Prostate Cancer: One size . . .

In this post and this post, I detailed the strength and resilience that my dad possessed in his early life and in his later life. This particular story, is not only one of strength and resilience, but of concurrent quiet contentment and acceptance.

It was at my mom's funeral that dad first experienced uncontrolled atrial fibrillation at 112 beat/minute.  He didn't look good and he didn't feel well.  What could anyone expect of him after having lost his life partner of 41 years?  after having given her 24 hour care by himself for 3 1/2 years up until 2 weeks before she died?  His heart was frazzled.  

I wanted to take him to the hospital.  "I'll be okay", he said, as he proceeded to down 2 shots of plum brandy.  With a weak smile he finished his sentence, "This will help".  No amount of cajoling on my behalf would see he, my siblings and I depart for K-W hospital.

Months later, when an EKG revealed a heart rhythm of controlled atrial fibrillation, dad's MD placed him on Warfarin for stroke prevention.  Dad wasn't keen on taking the medication since he knew it was rat poison, but I encouraged him to take it because he was more keen on not having a stroke.  The thought of possible loss of independence from a stroke, as it is with most people, was a frightening prospect for him.  He tolerated the Warfarin very poorly, and at even the lowest of low dosages, he would have spontaneous nosebleeds and bleed profusely from minor cuts.  He tossed the Warfarin into the garbage bin.

I put him on aspirin, Nattokinase, omega-3 fish oil, and high doses of Allicin (found in garlic).  His CHADS2 score was only 1, and because he was receiving some form of anti-thrombotic therapy with the ASA and botanical medicines he was taking, I felt slightly better about stroke prevention in a person with non-valvular atrial fibrillation on no Warfarin.  This was in the days before Plavix, but studies now show that for cases like my dad, using aspirin is not much different than using Plavix and aspirin together for stroke prevention.

He didn't die of a stroke.  Another disease was waiting for him.

Dad didn't like going to doctors much.  This is not an unusual sentiment since more than a few people have this same aversion.  The reasons for this aversion are wide and varied.  Some people are afraid of the diagnosis they may receive, while others just don't like their physician and can't be bothered to find another one.  Some are averse to invasive procedures, while others feel a sense of indestructibility and see no need to make an appointment with their MD.

None of these reasons explained my dad's reluctance.  He liked and respected his doctor, he wasn't afraid of disease, and he fully accepted that his eventual death would come when it would come - no sooner and no later.  He just didn't see the need for people fussing over him, and he lived by the adage that so many people do:  "if it ain't broke don't fix it".

In 2005, he was tired of my pleading with him to see his MD for blood work and a physical exam, so he up and did it one day.  His blood work was all normal except for his PSA count, which was 6 ng/ml at that time.  Dad's MD took a wait and watch approach (as though my dad would allow him to do anything else!).  His PSA dropped to 5.5 ng/ml when the test was repeated 6 months later.

After that, dad had no interest in getting any more blood tests.  I cajoled again.  He stood his ground.  In the light of recent studies, I probably could have backed off of the cajoling, and I'm sure he would have appreciated that.  But back then I was unaware of that recent study or this one.  The years passed and I saw that dad had no more interest in seeing his physician, so I asked him if I could take some blood from him to test.  He didn't seem to mind that plan.

Again, all of his blood work was normal except for a rising PSA, which was now 8 ng/ml.  I sat down with dad and I said, "Dad, I think you likely have prostate cancer, but we can't know for sure unless you have a rectal exam and possible biopsy.  Would you be willing to see your doctor so he can arrange to further exam you and have this type of testing done?"

"No."  It was the most firm, sure and gentle 'no' I had ever heard from him.

"What if it's cancer?" I asked him.

"So?"

Dad was very clear.  He was uninterested in discussing potential treatment of a likely diagnosis of prostate cancer with me or with anyone else.  He did not wish to hasten his life and he did not wish to prolong his life;  and he definitely did not wish to prolong his life if there was going to be a potential for uncomfortable side effects with treatment.

He was content.  Not fearful.  Not pushing or pulling.  Just accepting.

