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IW - January 10, 2005
June 2003
PSA rises to 4.2. My prior yearly PSA readings were in range
of 2.7-2.9. Primary care Physician recommends visit to Urologist.
August 2003
At Urologist.
PSA is 3.9. Come back in 3 months.
November 2003
PSA is 5.1. Urologist advised to come back for biopsy.
December 2003
Biopsy was performed.
January 2004
Urologist’s associate informs me of the pathology report,
which shows 6.0 Gleason, 3+3. He describes the choice available.
Suggests I come back in several weeks for hormone shots and
later, will place radioactive seeds in Prostate.
A friend of mine had Prostate Cancer treatment
two years earlier, so I called him for information. He recommended
that I go to a Prostate Cancer Support Group to learn about
other people’s experience. Three days later I attend
a Prostate Support Group meeting, which was attended by about
10 members plus me. Their experience goes back ten years.
Each describes his procedure, side effects and symptoms. I
left the meeting in an overwhelmed state by the amount of
information, but because of the revelation that one of the
members had a relatively new Cryo-surgery treatment in 1996
and the side effects of this procedure were minimal. I now
had a feeling of euphoria. I received the phone numbers of
some of the members with an invitation to call them if I had
any questions.
For the next three weeks I spent 12 hours each
day researching on the telephone and the Internet. I called
the two companies (in the world) that manufacture the Cryo
equipment. I collected and catalogued hundreds of articles
and papers from journals and reports. I spoke to a representative
of one of the Cryo treatment machines in their Syracuse, NY
office. He had prostate cryo-surgery three years earlier at
a Philadelphia Hospital and was released the same day but
he decided to spend the night at a hotel and drive back to
Syracuse the next day. His description of the procedure gave
me a comfortable feeling about the procedure.
As an engineer experienced in low temperature
physics (Cryo) I was convinced this process was the safest,
most controllable and efficacious way of destroying cancerous
tissue. I learned that the various nerves and venous ducts
adhereing to the prostate capsule were easily damaged and
that the surgery required extreme care and precision to avoid
damage. I decided to concentrate on finding the best surgeon
I could, to perform this procedure on me.
I spoke to representatives of the two Cryo
equipment manufacturers and inquired which doctors, and at
which hospitals they performed this procedure. I selected
two doctors and made appointments with each. I asked many
questions, including how many cryosurgery procedures they
had performed. This and the fact that one doctor also did
what is called Focused Cryosurgery helped me decide which
doctor I would use treat me. The Focused Cryosurgery procedure
only ablates the portion of the prostate, which has the cancer.
I chose this one since the side effects would be further minimized.
The doctor, Aaron Katz, told me that the actual
procedure took about 1 hour. It is performed with the patient
under local (spinal) anesthesia.
April 2004
The procedure was performed by Dr. Katz at Columbia Presbyterian
Hospital in NYC. After the procedure, I was numb from my waist
to my knees, for about an hour after the surgery. The numbness
gradually wore off at which point the Recovery Room Doctor
felt it would be safe for me for me to control my motion.
I was surprised to find that I had to remain in recovery for
4 hours before I was allowed to stand and walk away from my
bed under my own power and control. I had a supra pubic catheter
that conducted the urine from my bladder to a bag which was
strapped to my thigh. I was transported by wheel chair to
another department where I was given instructions on how and
when to empty the bag. I was given prescriptions for Flowmax
and a painkiller. At no time during the procedure or afterward
did I have any pain. Three hours later I was home.
The first night I had to empty the urine bag
2 times. On the second day Dr.Katz’s nurse called to
find out how I was doing. I asked her when I could stop using
the catheter. She told me to wait 2 more days and then I could
close the valve on the catheter to determine if my normal
urine control and plumbing functioned properly. I urinated
twice within the first 4 hours and was able to control the
flow normally. The amount of flow was only slightly less than
normal. I then kept the valve closed and was able to disconnect
and remove the urine bag. I called the nurse the next day
and she arranged an appointment for me to return to the hospital
where Dr. Katz removed the catheter. I wore a pad for only
2 nights and had a slight amount of urine leakage one of those
nights. During the first week I was feeling uncomfortable
one morning, so I took one pain killer pill. That was the
only one I took during and the entire postoperative period.
I was waking up four or five times each night to urinate during
the first two weeks.
During the day I would frequently have the urge
to urinate or defecate but I could not discern which it was.
By the third week I could distinguish my needs and I was pretty
close to normal with respect to urination and bowel movement.
I returned to Dr. Katz’s office for my
First Month follow-up examination. He told me I was doing
very well. I knew that myself because I was feeling anxious
to get back to my exercise and swimming.
The following were my PSA readings at the first
three quarterly examinations.
(May 2004 PSA 1.5)
(August 2004 PSA 1.3)
(December 2004 PSA 1.4)
My next checkup visit is 6 months away, in
June 2005.
