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Friday, Feb 08 2013 02:19 PM

Defying the Odds: Dodging the prostate bullet

By Lisa Kimble

“It has been 13 years since local Robert “Bob” Williams came face-to-face with prostate cancer. To hear him tell it, he dodged more than ammunition, he eluded a missile.

“I woke up one morning and was looking over the edge,” Williams said. “It’s not easy to deal with odds that estimate your life span.”

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“But Williams doesn’t believe he lucked out. “It was through careful and educated planning (that) I was able to skew the odds in my favor by doing the right things at the right time.”

“Prostate cancer develops in the tissue of the prostate gland in the male reproductive system, and is second, only to non-melanoma skin cancer, as the most common cancer in American men. About 241,740 new cases of prostate cancer may be diagnosed this year.

“The retired businessman was 61 in late 1998, when he underwent tests for a routine physical. His PSA — a general blood test known as Prostate Specific Antigen — spiked for no apparent reason. The spike was not extreme, but a second test two weeks later was still elevated.

“An urologist, after manual palpitations, noted that the prostate felt normal. An ultrasound revealed nothing, and a biopsy found “no evidence of malignancy.” With no family history of prostate cancer, Williams felt confident. “The ‘no evidence of malignancy’ message came on a Friday afternoon, and I felt like I had dodged a bullet or a Howitzer,” 74-year-old Williams said. Then came what he now refers to as “Black Tuesday.”

His urologist phoned to suggest a second biopsy. He reasoned that just because there was no clinical evidence of cancer, there wasn’t any evidence that cancer was not present either. “I trusted this doctor, but did not want to go through another biopsy,” he said of his initial hesitancy. “I had a choice to do a second or do nothing, wait and see, and seal my demise.”

Good call. The wrong decision would have been a death sentence.

“The second biopsy confirmed aggressive cancer. After considering the options of radioactive seed implants and external beam radiation, Williams opted to have a radical prostatectomy, an extensive abdominal surgery to determine if the cancer had migrated to the lymph nodes, and if not, to remove the gland.

“Williams wasted no time doing his homework. “It is imperative to learn your Gleason stage and grade. This is vital to chart your future actions,” he said. Prostate cancer staging is the process by which doctors categorize the risk of the disease having spread beyond the gland or the probability of being cured. Williams’ stage T1c meant the cancer was discovered at a routine exam and probably early on; a grade of 3+3 indicated it was aggressive.

““I had to develop a mindset to allow me to get through what lay ahead. I had to get my head screwed on right to handle what was coming,” he said, about how he could have easily fallen into a state of depression. “You don’t do yourself any favors. My epiphany came when I thought, ‘My God, thousands of men have gone through this successfully, I can do it, too.’”

“Williams eventually received four opinions on the pathology. His research found that Johns Hopkins University and UCLA were at the cutting edge of prostate cancer advancements. Westwood was closer. Williams consulted renowned urologist, Dr. Arie Belldegrun. “I owe my life to this fine doctor,” he said.

“The words “cure” and “treatment” were used regularly in Williams’ vocabulary. Every decision revolved around those two words, and the urinary nerves on both sides of the prostate. UCLA had developed procedures to remove the gland via a field clean of blood, allowing doctors to see what they were doing and protect the nerves during the operation, thereby retaining continence and potency.

“The procedure was a success. The cancer was contained in the prostate and had not migrated to other organs. There was considerably more cancer present than anticipated, and only time — and PSA tests — would tell whether minute amounts of cancer cells had escaped the prostate capsule.

“Not a day goes by that Williams doesn’t count his blessings, including the support of his wife, Bobbi, he said. He also felt empowered to help spread the word. He didn’t always find peers willing to listen, however. “Men don’t want to talk about it. Nor do they want to hear about it,” he recalled. “I have tried to talk about it, but some men get down right angry. They are scared to death.”

“Recovery for Williams was swift, once he learned how to retrain his muscles to control urinary functions. “Through Kegel exercises and a simple ‘start-stop’ exercise, surprisingly it was pretty easy and only took about a week.”

“He is also painfully aware that had he not been vigilant and educated himself, he might have had to follow a much different protocol. “The trick with any cancer is to catch it early,” he added. He also advises people who are told that the odds of saving their urinary nerves on either side of the gland are low, to keep looking for another surgeon.

“Good health planning can yield great results,” he said of the importance of establishing the habit of a routine annual physical at age 40, with typical blood work ups that include a PSA test. “If I had skipped the PSA at age 61, and had not tested for the next two years, I would be dead today, or if I had waited for symptoms, it would have been too late to obtain a cure rather than treatment.”

“Today Bob Williams’ PSA is 0.05. He will get one every year for the rest of his life. He maintains good health with regular exercise, takes a multi-vitamin, watches what and how much food he eats, and no longer worries. Now that he’s retired, Williams enjoys fly-fishing, traveling and playing golf a couple of days a week.

“Life can be full of fear, or a joyful, whole life based on optimism. The choice is up to me,” he said. “If I get down and glimpse the edge again, I don’t have to face the edge any more. I did all that was in my power, and that’s the best I could do. I can live with that.”

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