It’s the dream for getting older:  stay healthy, don’t get decrepit, keep all your marbles, and have a good life.  The four horsemen of the anti-apocalypse.  Nobody can guarantee this, and if anyone does, don’t trust that person any farther than you can chuck him or her!  However:  You can give it your best shot, and it’s not that hard!  With some simple changes, you can achieve big results! 

Here to help with some good advice is Elizabeth Platz, Sc.D., M.P.H., an epidemiologist at Johns Hopkins, who does a lot of research on factors that raise and lower your risk of cancer and other health problems.  I interviewed her recently for the Prostate Cancer Foundation’s website.  These tips aren’t prostate cancer-specific, and they will help you to get and stay healthier – so you won’t just be another year older, but another year better! 

Are you ready to start fresh?  Now is the perfect time:  it’s the Chinese year of the Rat – the first in the 12-year rotation of zodiac signs, which means that this is a year of renewal.  Let’s see what we can do to feel better and look forward to a healthier, happier, more active life!  First…

Don’t bother looking for a quick fix.  There isn’t a magic pill or miracle supplement or treatment, no matter what they may say on TV and the internet.  Getting healthier can’t be achieved by anything hawked in an infomercial.  “For healthy living, for good well-being, for avoiding premature mortality,” says Platz, “the right things to do are the things you have to work at,” like eating right and getting exercise.  But take heart:  you can make big changes by doing lots of small things, if you do them steadily.  You can also live it up sometimes – eat that slab of birthday cake, or have pizza night – if, in general, you practice moderation most of the time.

Be active.  Good news!  This doesn’t mean that you must haunt the gym! One of the best things you can do for your health, says Platz, is easy:  avoid sitting all day.  “In the modern world, people tend to sit.”  We sit in the car.  We sit when we’re on our phones.  We sit at the computer.  “We have protracted periods of time where we’re just stationery.  Build intentional activity into your day.”  Get off the old tuchus!

This doesn’t mean you have to spend hours on the treadmill or elliptical; remember, we’re talking about small changes here:  Don’t park right next to the building; park farther out and walk a little longer.  Take the stairs instead of an elevator to go up one floor.  Set a timer and walk around your house.  Take the dog for an extra walk.  Just move around.

Focus on the “big three macros,” proteins, carbohydrates, and fats.  “Macromolecules” is a trendy word, but it describes something very basic: “these major, fundamental components of our diets,” says Platz.

            Protein:  “As we get older, we need more protein to help keep from losing muscle mass.”  How much?  This varies a lot; one study recommends 1.2 to 1.5 grams per kilogram of body weight; this could mean 123 grams for a 180-pound man; the minimum amount recommended by the U.S. government for the average 160-pound man is 56 grams.  Bottom line:  You need more protein than you think, and more than you’re probably getting.  Make a point of eating protein with every meal.  Instead of just having a piece of toast or some cereal for breakfast, for example, add some Greek yogurt (which is higher in protein) or an egg.   Protein doesn’t just come from meat; it’s in fish, beans, dairy products, eggs, and soy products, too.  It’s also in meal replacement drinks like Ensure and Boost, and in protein bars.

            Carbs: Again, moderation:  “Don’t overdo simple carbohydrates,” the kinds of sugars found in sweets, white bread, and even plain old potatoes:  yes, the humble potato, minding its own business and serving as a dietary staple to millions, now finds itself on the nutritional naughty list of “simple carbohydrates,” because it takes less energy to digest a spud than, say, a sweet potato, which is a more complex carb.  “Whole grains can be delicious,” notes Platz.  “They’re more than just what’s in whole-wheat bread” (which, admittedly, can taste like cardboard).  “Many grains can be mixed into your diet without a lot of effort.”  On the pasta aisle in the grocery store, check out faro – a nutty-tasting grain.  There’s also quinoa, barley, and bulgur, to name a few.

            Fats:  “Good fats are good for you.  Try cooking with olive oil instead of butter,” suggests Platz – who is quick to add:  “You don’t have to remove butter from your diet; olive oil just tastes good.”  And watch out for calorie-rich dressings, sauces, and gravy.  Again, this doesn’t mean don’t eat them; “just make sure it’s the right serving size – which is often more like a tablespoon, rather than a quarter-cup.”

Indeed, watch your portions.  One basic strategy to make sure you’re not getting more than you need:  use a measuring cup.  “Even when you’re eating something that’s healthier, make sure you’re not overdoing it from a calorie perspective.”  Those pesky calories add up, and this is how you gain weight: consuming more calories than you burn.

Weigh yourself.  As we get older, sadly, the weight we gain “tends to be fat,” says Platz, “at the same time as we are losing muscle mass.  Loss of muscle mass is particularly worrisome, and is linked to premature death.  It’s not just how much you weigh, but the proportion of lean mass – muscle and bone.”  What’s a good way to maintain and build muscle mass?  “Weight-bearing or resistance exercise.  Lifting weights.”