Once in while, perhaps 3 to 4 weeks I feel
an urgent need to urinate. This is when I drink a lot of liquid
or when I am away from home for an extended period of time.
I am very satisfied with the outcome of my
Cryosurgery.
Yi Perry Huang December 31, 2004
As a prostate cancer survivor, I am happy to
report the cryotherapy I have gone through, a treatment which
has probably saved my life.
I am 87 years old. Until two years ago, I was
a very active and healthy man. Mindful of the importance of
regular annual physical check-ups, my family doctor routinely
checked my prostate by digital rectal examination.
In 2003, another doctor examined me for an unrelated
medical condition, and ordered blood tests which, for the
first time in my life, included a test for PSA. The number
was an astonishingly high 30. My family doctor, informed of
the test result, immediately recommended me to see Dr. Aaron
Katz, Urologist at Columbia Presbyterian Hospital Center in
New York. Dr. Katz, after the digital check, said that I had
prostate cancer.
During the four months which followed, a series
of tests were performed. These tests included a biopsy, bone
scan and CAT scan for my abdomen and pelvis. At the same time,
monthly hormone injections (Zoladex) were quickly initiated.
Despite the fact that the biopsy test showed the prostate
cancer had reached Gleason scale 9 and 10, I felt very fortunate
that the bone scan and CT scan of my internal organs showed
no spread of cancer cells. The monthly hormone treatment apparently
worked very well for me, because the PSA marker dropped dramatically
from an earlier 36 to 2.3. Dr. Katz then decided that I could
go ahead with the cryosurgery. The operation was immediately
arranged.
Dr. Katz had assured me that the cryosurgery
is virtually painless; the actual operation took approximately
two hours. The operation was carried out while I was under
partial anesthesia. After the operation was completed, Dr.
Katz came to me and said, "I have killed the cancer." When
I heard that, I felt very relieved, and was extremely grateful
to him. I was released from the hospital after 24 hours. I
felt no pain, and was able to walk out of the hospital without
any need of personal help.
At the time of my release from the hospital,
I was given a copy of the post-cryosurgery instruction sheet,
which listed certain undesirable but normal physical conditions
that might happen in the days or weeks to follow. This included:
(1) testicular swelling and bruising, (2) blood in the urine,
(3) frequent urination and urgency to urinate, and (4) constipation.
In my case, only the first three conditions occurred. Although
during that period of time I did have moments of anxiety and
discomfort, all of them did gradually stop, as predicted.
Ten days after the operation, Dr. Katz examined
me and found my recovery was as good as he had expected. He
removed the supra-pubic catheter from my bladder, thus allowing
urination through my regular channel. As a follow-up to the
cryosurgery, Dr. Katz checked my health condition at regular
intervals, including PSA blood tests. The first PSA reading
one month after the operation was 0.2. Three months later,
the second PSA reading became 3.2. Dr. Katz decided that I
should resume hormone treatment, applying Zoladex every three
months. The next two 3-month PSA readings were 0.9 and 1.2.
Again, the hormone treatment seemed to work for me, although
not as definitively as I had hoped.
A month later, because I began to feel a dull
pain in my back, Dr. Katz ordered another bone scan test as
a precautionary measure. The new test showed no significant
change since the bone scan of a year before. He thought that
the pain might be from arthritis.
The latest PSA tested a month ago numbered 1.4,
which indicated a slight rise from the previous ones. Although
in recognizing that my prostate cancer was a very aggressive
one, I am confident that, with Dr. Katz’s expertise and his
care and kindness towards his patients, I am in the best hands
that I could ever hope for.
Primary Prostate Cancer Patient
I would like to recommend to anyone that has
prostate cancer, to receive the procedure called Cryocare.
Dr. Katz performed my operation, which took only one hour
and forty five minutes. I chose to stay overnight, although
I could have gone home the same day.
I am eighty four years old, and had a quadruple bypass three
years ago, and I feel as if I was fifty. My PSA was 7.5 before
the procedure and after the following blood test it went down
to zero. I would like to thank Dr. Katz and his staff for
the special care I received during my stay.
Primary Prostate Cancer Patient
I was first diagnosed with prostate cancer in
1993 at age 59 with a PSA of 5.5, a Gleason score of 5, and
the tumor confined to the prostate. I decided on radiation
treatment. This was successful; my PSA dropped to 0.3 and
remained there with minor variations until 1999. At this point,
it began a slow oscillating rise to 1.44 in June 2003. The
next four readings showed a steady, sharp rise to 3.06 in
September 2004, with a doubling time of 14 months.
I am a scientist and take a very thorough, objective approach
to researching my options in making important life decisions.
But I was certainly very troubled by my situation! I collected
all the data I could find and made a rough prediction of life
expectancy of 8 years if I did nothing, with the last half
of this time in deteriorating health and poor quality of life.
At 71, all other aspects of my health were excellent. I have
my own high tech training and consulting business, work full
time, and lead a satisfying, intellectually and culturally
rich life, which my wife and I saw seriously threatened. It
was evident that I had to do something.
