovery is simply a case of aim. He feels that Dr Taylor could have easily missed the one small area of cancer and returned a normal biopsy. In my case it was simply chance that my cancer was discovered.

We discussed the multitude of options I have available: RP, RLRP, Cryo, Focused Cryo (trial ongoing at Johns Hopkins now), Brachy, etc. Apparently I have the entire menu for my choosing. The most important thing I have right now is TIME. I didn't expect a surgeon to discourage me from a procedure. Dr Burgess thinks surgery isn't necessary...yet. When the time comes though, I'll have him do a Da Vinci RLRP.

For now, we're not doing anything. We'll diligently monitor my little walnut, I'll continue living my life, repeat a PSA next March with another 15-core (or more) biopsy early next Fall. There is no need for surgery at this point. Dr Burgess feels it's too early for RP because I have so little cancer and since for me, surgery would not result in a "life change" only a "lifestyle change." This also gives me a chance to donate and preserve some sperm for use when Katie and I decide to have children.

This news does not change the fact that I am 40 and have prostate cancer. I will have to treat it eventually... What this does mean is that I'm 40 and LIVING with Prostate Cancer.

Well, I received some pretty good news yesterday. On the advice of my Urologists Drs. Taylor and Burgess from Hampton Roads Urology, I had my biopsy slides sent to the James Buchanan Brady Urological Institute of Johns Hopkins University in Baltimore, MD. [without wishing to imply I'm in the same class as these good doctors, that is my advice to every one - see Recognised Expert Pathologists.]

My slides were reviewed by Dr Jonathan I Epstein, a specialist in "...diagnosis of limited adenocarcinoma on needle biopsy..." Dr Epstein's opinion is that I DO NOT HAVE CANCER...yet. My Biopsy definitely contains abnormal cells, most likely pre-cancerous, but not yet definitively cancer. His recommendation for treatment also coincides with that of Drs Taylor and Burgess. For now, surgery is absolutely not warranted.

I will continue to monitor for changes, repeat PSA's every six months, and have a more thorough biopsy in four months. More updates then...

I met with Dr Burgess of Hampton Roads Urology a few days ago for a follow up. My annual FD physical this year revealed a PSA again of 1.4, which shows no change since September of last year. With this in mind, Dr Burgess and I decided to continue watching. I'll have repeat PSA's every six months and diligently monitor myself for any changes or abnormalities.

To quote Dr. Burgess "...if the grand poo-bah holy high muckety-muck of prostate cancer [referring to Dr Epstein] doesn't think intervention is necessary yet, then we have some time. There's no reason to go rushing into unneccessary surgery..." [Not too sure that Dr Epstein would be too keen on this title ....:-) ] I wholeheartedly agree and am quite comfortable with this decision.

The proverbial 'gorilla' is still sitting in the corner, but he's not quite so scary anymore. Thanks again to all here for your bravery and encouragement. I'll update in six months or so.

Thanks as always to YANA and especially to George H. and Terry H. for reminding me to update my story. I'd had no problems of note until August of 2010 when I started having blood in my ejaculate. I first noticed only a small amount appearing infrequently and without pain or discomfort. I reported this to Dr Burgess when it first occurred. He initially told me not to worry about it, it's usually self-correcting and clears in two to three weeks. My PSA at that time was trending down to 1.2 and didn't generate any real concern.

My research taught me that it's not all that unusual for men over the age of 35 to have small amounts of blood in their ejaculate. It's usually benign and often goes unnoticed, since most ejaculations are intravaginal and can be caused by a number of benign factors including trauma or infection (I had a traumatic Foley catheter removal during a hospitalization in '06 due to an improper removal procedure by an overworked and apathetic RN). Dr Burgess said not to worry, so I waited.

In December, the amount and type (dark-brown 'old' bleeding) had increased in frequency and quantity (bright red 'new' bleeding) to close to that of just after my first needle biopsy. I also began seeing blood and clots in my urine. Pain was minimal and occurred only with ejaculation. I reported this to Dr Burgess, he asked me to come in ASAP for an exam. I scheduled an appointment for late in January but never made it.

Just after Christmas, I was having significant, sharp prostatic pain and bright red bleeding with urination and ejaculation. When I reported this new development, Dr Burgess decided to forgo the office visit and instead scheduled a 20-core needle biopsy and cyctoscopy.

