Dr. Prabodh Shah, 81 shares his journey with Prostate Cancer, his initial symptoms of problems in urination, seeking help promptly, how he managed side effects of the treatment. He candidly talks about how he struggled and coped with depression and his exercise routine that has helped him regain strength.
Diagnosis:
The first and only symptom I noticed was that I could not urinate like before. It would take a long time to empty my bladder. Sometimes, it would take me 30-60 seconds. As a result, I went to see a Urologist and during his physical examination of me, he did a DRE or a digital rectal examination to check on my bladder and prostate gland. After the examination, he called my wife back into the room and told us both that he suspected a lump in the prostate. My initial reaction was “what is next”? And "what expectations should I have?" I was sent for further tests like blood, PSA levels and biopsy. My PSA cancer test level was 23. The biopsy confirmed that it was stage 1C prostate cancer. There is no family history of cancer. This was in March 2018.
Course of Treatment:
Once we had the diagnosis, I wanted to know if it was curable and can be fixed. The surgeon at the time told us that he would not suggest a surgery because that would not be curative. All the scans had revealed that it had not spread, so according to him, the best choice was to go with radiation, chemo and hormone therapy. My son connected with the top doctors in Chicago and to my relief all agreed that since cancer was just outside the covering of prostate and not spread anywhere the best treatment was radiation therapy and hormone therapy. I did not want chemo and my family supported that so we went ahead with the treatment.
I was first started on hormonal therapy called Lupron, which is a is a synthetic gonadotropin-releasing hormone. Since it is not available in pill form, it has to be administered as injections. They were first given every month and then every three months. Then radiation started for 8 weeks, about 50 turns in all.
Managing Side-effects:
It was extremely difficult to go through 8 weeks of radiation. Mentally, it was really difficult. My psychiatrist friends called me and said you have reason to be depressed but try to manage. They offered to prescribe anti-depressants and I even got the prescription but never filled it. I talked to all my friends and that made me feel better. My brother from Seattle would call and pep me up often. My wife had to cope with this and she toughed it out.
During radiation, I got radiation cystitis (infection of the bladder) and had to go to the washroom every ten minutes during therapy. The radiation oncology nurses and doctors helped me get through those eight weeks of treatment. They allowed me to choose the time for treatment, were available to answer my questions and would come chat with me about Indian food and restaurants etc. After radiation ended, my hormone therapy lasted till May of 2020. The side effects of my hormonal treatment were growth and tenderness in the breast area, shrinkage of genitals and loss of libido or sex life. Depression is also a side effect.
What helped most was that I decided to focus on some form of exercise daily. Initially I started with 10 minutes of walking, now I do an hour or so. Luckily, there is a heated pool in the Condo complex where I live, so I was able to swim which I enjoy. To build up muscle which had become soft and loose, I do weightlifting of up to 12 lbs. I have no dietary restrictions.
Most painful time:
After my biopsy, I was unable to urinate properly, so I had to use a catheter to empty my bladder each time. I thought, I could do this myself and so every 8 hours, I would catheterise myself. This went on for nearly 2 weeks. It was very mentally disturbing and painful.
Current condition:
Presently I am doing great as far as the cancer goes, last 3 PSAs were below 1, one was actually 0.04. That gives me comfort that the cancer is controlled. Currently I am on no medications. Due to the pandemic, I have been mostly at home since the situation in US is quite bad. Yes, overall life is different, restricted somewhat but recently made a trip to India for 10 days and it worked out well. At night I am ok with my PSA numbers and ambien takes care of sleep and hope remains that if something goes wrong again, there are many treatment options.
Coping:
Biggest challenge is to accept the diagnosis and understand what is ahead of you. Managing this diagnosis was not easy to say the least. I needed support and my wife and son supported and even my granddaughter of 13 supported and admonished the use of word “death”. Biggest help mentally was that I had no financial debt because cancer treatment in the US can be quite pricey.
Advice to others:
Keep your faith and belief in God! Family support is as good as any meds you receive. My advice to patients is stay strong. Ask all questions to your doctors and confide everything to family members and make sure you take care of “final” wishes, keep documents in order. Keep a smiling face and not let others read unhappiness in your face. Bottom line do not give up. If you need help, just ask and you will see that the whole world will help you.
Read: Cancer screening guidelines for India by Dr. Gauravi Mishra, Preventative Oncologist
According to CDC, the U.S. Preventive Services Task Force (USPSTF) made the following recommendations about prostate cancer screening in 2018
- Men who are 55 to 69 years old should make individual decisions about being screened for prostate cancer with a prostate specific antigen (PSA) test.
- Before making a decision, men should talk to their doctor about the benefits and harms of screening for prostate cancer, including the benefits and harms of other tests and treatment.
- Men who are 70 years old and older should not be screened for prostate cancer routinely.
The above recommendation applies to men who—
- Are at average risk for prostate cancer.
- Are at increased risk for prostate cancer.
- Do not have symptoms of prostate cancer.
- Have never been diagnosed with prostate cancer.
Dr Prabodh Shah, MD. Hematology Oncologist (now retired) is 81 years old and lives in Chicago, USA