Further radiation was ruled out. I ruled out a salvage radical
prostatectomy because of the high likelihood of incontinence,
a serious factor for my business and happiness. The only option
seemed to be hormone therapy.
My investigations of hormone therapy included a lot of reading
and talking to 15 to 20 people who were experiencing it. This
brought out some very unpleasant side effects: almost universal
hot flashes, bone density loss, weight gain, fatigue and loss
of motivation to exercise and keep in shape for your health,
and loss of mental sharpness and energy. The latter is very
important to me. One man I talked to stopped taking the newspaper
because he lost the concentration needed to read it. Also,
the hormone blockade eventually loses effectiveness - current
statistics indicate that the average prolongation of life
is 3 years. I do recognize from anecdotal evidence and current
trends that this may be low but I haven't seen solid evidence
that it is greater.
At this point, I heard of cryosurgery. I performed an extensive
search of the Internet. I was looking for credible information
so I focused on the National Library of Medicine and papers
in peer-reviewed journals such as the Journal of Urology.
Since I am a scientist with strong statistical background
and experience reviewing hundreds of papers for journals and
conferences, I think I was able to make good judgments about
what I read, even though my background in prostate cancer
was restricted to that of an intelligent patient who has read
a fair amount in the field.
One of my initial findings was that cryosurgery was greatly
refined around the year 2000, so that only recent data gives
a true picture of effectiveness and side effects. Thus, it
is difficult to determine long-term effectiveness. But it
was reviewed by Medicare and approved as an effective treatment
around 2001, so I thought it must have something going for
it. Another finding was that the skill and experience of the
surgeon have a strong effect on the results.
I realized that I would have to take a risk on long-term effectiveness
– good long-term data is simply not available. However, when
I found that the operation could be repeated if cancer returns
locally, I decided that taking the risk was very prudent;
cryosurgery would be far superior for me than hormone therapy.
I talked to one man who dropped hormone blockade about two
years ago because of the side effects and opted for cryosurgery
- he is very happy with his choice. That clinched it!
Since results are so dependent on the skill and experience
of the surgeon, whom should I approach for the surgery? By
researching who were writing papers on cryosurgery and looking
at their results, I found that there were several good surgeons
in the United States and Canada. In comparing them, I was
particularly impressed by the work of Dr. Aaron Katz of Columbia
University and New York Presbyterian Medical Center. Urology
Times (Sept. 1, 2004) quoted his results for radiation therapy
salvage operations (my situation), which are often considered
more difficult than "virgin" operations, as follows: 95.6%
cancer-progression-free at a mean follow-up of 44 months and
6.3% urinary incontinence. He appeared to be one of and probably
the world leader and innovator in cryosurgery. My impression
was that he has trained most of the other cryosurgeons.
I decided to go talk with him, bringing my wife. I learned
that as of the end of 2004, he has done about 400 operations
and he currently averages 4 per week. His latest data on urinary
incontinence indicated a rate of less than 3%. As a former
manager, I “have a nose” for competence, and his knowledge
and painstaking skill came through very clearly. I found him
very responsive to questions. My wife, a psychologist and
an excellent judge of people, was also impressed. Naturally,
I decided on the best.
There was one requirement for cryosurgery to be effective
– the prostate cancer must still be localized. I sweated out
the results of bone and CT scans for several weeks – they
both were negative. But this wasn’t enough. It was also necessary
to have a positive biopsy to be reasonably sure that the cancer
was still localized and that this was the cause of the rising
PSA. The results came back just before the Christmas holidays
- the biopsy was positive with Gleason scores of 6 and 7 (interpretation
by two different pathologists). My wife and I celebrated,
although I don’t think most people would view positive evidence
of cancer as the nicest thing that could happen to them!
I had the operation with Dr. Katz in early January 2005 –
in and out day surgery. I never felt any pain. The worst thing
was the discomfort of the catheter for five days afterwards.
Although from a medical viewpoint I could have immediately
resumed all but strenuous activities (such as heavy snow shoveling),
I did not feel like moving a lot until the catheter came out.
I memorialized the day it was out with a half-mile walk (I
could easily have done my usual two miles!) and by going out
to dinner with my wife. My scrotum was black and blue, but
there was no tenderness or swelling. There was frequent urge
to urinate and some tenderness and burning during urination
- mostly disappearing about 10 days following the operation.
There was no incontinence and no other problems! As I write
the initial version of this account at 10 days, I feel totally
normal and am doing everything but heavy snow shoveling.
The ultimate test will of course be my PSA’s over the next
few years. I eagerly await the first postop PSA, scheduled
for early March 2005.
Why am I writing this when I don’t have a complete story?
Because my experience so far has greatly surpassed my hopes.
I did not want to delay making this experience available to
others whom it might help, even if not complete. I plan to
update it later in case you want to follow the history.
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