I was not as accepting as he was of his decision to not continue with further diagnostic testing, but I respected him enough to say to him, "If that's what you want dad".

I consoled myself by trying to convince myself that dad would probably hate androgen suppression therapy, never in a thousand years agree to a radical prostatectomy, and never in a million years agree to brachytherapy.  That didn't seem to work though.  Then I consoled myself by telling myself that prostate cancer was a slow growing cancer, and most older men have prostate cancer whether they know it or not, as seen in autopsies in 80% of men aged 70 and older.  Dad would likely die of something other than prostate cancer I reasoned.

I was wrong.

He was 84 years old, and five years had passed since his first elevated PSA test.  In June of 2010, during one of our weekly long distance cross country phone calls, he told me that his back was hurting and that he was limping a bit.  He said he probably lifted some heavy jugs of chlorine and pulled some back muscles.

That was the first time I had a vague sense that this was the beginning of the end.  You see, my dad essentially never complained about anything, least of all, matters pertaining to his own well-being.  Whenever he would call me to tell me about any symptoms he was experiencing, I knew it was serious.  He always made it seem like it was no big deal, but even a mild mention of any symptom meant that dad was suffering some serious ailment;  a gangrenous gallbladder, a dislocated shoulder, an abnormal heart rhythm.

"Dad, please go and see your doctor and get an X-ray and a CT scan".

"I'm okay", he said.  "Don't worry about me".

"I'm not worried dad, I just think it's best to know what we are dealing with".

He then changed the topic of the conversation and I continued to push.  He became a bit annoyed with me and tried again to reassure me that he was okay.

I knew that his body wasn't okay.  At least this time it would not be like the shocking experience that unfolded from my mom's diagnosis.

Metastatic bone cancer from advanced prostate cancer.  I smelled it 3000 km away.  My brain tried to desperately grasp on to other possible causes for his pain:  osteoarthritis, severe osteoporosis, spondylolisthesis, muscle strain, ANYTHING else.

When dad's pain was finally too unbearable, he agreed to have an X-ray, bone scan, CT scan and blood work.  A month before he was tested, he told me about a dream he had had.  In the dream was his mother who had passed away in 1981, his father who had passed away in 1990, and my mom who died in 1999.  In the dream, mom was telling him, "Danny, hurry up, what's taking you so long?"  In the same dream, he was trying out his coffin and said that it felt very comfortable.  He dreamt that he was at his own funeral, drinking a few shots of alcohol, and was pleased with himself that he didn't have to foot the bill because it was already taken care of.

Dad started to laugh as he told me his dream.  At that time, I didn't find it too amusing.  He was 84, ready to go, and I was selfish and not quite ready to see him leave.

"You're the best dad I could have ever asked for".  I didn't have to wait for the test results to come back to know that the writing was on the wall.  I had spoken those words many times before, but this was the first time I had said them with a mix of profound gratitude and excruciating sadness.

"Don't be sad.  I don't want anybody crying because of me", he replied.  At least being on the phone at that time, it was easier to hide the tears.

The tests came back.  Extensive mets to the spine, a large mass anterior to the spine, mets to the lungs, and a PSA of 13.  Even to this day, we can't say for sure that dad had prostate cancer because a biopsy was never done, but with all of the data that was available to the medical staff, that was the most likely diagnosis that was given.

For those who prefer treatment over no treatment, early detection and treatment of prostate cancer offers the best chance of recovery from this disease.  A new study suggesting that Vitamin E increases the risk of prostate cancer, needs to be examined more carefully.  The form of vitamin E that was used in this study was an alpha-tocopherol.  Naturopathic physicians have known for a long time that this form has the potential for causing problems when not properly balanced with beta, gamma and delta tocopherols, as seen in a mixed tocopherol preparation of Vitamin E.

I very rarely use Vitamin E in clinical practice, even in the mixed tocopherol form, so I can rest more easily knowing that I didn't hasten my dear dad's demise.

Prostate cancer.  One size does not fit all.  Not in desire for treatment, and not in response to therapy for those who choose it.  Each man will find his own way.