When the cure is worse than the disease

The bane of all men is prostate cancer.  More so than heart disease because of what happens once prostate cancer is suspected. Unfortunately, too often it is addressed with aggressive surgical methods. For the past 40 years, prostatectomies have been the leading method of treatment.  These surgeries are not just plain barbaric in the operating room (I’ve seen too many performed), but their aftermath is devastating to the men.

Advances in treatment have led to more conservative cyberknife procedures and radiation therapy. Still, the results cannot be measured just by statistical data that reflect long-term survival from prostate cancer; they must be measured in the quality of life for the victims and their families. And we don’t talk enough about that.

Men of all ages who have had their prostates removed as soon as their PSA levels started to rise (as determined by a totally unreliable blood test), as well as men who have been subjected to biopsies of the prostate that are extremely painful and often confusing in results, leading to radical surgeries in the name of preventing spread, can attest to the devastation left behind.

Incontinence and impotence occur in all cases to some degree. Men define themselves by the ability to perform sexually and the loss of this ability is nothing short of life-altering, leaving them in a deep and often permanent depression. Women whose partners suffer with the disease or worse, the side effects of the treatments, deplore the day they went along with the surgical approach as the best option.

I cannot help but be reminded of the vibrant 43-year-old man who came into my office seven years ago with his young wife to consult with me on his situation. His father had died at 50 of metastatic prostate cancer and the man’s PSA had been slowly but consistently climbing over the previous two years. His urologist had seriously recommended he undergo a “prophylactic prostatectomy” so as to not follow in his father’s footsteps. The urologist had also reassured him that all the nerves to the penis would be spared during the surgery so as to prevent incontinence and impotence from being side effects.

The man and his wife were in total panic mode and for good reason. They were very well-informed and knew the urologist may have been hoping to avoid the consequences of potential cancer. But the chances were that the patient was going to sacrifice his quality of life to avoid the unknown.

Nevertheless, fear led him. He had the prostatectomy and his pathology showed a mixed bag with parts of the prostate being atypical (not cancer) and other areas clear of any disease.

When he emerged from the surgery, the urologist told the wife, all was clear, he had gotten all the prostate out and her husband was safe from prostate cancer.

Unfortunately, he was safe from prostate cancer but was never the man he had been before.

He did become incontinent and impotent. He wanted to continue having sex with his beautiful wife and had to learn to inject himself in the penis with Caverject as the only way to achieve an erection. You see, Viagra and Cialis work on functioning males. They don’t on postsurgical ones.

In time, that procedure became unbearable and he had a penile prosthesis inserted, which made sex a little more spontaneous, though he had no sensation in his organ.

Finally, with the passage of time, in spite of reassurances from his doctors that the nerves would heal and he’d be back to normal, the incontinence caused him numerous urinary tract infections and serious intestinal problems from all the antibiotics. He became depressed and had to go on antidepressants, which only served to make him feel even less virile. His doctors found his testosterone levels had plummeted, but told him taking testosterone would be dangerous.

I wish this story were the exception, but unfortunately, it is the rule.

This is a quiet, unspoken tragedy that occurs in thousands of households every year.

Men don’t like to talk about these things, and doctors don’t seem to pay it much attention. The goal in medicine is to rid the body of cancer or would-be cancer.

The goal should be to keep the man healthy and happy but it isn’t.

In 1939, an article published in a prestigious urological journal connected high testosterone levels to prostate cancer in one patient. It started a cycle of more than 60 years of mistreatment and misunderstanding of the role of testosterone in male and prostate health.

Testosterone was perceived to be the fuel for prostate cancer, and drugs were developed to wipe out the juice of life from men suspected of having or being treated for prostate cancer. Aging men with flagging libidos and growing beer bellies, couch potatoes with low testosterone levels were prohibited from getting testosterone due to the fear of giving them prostate cancer.

Although hundreds of studies following the 1939 report failed to find any connection between prostate cancer and testosterone, it wasn’t until 2007 when a distinguished Harvard professor of urology, Abraham Morgentaler, published an extensive review of all the studies that it became clear testosterone wasn’t harming men’s health.

In fact, study after study has shown that testosterone keeps men feeling great, not just sexually but also medically, building muscle, protecting the heart, maintaining brain function and preventing frailty.

It was only recently, then, that we realized giving testosterone to men may not only be good for them, but it may even prevent the dreaded prostate cancer.

It’s just common sense that testosterone is a good thing for men. If it were the cause of prostate cancer, wouldn’t we see cancer rampant in the young men whose blood streams are overflowing with testosterone?

In my practice, I have been treating men with testosterone for almost two decades.

The results are amazing. Depressed, haggard, sad men turn into wonderful, happy, positive and loving partners.
Maybe, progress is found in doing less, re-evaluating the information we have and turning to the young for some help.

And one more thing: Prostate is a very slow-growing cancer. A great Westchester urologist told my 75-year-old dad when he developed prostate cancer that he wouldn’t treat him since his life expectancy was less than the time it would take for the prostate cancer to grow enough to spread.

My father died at 76 of a heart attack.  With what I know today, I do believe that if we had given him testosterone, it may have extended his wonderful life.

Now to me, my father’s doctor was practicing good medicine. We certainly need more doctors to look at men, prostate cancer and testosterone through this empowered prism.

 

For more information, email Dr. Erika at Erika@drerika.com.

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