Choices for healing… three couples confront prostate cancer - together

Tom and Ann Hiatt, Palos Verdes, Calif.

In August 2000, Tom Hiatt, now 68, and his wife, Ann, traveled to Africa. When they got home, the retired attorney found a postcard from his doctor requesting that he make a follow-up appointment. Tom and Ann exercise daily, eat well, are rarely sick, and have no history of disease. Besides, Tom was quite busy. Shortly after their trip, the Hiatts began tearing down and rebuilding their house. As a result of all this, Tom lost track of the postcard and did not see the doctor.

When Tom rediscovered the card in April 2001, he called his doctor to see whether a visit was still necessary. The answer was a resounding yes. The card had been sent alert Tom that, in August, his PSA had been slightly elevated. On retesting in April, it was a whopping 31. The number didn’t frighten Tom—until the found out that a normal PSA level is 4 or less. He quickly made an appointment with a urologist, who repeated the PSA. This time it was 60. A biopsy proved positive, and an MRI found that Tom not only had prostate cancer but that had spread to his spine and hip.

The doctor told Tom his cancer was inoperable and that even radiation was no longer an option. He said he’d put Tom on androgen deprivation therapy (ADT), which uses drugs to halt the production of male hormones that fuel prostate cancer. Still, he offered little hope “I was told to get my house in order, that I had 18 months to two years to live.”

After hearing the news, Ann went into the ladies’ room and threw up. “I don’t know how we drove home,” she says. “Tom told me he wasn’t going to fight. I was furious. I told him, ‘You are going to fight. You’re not going to leave me to deal with the house alone.’ We went to a bookstore and bought every book on prostate cancer we could find.”

The Hiatts decided to take control. They switched to a diet rich in raw foods and low in fat and red meat. They also learned that some oncologists specialize in prostate cancer—and decided to seek another opinion.

They saw a specialist in New York who prescribed intermittent ADT, which would allow Tom to go off the medication when his PSA levels got down to normal and resume taking it only when his PSA levels rose. This strategy gives patients some relief from ADT side effects, which can be severe. Tom was on ADT for 13 months, off for 14, then on again.

While on therapy, Tom has had to deal with several side effects. His skin thins, he bruises more easily, and he has to work out regularly to help prevent the loss of muscle tissue. He is also moodier. “I tend to be more defensive and argumentative,” he admits. “Ann has been wonderful, but I know I stress her. I try to watch my tongue.”

At one point, Ann’s blood pressure spiked and she was put on medication she couldn’t tolerate. It turned out that her blood pressure was fine, but she was having panic attacks. At the time, Tom was too worried about his own health to give Ann the attention she needed. “The sexual part is also very difficult,” she admits, “I think Tom and I argue more because of the total lack of intimacy. But I meditate and do yoga when I can—and a lot of deep breathing.”

When Tom asked an oncologist for help administering his ADT in California, he was offered yet another option: chemotherapy. The thought of undergoing chemo scared Tom, but he said yes anyway. Doctors put him on a regimen that included three medications. He received the drugs daily for six weeks, took two weeks off, and resumed treatment for six more weeks. Tom’s PSA plummeted to 0.05.

After a while, though, his PSA level started to creep back up, and Tom had to go back on ADT. The drugs he’d used initially stopped working, and he is now on a new drug regimen that, so far, is keeping his PSA levels low.

Even during chemotherapy, Ann made Tom walk their usual three to five miles a day. They also work out at the gym, and baby-sit their grandchildren, ages 5 and 2. Tom has joined the board of the national prostate support organization called “Us Too.”
“We also have a big social life,” says Ann. “I have my kids and my garden and a great companion. I don’t think the cancer will get him; Tom is going to outlive me!

Hilary and David Borthwick, Doylestown, Pa.

David Borthwick, 73, was shocked in March 2007 to learn that he had prostate cancer. David, who is chairman of a group of private machinery companies, had visited a urologist as a precaution after two of his friends were diagnosed.

