Looking at my calendar, the most important appointment for the week of March 22nd was my wedding anniversary on the 19th. Our daughter Laura had bought us a weekend at a bed and breakfast in Carmel for later in April. Carmel is one of God’s natural beauty spots, only fifty-five minutes from where we live.  Next, was the installation of our DSS satellite receiver. And on Friday, squash with my old friend Alex, an appointment with my tax advisor later in the morning, and tickets to hear William Safire, the New York Post columnist, speak in the evening.

On March 20th, I had an appointment with Lionel Foster.  After going through the normal label production process, I was lead into his waiting room the one with Draconian pictures that I described earlier. The familiar knock on the door was followed by the door swinging open with less vigor and the less than animated face of Lionel Foster.  After shaking my hand, he said he had some bad news.

“I am sorry to say this, but you have prostate cancer.”  

I was devastated. I know that I should have expected that cancer was a real possibility, but I guess we all have a built in defense mechanism that tries to hide bad alternatives.     

“The good news is that it’s Prostate cancer” and “not cancer of the liver or colon or any number of the other cancers that afflict men,” he said.

“Prostate cancer is much more common, and we know so much more about it than the other forms of cancer.  There are a number of treatments available depending on the patient’s age and physical condition.”  My mind was still in a mist. He drew several sheets of papers from my folder.

“These are the results of your biopsy,” he said. You have a Gleason score of 6.  The Gleason score is a measure of the intensity of the growth of the cancer.  Anything below a score of 4 is considered a slow growth cancer, 5 to 6 is considered intermediate and anything above 7 is considered high growth.”

Further examination of the report showed that cancer was present in a concentration ranging from 33% to 62% of the samples harvested.

“I know you have had some bad news,” he said.  “But I feel confident that we have caught the cancer before it had time to spread beyond the prostate gland.  Your two PSA scores came in at 8.5 and 7.8.  With any reading below 10 there is less than a 1% chance that the cancer has spread to the lymph nodes.  If you had a reading above 10, there would be a 35% chance that the cancer had spread to the lymph nodes.”                                             

“You owe the doctor who sent you to me your life,” he added.  I mentally
thanked JBQ.

“What are my options?” I asked.

“There are several, but they all have some potential problems and or side affects that you should know about before you decide on any course of treatment.”

“As you know, the prostate is part of the male reproductive system.  There are two sets of nerves that are associated with the gland.  One group of nerves controls continence or the control of your bladder.  The second group of nerves controls erections.  Both sets of nerves are subject to damage to varying degrees by all of the different methods of treatment.”

“What treatment would you recommend for me?” I asked.

“Considering your age, you have perhaps 20 to 30 years ahead if all goes well.  Then the most important consideration is to save your life, and that means eradicating the cancer once and for all.  This leaves only two options, either radiation or surgery to remove the cancer.”

“My recommendation is surgery, because we can physically remove the cancer from the body.”  He went on to talk about the various risks associated with the different procedures.  It was apparent there was no one panacea.

“I don’t want you to make any decisions to-day. I am going to give you some material to read, and I suggest that you read as much as possible about prostate cancer from these and as many other sources that you can.  Then you can make an informative decision. I will always be here if you need any help.”

“One alternative is to do nothing,” I said.  “What are the consequences of that?”

“You will live five maybe six years, then the cancer will migrate to your lymph nodes and into the local bone area and you will die a very painful death.”  With this less than hopeful prediction, he gave several booklets and sheets of materials to read.  I thank him, and told him I would see him in a couple of weeks.

“Look, I know you have just received some bad news. But I’m going to make sure you live for many years to come, so I don’t want to see you cashing in your 401K or maximizing your credit cards.  We are going to get you through this.”  I was still not very optimistic.

“By the way,” I said, “I have this annoying cough.  I know it’s not in the same league as cancer, but is there anything you would recommend?”

“Why don’t you get some Robitussin, that should help you sleep at night,”  he said.  I got into my car and drove towards home. “CANCER, how the hell can I have CANCER?” Yet this supposed expert said I did have it. “Why me?” I’ve got so much to live for!! I don’t feel ill”.  I was so pissed with life I didn’t know what rationally to do.  I stopped at the Longs Drug Store in Morgan Hill to buy some Robitussin for my cough.  I felt the cashier thought I was some kind of a wimp with a cold, not realizing the seriousness of my condition. How could she? She lived in a non CANCEROUS world, the lucky bastard.  Damn, I was as mad as hell. CANCER, a destroyer of healthy tissues, an internal Hitler that had to be
eliminated.  At that moment, I thought about my favorite Bricklayer and war hero Winston Churchill, and I was resolved to beat this bastard no matter what it took.  I had my own personal Battle of Britain to win.  And, I knew that my internal Spitfires and Hurricanes would be my defense. Let Hitler’s CANCER try to cross my White Cliffs of Dover, and he’ll be shot down just as before.  

When I got home, Sarah was talking on the phone to Laura.   She waved
“Hi, how are you doing?” was her response.  “Your father has just walked into the room,” she said into the phone, while looking at me with raised eyebrows.  “I’m talking to Laura; she phoned to find out what the results are.”
            “I’ve got cancer,” I said.  Not knowing how to explain my feelings, it still wasn’t a reality with me and it would not be for several more days.  She passed the essentials on to Laura and said goodbye. Replacing the telephone receiver she looked at me with some confusion in her eyes.

I looked down at my right hand and saw the reason for her confusion.       
“No, this bottle of Robitussin is for my cough. It is not an elixir for my prostate cancer.”  She held out her arms and asked me to tell her the whole story, which I did with tears in my eyes.