The procedure went better than expected. I reported, scared and anxious, to Riverside Doctor's Surgery Center in Williamsburg on a Thursday afternoon early in February. I was greeted by a very nice and friendly staff, eager to answer questions and help me relax (a little pre-op Midazolam had some influence as well). Since I was under general anesthesia, Dr Burgess was able to take his time and pay attention to his 'aim' as he passed an endoscope through my urethra and into my bladder, then took 18 tissue samples from my prostate. He was relaxed and comfortable, I was unconscious and didn't care. It was a significantly better experience than the first 12-core biopsy that was done with local anasthetic in Dr Taylor's office a few years earlier. Post-op discomfort was minimal, I bled a bit more and for a longer time but had generally less discomfort compared to the aforementioned 12-core biopsy.

I received my results from Dr Burgess a few weeks later during our follow-up office visit. The results were essentially unchanged: Less than 5% pre-cancerous/abnormal cells in 1 of 18 cores, graded at Gleason-6. Based on this result, I chose not to have the slides re-examined by another pathologist. My bleeding was caused by idiopathic urethral polyps, which are benign and will require intervention only if they begin to cause urinary problems. The treatment is to usually scrape them out with a large-bore endoscope and can be done in the office. I'm in no hurry to have anything else in my urethra for now. That too, can wait.

So now, to draw this long update to a short statement, everything's going well. No changes, no new develpments, no new plans other than to closely observe for changes and repeat PSA's at six-months. I feel blessed and fortunate for this littel bit of luck. To again quote Dr Burgess "...eventually you'll have to [poop] or get off the pot, but don't need to do anything more than what we're doing now..."

Thanks again to all at YANA. Your bravery is truly contagious. My hope is to be able pass that on to someone else in need by sharing my story.

Bye for now, surf's up and I'm heading to the beach...

April 2012 Update

Well, luckily things continue to improve for me. My last PSA in Sept of 2011 was 1.0, showing a continual downward trend. I will only go annually for repeat exams unless anything changes or I develop new symptoms.

Recently, I was contacted by someone who read my YANA account and wanted to know if I follow a special diet or take any kind of supplements. My short answer is no, I don't do anything special, there's no magic meal or special elixir that makes cancer go away or drops your PSA.

My reply to his question follows. Granted, I'm no nutritionist, diet guru, or natural diet advocate. This is what works for me:

"Hi [***],

I assume you saw my post on YANA?

To answer your question about my diet or special supplements I take; I don't follow any strict type of 'diet'. Actually, I just pay attention to what I eat in general. I do follow a few simple rules and have attempted to summarize them for you:

RULE 1 - If it's not food, don't eat it.

- Avoid, or significantly reduce (if and whenever possible) any processed food. Eat real food and avoid the fake stuff. Most of what's in processed food can't really be classified as food anyway, so I don't put it in my body. My work schedule makes it hard sometimes to avoid fast food or take-out (like when lunch is at 430pm and dinner is a few bites of something cold when I'm running out the door at midnight). I try not to eat crap if I can, that's not saying I don't, I just prefer not to. When there's no other option, I try for a sandwich or sub shop, it's easier to control what's between the bread that way (I can't remember the last time I ordered at a drive-thru).

RULE 2 - Cut back on the moo.

- Reduce red meat intake. I do so love a thick, medium rare filet mignon cooked over charcoal and smothered in gorgonzola with a glass of nice Cabernet Sauvignon, but it's not what's for dinner every other night. Most red meat is full of hormones, antibiotics, chemical preservatives, and other stuff that's indigestible (that's why it stays in your system so long) and medical studies have shown that stuff to be bad for you. I never did eat that much red meat anyway and rarely ever eat pork (bacon is excluded) but have significantly decreased how much and what type I am eating since my diagnosis. Go for 'organic" types of meat, grain fed, no hormones, and locally sourced if possible (if it's fresh, there's no need to chemically preserve it...).

RULE 3 - SEE RULE 1.

- Pay attention to what type of oils and fats are in your food. Read labels! Stay away from transfat and partially hydrogenated anything, and look for food with low amounts of high fructose corn syrup. With the recent social and governmental focus on transfats and partially hydrogenated oils, the food processors are disguising it and calling it something else (I've seen things like "semi-saturated" and "minimally processed"). It's still the same crap they were putting in our food all along. Even though it's not cheap, I almost exclusively use extra virgin olive oil, or EVOO for cooking (even when frying oysters for my po-boys). Otherwise, Canola oil will do. I also use REAL butter, unsalted. No margarine, 'whipped spread' (whatever that is) or vegetable oil 'tastes just like butter but without the fat' stuff. A nutritionist would talk about all the omega-whatever's and anti-oxidant gobbledy-gook protective voodoo that these oils do, but I'm no nutritionist. I just know I feel better when I avoid the fake stuff, and it's bad for you anyway.

RULE 4 - Get off your butt.

