'You have cancer'

Greg Campbell is professor emeritus of chemical and biomolecular engineering at Clarkson University in Potsdam.

"You have cancer." Three words that strike terror in your heart. In my case, at age 66, my urologist delivered the verdict: I had prostate cancer.

About 230,000 men are diagnosed each year with prostate cancer and 30,000 of them die eventually. More people die of prostate cancer than breast cancer, and I did not want to be one of them.

What's a man to do? Choices are stark — 190,000 have surgery each year, surgery that can lead to incontinence or impotence.

Fortunately, my friend Russ, who has been fighting prostate cancer for 10 years and is director of a national prostate cancer support group, US-Too, urged me to "read and use the Internet to get as much information as you can."

Wise advice. Coupled with a box of materials, including books that Russ sent me, I began my quest to find a way out of this nightmare.

But back to the beginning.

My prostate specific antigen (PSA) numbers — a guide my family physician used to determine the extent of the cancer in the prostate gland — had been established at a normal 2.6, meaning no cancer. After 20 years, in spring 2005, the number suddenly jumped to 4.6. On my next visit, the PSA number dropped back to 2.8. My doctor and I decided against a follow-up with a urologist.

Not a smart move, as it turned out.

In spring 2007, my PSA jumped again — to 4.6. Time to see a urologist. He reviewed my medical history, did a digital rectal exam, felt an abnormality in the prostate gland and ordered a biopsy.

Two weeks later, I got the three dreaded words: You have cancer.

Four of the eight biopsies turned up cancerous tissue. Now the PSA was at 4.8.

The urologist also threw out some new numbers — my Gleason Score (a measure of how much the cancer cells had mutated from normal cells) stood at 7 for one of the biopsy cores and 6 for three others from the gland's right side. The left side was cancer-free.

Like most men hearing this verdict and these numbers for the first time, I knew nothing.

My urologist recommended surgery to remove the cancerous prostate gland.

He also scheduled a computed axial tomography (CAT) scan of my pelvic area to determine if the cancer was spreading.

What to do?

I searched for some answers: Should I have surgery? Are there other ways to tackle my cancer?

Among the books I checked were two from US-Too that Russ recommended:

■ "A Primer On Prostate Cancer" by Stephen B. Strum and Donna Pogliano (2002, The Life Extension Foundation, Hollywood, Fla.).

■ "Surviving Prostate Cancer Without Surgery" by Dr. Michael J. Dattoli, Jennifer Cash and Donald Kaltenbach (2005, Seneca House Press, Dattoli Cancer Foundation, Sarasota, Fla.).

The primer was not easy to read but it had some eye-opening information.

For example, there are about 12 bad choices facing someone with prostate cancer, and major complications from those choices include high rates of incontinence, impotence and rectum damage.

Even worse is the high probability that surgery would not get all the cancer. This is an aspect not normally part of the discussion by the urologist. Remember, all urologists are surgeons.

Watchful waiting might be in order for some men diagnosed with prostate cancer — those whose PSA numbers are monitored regularly and aren't doubling rapidly. With my PSA now at 5.8, I was among the 10 percent to 20 percent of men whose PSA numbers indicated the cancer was aggressive. Watchful waiting was not an option.

I discovered the Partin Tables, which provide probabilities of the outcome of radical surgery. For me, there was only a 35 percent chance surgery would get all my cancer.

This meant I was reduced to radiation therapy, which often holds risk for bladder and rectum damage.

But the more I read, I realized there was another option — the use of beam and seeds, an approach successfully pioneered by Dr. Dattoli, co-author of "Surviving Prostate Cancer Without Surgery," at his clinic in Sarasota.

I elected to pursue this strategy. And thus began my journey from Northern New York to sunny Florida and the road to treatment.

Like all engineers, I tend to ask a lot of questions. I already had found answers to lots of them. I now needed to know what the Dattoli Clinic was going to do to treat my cancer.

The clinic team is efficient. After I faxed my medical records to them, I had a 40-minute, long-distance phone conversation with Dr. Richard Sorace, Dr. Dattoli's partner, telling him I wanted to be a patient. The next day, a nurse, by phone, reviewed more of my medical history.

Once accepted as a patient, I had more forms to complete, and they scheduled two more tests before my office visit with Dr. Sorace.

The first test was a ProstaScint, using a radioactive monoclonal antibody that binds only with prostate cancer cells. The other was a positron emission tomography (PET) scan, conducted at a clinic in Sarasota near the Dattoli facility.

My wife, Sue, and I headed for Florida, where we occupied an efficiency apartment for the lengthy run of tests.

For the ProstaScint exam at Orlando Regional Health Care in Florida, I was given radioactive injections and sent away for five days while my body absorbed this material.

In the meantime, I underwent a PET scan of soft tissue and bone. Before the scan, I was injected with radioactive fluorine, which is attached to a sugar molecule. In the soft tissue, cancer cells need more energy than normal cells, so more fluorine is left in the cancer cells and will show up as "hot spots" during the PET scan.