The urologist did a digital rectal exam and a blood test to screen for prostate specific antigen (PSA), a protein produced in the prostate. High levels can indicate the presence of cancer; normal PSA levels are 0 to 4. David’s was 7. When his doctor asked David to come to the office to discuss the test results, he knew he wanted Hilary to come along. Hilary, 67, is a registered nurse, though she hasn’t worked as one since the couple moved here from their native Scotland in 1986. “My father died of prostate cancer,” she says, “and I couldn’t imagine life without David.”

Hilary and David were numb for about a week after getting the diagnosis. “Then one morning I woke up and looked at David and said, ‘We can’t get depressed over this. We’ll fight,’?” says Hilary. “From that moment on, we were looking at the brighter side, and that made all the difference.”

David’s urologist recommended surgery to remove the prostate, but the couple wanted a second opinion. They made an appointment with a highly respected surgeon at the Hospital of the University of Pennsylvania. Although the surgeon, like David’s urologist, suggested a prostatectomy, he sent the couple to a radiologist and to another surgeon to discuss robotic surgery.

David and Hilary listened to all the doctors’ opinions, read books, did research on the Internet, and spoke with other prostate cancer patients. In the end, they decided their best option was a specialized radiation treatment available at Penn. The treatment utilized high-tech equipment that carefully tracks the movement of internal organs, enabling doctors to target radiation more precisely while minimizing damage to healthy tissue.

In July doctors implanted three tiny pieces of metal grains into David’s prostate gland. During radiation, infrared cameras tracked electromagnetic signals reflected by the metal grains, giving technicians clear pictures of the prostate’s location. Beginning in August, David and Hilary drove to Philadelphia for treatment five days a week for nine weeks. Though the treatment lasted only minutes, the commute took three hours round-trip.

Luckily, David experienced very few side effects from treatment. He was able to continue working and playing golf. The last time his doctor checked, David’s PSA was a comfortably low 1.4.
David credits his excellent outcome to three things: great treatment, a positive attitude, and his wife’s support. “Together we looked on it as a battle,” he says. “Rather than ask ‘Why me?’ we went on the attack.”

Marvin and Celia Dozier, Brooklyn, N.Y.

Marvin Dozier, 64, has been a systems analyst for the city of New York for 27 years. He’s also a part-time minister for an interdenominational Christian church. His father died of prostate cancer. As an African-American with a family history of the disease, he was considered to be at high risk and saw his doctor twice a year for tests. In August 2007, Marvin learned that his PSA, which had been 3.5 in January, had risen to 5.3.

He immediately saw an oncologist who performed a biopsy and confirmed that Marvin had cancer. “The doctor said it wasn’t something I needed to deal with right away,” Marvin recalls. “I thought, If it’s cancer, why wait? But he told me to look at my treatment choices.”

Marvin’s wife, Celia, was at her husband’s side when he got the news. “She insisted on being there with me,” says Marvin. “She said we were in this together.”

Marvin and Celia first considered radiation. But doctors told Marvin that if he chose radiation now, it might be impossible to perform surgery if he needed more treatment in the future because radiation changes prostate tissue. If Marvin had surgery immediately, however, radiation or chemotherapy could still be used if his cancer recurred down the road.

Since surgery seemed the best option, Marvin and Celia had to decide between traditional “open” surgery, in which the prostate is removed through a large abdominal incision, and “robotic prostatectomy,” in which a doctor manipulates robotic arms connected to tiny instruments that remove the prostate through small incisions.

Marvin saw a top robotic surgeon in Manhattan, and the two hit it off immediately. “He told me regular surgery was the equivalent of a jeweler trying to appraise a diamond without an eyepiece. With robotics, the doctor has the eyepiece, which makes the surgery more precise.”

Marvin’s surgery took place on Nov. 16. Within hours he was up and walking around. It can take patients a year to regain bladder control and sexual function after prostatectomy, but Marvin hates to wait, so Celia reminds him to be patient. Initially, he says, he had no bladder control; luckily medication helped dramatically. Marvin still struggles with erectile dysfunction, but he has quit smoking and is trying to be patient with himself.

The side effects of surgery have affected Celia, too, though coping has not been as difficult as she feared. “I understand that healing is a process, and if he comes back to the way he was, it’s okay. And if he doesn’t, that’s okay, too. A lot of it is really just accepting the terms life gives you.”