Looking forward to life after prostate cancer treatment

After being treated for prostate cancer recently, I did a review of my writings on the subject through the years. Pretty consistent stuff: Get screened regularly, fellows, as I was doing, and stop being so chicken-hearted about those digital exams.

I still believe that's the right message, but I cringe at the tone, at my calling men ignorant and fearful for not doing the right thing. I'd like to correct that now.

When doctors said I had prostate cancer, I got weak in the knees. When they began diagramming the surgical procedure, I wanted to jump out the window. I wasn't even consoled by the good news: that the problem had been detected early enough to be cured with a relatively simple procedure.

The cancer had been detected so early that I probably wouldn't show symptoms for another 15 years, when I was 73. I figured I'd suffer through surgery or radiation and probably end up dying of something else -- when I was 72 and a half.

Then doctors started using the "I" words to describe possible side effects of treatment: incontinence and impotence. Those are among the most awful things a man could experience, I cried. Doctors tried to assure me that those problems were not nearly as serious as they were before the development of new surgical techniques, including robotics, and advances in radiology.

But if I wanted to play the false choice game, my doctor would oblige: Would I rather live without sex or die? he asked. I wrangled with the question for days, until friends began calling me a dummy for having to think about it at all.

A column I wrote in 1998 raised questions about why black men died of prostate cancer at rates so much higher than white men. "I'm no doctor," I wrote, "but perhaps the key to answering some of those questions lies in the answer to this one: Are black men somehow losing the will to live?"

Turns out, the dummy had the answer all along.

So, you can see why there'll be no more taunting from me.

I took news of my diagnosis so poorly that, in the end, my own thoughts had hurt more than the treatment. Fear of negative outcomes had me feeling like the worst had already happened. Oh, woe, is me; I'll never make it to the restroom in time again. And goodbye to all that loving. (As if the ID card in my wallet read "Casanova" instead of "AARP.")

A word of caution about information overload: There is so much conjecture and myth mixed in with facts about prostate cancer that separating wheat from chaff was nearly impossible. Rely on the Internet at your own risk. I recommend a book, "Guide to Surviving Prostate Cancer," by Patrick Walsh, a physician at Johns Hopkins University's Brady Urological Institute. Also, talk to a urological oncologist.

I did come across two studies that gave me pause, both published last year in the Journal of the National Cancer Institute.

One said that for every man whose life was saved by prostate cancer treatment, at least 20 received treatment that was unnecessary.

Their cancers were found to have been growing so slowly that the men probably would have died of something else if they hadn't known they had the disease. My worries, so it seemed, had not been completely unfounded.

Based on that study, my odds of surviving prostate cancer without treatment were 20 to 1. That raised the Dirty Harry question: Did I feel lucky?

The other study said that black men, perhaps for genetic reasons, were 21 percent more likely to die of advanced prostate cancer than white men, even when they received equal treatment.

Question answered.

I went to Washington Hospital Center and received outstanding medical care from a team that included Robert Dibble, my primary physician; Mohan Verghese, chairman of the urology department; Jonathan Hwang, director of robotics; and Bernadette Denis, a registered nurse who is expert in calming fears.

Good friends counted just as much. There's nothing like being able to talk with the fellows about "sensitive" health issues as easily as we do sports.

When I mentioned to a friend that I was writing about my experience, he said, "That's courageous." Not really. Men trying to cope with the pain of advanced prostate cancer and the family members who suffer with them, they are courageous.

Getting tested and treated in time is a walk in the park by comparison.

E-mail: milloyc@washpost.com