I returned to Orlando for the ProstaScint scan, which can detect the presence of cancer cells in the prostate gland and determine whether they have spread into nearby lymph glands.

Test outcomes from both the ProstaScint and the PET scan were merged to give the Dattoli staff a good picture of my situation.

Then came my first appointment with Dr. Sorace. My wife accompanied me. After a nurse checked my blood pressure (106 over 59 — the nurse offered the ironic observation, "Some people would kill for those numbers.") I finally met Dr. Sorace.

He discussed my family medical history, and when I told him the Partin Tables indicated I would, on average, have a 35 percent success rate with surgery, he countered that the Dattoli radiation protocols had an 85 percent chance of keeping me cancer-free for 10 years. He prescribed Avodart and Cosodex, both hormones to inhibit cancer growth in the body.

Turning to my ProstaScint and PET scans, he said both tests were negative — on the surface, good news. But I also knew by now that a relatively large tumor — 0.8 centimeter in diameter — could be present and not detected by these tests.

Dr. Sorace agreed that he could not rule out the growth of smaller cancer tumors elsewhere in my lymph system and bones. But he reassured me that Dattoli procedures result in a less than 1 percent chance of incontinence (compared with 15 percent to 20 percent with surgery) and 25 percent chance of impotence (60 percent to 70 percent with surgery).

The next step was a visit to the Doppler ultrasound room. I was installed on a table, flat on my back, my feet in stirrups, and a Doppler probe was inserted in my rectum to take 5-millimeter color images of the prostate. There was a computer screen that both my wife and I could view — seeing the same things the Doppler operator was viewing.

What we could see was not much different than what I'd seen a while back in my urologist's office in upstate New York. The digital images of the rectum and prostate gland were integrated to reveal a prostate gland that was 42 centimeters cubed.

The operator turned on the color Doppler, and suddenly large areas of red popped up on the screen — these were the cancer tumors. The images showed Dr. Sorace that cancer "fingers" had already moved into the fatty tissue around the prostate and that surgery was not guaranteed to get them.

The Dattoli Clinic has a special computer software program that allows them to create a three-dimensional image of the prostate and the cancer sites — helping them pinpoint exactly where to plant the radiation seeds.

Then came the "fun" part — a catheter was inserted in my penis to send iodine dye into my bladder, while simultaneously another catheter was pushed into my rectum for a barium enema.

Then, they ran me through a CAT scan — a "simulation" or dry run for the real thing, which would come later. They just wanted to have a good picture of where everything was for the later radiation seed planting.

And I said this was "fun"? Well, the aftermath was — Dr. Sorace told me to drink lots of liquids to get the iodine dye out of my system. As a matter of fact, he suggested a six-pack of beer would do the trick. Done!

This was on a Thursday. I returned to the clinic the following Monday for X-rays in the e-beam accelerator, which would be used as a baseline analysis.

With all the tests and analysis done, the clinic began the real work: 25 sessions of guided and intense radiation therapy — one session a day for five days, then a weekend break. This went on for five weeks.

This technique, unique to the Dattoli Clinic, is designed to target the radiation where it will kill the cancer cells and minimize radiation exposure to the bladder and rectum.

I would show up daily at 2:20 p.m. for my date with the beam accelerator.

After those treatments, I got a two-week break, allowing my body to recover. And then Dr. Dattoli, in an outpatient surgical procedure at the Sarasota hospital, inserted 69 radiation seeds near my prostate in a 23-hour ordeal — 45 minutes to plant the seeds and then monitoring me to make sure everything was OK.

Then it was back to Canton at the end of March.

I returned to the Dattoli Cancer Clinic in late June for eight more "cleanup" beam treatments on the outer part of the prostate area.

One of the first things they did was order another PET scan.

In January, when they did the first one, Dr. Sorace indicated they had found some activity in my chest — even I understood that this could mean some type of cancer there. When I was told a couple of days later the PET scan showed no signs of cancer, my wife saw the tension disappear from my body.

I finished the "cleanup" on July 8. Dr. Sorace told me everything looked fine and I could stop taking the hormone supplement at the end of these treatments. I did. I hope never to take them again.

My current hormone-depressed PSA is 0.039 and I'm hoping it will stay there. I am one of the 85 percent of Dattoli patients who are cured.

Incidentally, Dr. Dattoli allows one of his team to score him on how well he places the radiation seeds around a patient's prostate. In my case, he scored a 99.2. Not bad. I wonder how many times he's perfect!

There were no side effects from the cleanup treatment. And I can say clearly: "I am now a surviving cancer patient."

Like most men who get the prostate cancer diagnosis, I asked, "Why me?" This was quickly followed by, "I will fight this until I win or die of other causes."

Luckily, prostate cancer is treatable if detected early. It was for me. I look forward to a long and active life, and at the end I hope to be able to say — to quote an Irish friend — "As I slide into the grave I want to be shouting, 'It's been a hell of an interesting ride.'"