- Get off your butt and go outside. Get some exercise. Your body will thank you (after it's done punishing you for it initially). I have to stay active in order to do my job. Being in shape not only protects me physically, but helps me cope with the mental and physical stress of what I do everyday I'm working. Days off spent recovering are far more productive. Don't be afraid to push yourself once in a while, just don't start out that way. If you're not a self-motivator, check in at a gym or local YMCA for organized classes or sessions, they're sure to have something that fits your style or needs. There's plenty out there to do if you're willing. You'll feel better and your body will thank you for it.

RULE 5 - Cut back on the booze.

- Stop getting hammered. Pay closer attention to your alcohol intake. Just because the bottle's open doesn't mean you have to finish it. Follow the medical guidelines for drinking, a glass or two of red wine won't kill you tomorrow, just don't do it every night. As an added bonus, think of the money you'll save every week if you're not buying a bottle or a six-pack every other day...not to mention the reduction in calories.

I don't take any magic pills or supplements other than a protein shake after a strenuous workout (helps with recovery and keeps me from getting as sore). If you're eating a healthy and balanced diet (see RULES 1-3 and 5), you don't need supplements anyway.

To summarize even further [***], really what I do is pay attention to what and how much I eat, and get regular exercise. By following these very basic rules, I've been able to keep my body weight within 20 pounds of what it was in my late 20's (I turned 43 this month [March '12]) and my PSA has dropped from a high of 1.7 three years ago to 1.0 at my most recent exam a few months ago.

None of this is any big secret or special technique, it just seems to work for me.

I hope you have a few new ideas or at least a direction to go for a better answer after reading this. Please don't be shy if you need anything else.

Talking openly about my cancer is the single most effective treatment I've had so far. That, and the guidance and encouragement from the folks at YANA. It's an essential resource.

Thanks for your message, I wish you all the best.

-A"

Hello Terry and Mark,

Thank you for the reminder to update my story. The bad news is that there is nothing to update; the good news is that there is nothing to update. I am still in an active surveillance regimen consisting of annual PSA and DRE exams. The results for the past two years have been a steady decrease in PSA readings (now 1.27). I do suffer from occasional ED which is easily managed with a little Viagra when necessary. Until the need arises to take other action, I intend to continue along this path.

I have spoken and written to many YANA members, colleagues with similar problems, and strangers who have reached out to me to share my experience with them. I give complete credit to the unquestionable support, wealth of knowledge, and generous perspectives offered by the YANA site and its members. You have done a great service to many more men and families than you will ever know. I consider myself extremely lucky, not only for my diagnosis, but for finding the outlet that is the YANA website. Without YANA, this would have been a much more confusing and terrifying experience.

Thank You does not adequately summarize my gratitude for the service you provide.

Hello Terry, Mark, and YANA,

It's been a while since my last update, and again, there's very little to mention. I moved to Nashville late last summer and am getting established with a new treatment team. I am essentially asymptomatic, have infrequent ED (age related?), and have had no episodes of hematuria or pain.

Thanks again to you all.

-A

Hello again,

After many, many years of no updates, I'm sorry (or pleased, I suppose) to say that I have no updates...

I remain under active surveilance for my Gleason 3+3 cancer. I go in for q6mo (every 6 month) PSA and DRE (Digital Rectal Exam) checks, and have added a few MRIs. I relocated to Nashville in 2013 and have been through three different urologists (all with the same medical group). With each visit, I frustrate my doctor since I'm not willing to undergo repeat biopsies every other year, even though it's considered standard of care for active cancer. I've instead had a biopsy every 3-4 years.

My unwillingness to subject myself to this horrible procedure is based solely on the fact that nothing, absolutely nothing, has changed since my original diagnosis in 2009. My PSA has never been over 3.0, my biopsies remain unchanged from my original diagnosis. MRI shows no visible lesion. Should any of this change, I'll readily take a more aggressive tactic. But, until I need to do something about it, I'll keep doing what I'm doing. When the time comes, if I'm still otherwise healthy enough, I'll likely elect for prostatectomy unless there's a more appealing treatment.

I encourage you (readers, patients, family members) to arm yourself with knowledge about your condition. Challenge your provider and don't just accept their advice without first doing some research. I'm not suggesting a general web search, try instead PubMed, Up To Date, and MedScape.

If I'd taken the advice of my initial diagnosing physician, I'd have been without a prostate 15 years ago at the age of 40, which also means I'd have been unable to start a family and would now be without my amazing son.

Education is power, healthcare is a team effort, and you're in charge.

Good Health, Good Luck

-A

Andrew's e-mail address is: andyman0369 AT gmail.com (replace "AT" with "@")