Understandably, I didn’t get much sleep that night, tossing and turning, keeping both myself and Sarah awake. Next morning, I had to be up early to catch a 6:50 am business flight to Las Vegas.  At the San Jose International Airport, I met Gene Lucas, the Engineering Manager at FloStor Engineering, the company I worked for.  He asked me what the results of the biopsy were; I gave him a précis of the evening before.  He empathized with my situation since he went through the “ Roto-Roota” procedure for an enlarged prostate a couple of years ago.

We were meeting with a customer to help design a manufacturing process for making cylinders to transport Compressed Natural Gas across the highways.  But the day dragged on in this windowless building on the edge of town, originally built to manufacture missile engines. In the evening, we had dinner with two of my consultant friends at one of the casinos, but my recent news kept me from enjoying myself.  The return flight was at 9.10 p.m. which meant I could get to bed by 11, and I was tired.  Upon  arriving  at the  airport, we  found out  that our  flight  had  been delayed until 10:30 p.m., and of course it arrived even later than that.  I eventually got to bed a little after 1 am.  With only probably four hours of sleep, I was up at 5 a.m. to get to the Decathlon Club for a 7 a.m. squash match with my long time friend Frank Greene.  After six hard games, we
sat down to catch our breath, and I told him about my resent diagnosis.  Frank is a very successful entrepreneur, having started and sold several High Tech. companies in Silicon Valley.  Through his association with the NAACP and other African American organizations, he knows all the movers and shakers in the African American community in the Bay Area.  I thought it might be a good idea to do some due diligence on the good doctor.  And I thought that Frank might be
able to help me.

“My urologist is an African American called Lionel Foster,” I told him.  “I have only met him four times, and twice he has stuck his finger up my bum, and now he wants to cut me open and put my life in his hands. Do you know anything about him?”  I asked.

Talking squash and prostates with Frank Greene 

“Foster, no I don’t think I have heard of him.”  I thought, this only goes to show that Lionel was not a mover or shaker in the local African American community.

“One of my skiing buddies is an oncologist, and we are going up to Lake Tahoe later this afternoon.  I’ll ask him if he knows Lionel Foster. I’ll phone you before we leave,” he said.  I thanked him and we both went of to get showered and dressed.

Four hours later, Frank phoned to tell me that he had talked to his oncologist friend.     
“In the Bay Area, Dr. Foster is known as Dr. Prostate. It seems it’s his organ of choice. He has written many articles and delivered many talks on the subject,” said Frank.  Then he said, he had asked his friend the ultimate question,  “If you had prostate cancer, who would you go to?”  “Foster, ” was his friends quick reply.  I thanked Frank for his help, and wished him and his
oncologist friend a good and safe skiing trip. I felt relieved that if surgery was to be the choice, then I was in good hands.

Over the course of the next several weeks, I gathered and read everything I could about prostate cancer: published articles, books, magazines, news papers and the Internet.  I also talked to several people by phone in different parts of the country that had various treatments for prostate cancer.

I found out that prostate cancer in the United States is the second most common cause of cancer death for men after lung cancer. Although no specific cause for it has yet been found, either in life style or the environment, a number of conclusions can be drawn. It is certainly age related, and most specialists agree that men should start digital rectal exams and P.S.A. test at 45 years of age and follow up on them every year after that.  Another fact is that the United States has one the highest incidence of prostate cancer in the world, and California has the highest incidence in the USA ,and Santa Clara County has the highest rate in the country.  And I happen to live in Santa Clara County ! 

It is also somewhat race related, with African Americans having the highest probability of risk followed by Whites, Hispanics and Asians. Since my urologist is an African American who works in Santa Clara County, he and I may end up having more in common than we think.  For his sake, I hope I’m wrong.

The conclusion I came to is that there is no right answer for everyone. There are a lot of variables such as age, the stage of the cancer is in at the time of testing, other general health conditions and the skill of the doctor.

I promised you that this would be a humorous account of my adventures, so I will not go into all the alternatives and the arguments (pro and con) for each form of treatment. Believe me, the alternatives and their consequences are not a happy topic. There are many publications that can detail the various alternatives available, and these should be read, and in consultation with ones wife and doctor, a course of treatment should be decided. Besides the decision on the method of treatment, was the question of cost. How much would the medical insurance pay for, and how much would we have to budget for out of pocket expenses?  Fortunately, our daughter Laura  works in the Human Resource Department of a local high tech. company in the Silicon Valley, and she is familiar with handling medical claims.  She volunteered to look through my medical coverage documents.  I am covered by both my company’s plan and my wife’s employer’s plan.  After about an hour, Laura came to the conclusion that my wife’s plan should take care of any of the deductible doctor and hospital expenses not covered by my own plan. The only thing I would have to pay for was the co-payment on any prescription drugs that were required.

On march 29th, Sarah and I had an appointment with Lionel Foster.  We went through the list of questions we had compiled, and he answered them all.  Lionel again explained the procedure and the risks, and he assured  me that he felt confident that he could not only save my life but also preserve my quality of life. With this assurance, we agreed on a radical prostatectomy.  I told him I had
only two requests.

“When I wake up from surgery, that the nurse places a picture from the current month centerfold of Penthouse in front of my eyes.  Secondly, I want my prostate.”

“What do you mean you want your prostate?”

“I can’t be any clearer than that. It’s my prostate that you are going to take out.  And I want it.”

“I don’t think you can have your prostate,” he said.
“Who does it belong to?” I said.
“Well, I guess technically you, but….”
“No buts about it, it’s mine and I want the son of a bitch encased in Acrylic and to use it as a paper weight, so that I can have the last laugh.”

“But nobody has asked for their prostate before.  We have to send it to the pathology lab to run tests on.  They will cut it up and put it on slides for microscopic examination.”
“OK, I want the slides then,” I said with vengeance.
“There’s always a first time for everything.”