Weight-bearing exercise.  Again, this isn’t as hard as you may think.  Nobody’s suggesting that you need to bench press the weight of a Saint Bernard, or dead lift the equivalent of Dwayne “The Rock” Johnson.  “I’m talking about hand weights.  Light-weight weights.  You can even use your body weight,” by doing planks, push-ups, or yoga-type exercises.

An engaged brain functions better.  Thus, get a hearing aid if you need one.  “There is solid, very sound research showing that people who have greater hearing loss tend to have greater cognitive decline,” says Platz.  If you can’t hear, “your engagement with others tends to wane.  When your brain is no longer stimulated to the same extent, it’s associated with cognitive decline.”  This is the “use it or lose it” idea; if your brain isn’t actively engaged – if you’re not hearing conversation, or the TV, or the sounds of nature, or a sermon in church, or your friends and family members talking to you – those un-engaged brain cells can shut down.  Isolation is bad for the brain, and bad for your health in general.

So:  Stay activeVolunteer, play poker, meet friends for coffee, take a class.  Keep your brain working.  Talk to people.  That kind of engagement is good for your brain, and it prolongs life.  We are hard-wired to talk to other people, and to listen to them, and hey!  If we can help others while we’re doing it, it’s a win-win.  “You’ve accumulated wisdom, experience, and expertise, and if you can share that with others, including the next generation, so much the better.”  For more things you can do to prevent dementia and keep your brain engaged, see this post, and this one.

            Take care of your liver.  If you drink too much alcohol, or if you are overweight to the point where you are at risk of becoming pre-diabetic or diabetic, your liver can pay the price.  “Fatty liver disease is emerging as an epidemic in the U.S.,” says Platz.  If the liver is overloaded, it accumulates fat, becomes inflamed, and several things can happen:  the liver can develop fibrosis, or scar tissue, that may even lead to cirrhosis.  “If you feel like you’re starting to go down that path, now is the time to reassess your diet and lifestyle.  The best analogy is foie gras, where we force-feed ducks to create fatty liver and make good pâté.  When you accumulate fat in your liver, it’s the same thing that happens with those ducks.”

Make it your life’s mission not to fall.  The older you get, the harder it is to bounce back from a fall.  A toddler can face-plant and spring back up.  An older man can fall and break a bone, wind up in the hospital, and if he doesn’t push the physical therapy and exercise afterward, not ever fully recover all his flexibility and strength.  So, let’s do our best to avoid this scenario!  Here’s where yoga and some very simple exercises can help you maintain balance and flexibility.  “This needs to be a huge focus for men as they age,” says Platz.   It’s not so much about strength – again, nobody’s asking you to heft a giant barbell – as it is about stretching and working on your balance.  And, keep your bones strong:  make sure you get enough calcium.  Calcium doesn’t have to come from milk and cheese.  You can get it from leafy green vegetables, and some foods you might not expect – like sardines, and even tofu.  However:  “The recommended dietary allowances for men aged 51-70 are 1,000 mg a day of calcium; and for men age 71 and older, 1,200 mg.  A half-cup of raw broccoli has 21 mg.  But if you’re trying to get to 1,000 mg, you’d have to eat an awful lot of broccoli.”  In a perfect world, you would achieve dietary perfection by eating an exceptionally well-rounded diet.  Most of us don’t achieve that, and if you’re not getting enough calcium, you may need a supplement.  Don’t go overboard!  With dietary supplements, it’s not a case of, “if a little is good, more must be better.”  Just getting enough is fine.

Fasting?  Intermittent fasting, in various forms, has been in the news lately, and “some studies suggest there is a biological benefit.”  However, there is an easy way for you to take a break from food every day:  Cut out the late-night snacks.  “If you get the munchies at 10 at night, you’re basically having the calories of another meal.  Just not having food after dinner can make a big difference.  Sometimes, half the battle is simply recognizing what we’re eating.”  Are you eating more than you think?  An easy way to find out is to write it down, or use an app on your phone to record everything you eat.  Keeping a record – just for a few days, even – might make you think twice before saying yes to that late-night piece of pie.

Try to get more sleep.  Most of us don’t get enough sleep, or don’t sleep well.  There are some simple things you can do for better “sleep hygiene,” including not being on your phone or the computer right before going to bed; the blue light these devices produce messes up your body’s clock.  Drinking caffeine or alcohol too late in the day can affect your sleep, as well.  Herbal tea, with lavender or chamomile, or other natural remedies can help; so can taking melatonin, a hormone your body naturally produces.  We make less melatonin as we get older; ask your doctor about taking an over-the counter melatonin supplement.   Also:  “Many men tend to snore as they get older.  If your partner tells you that you’re snoring, maybe you should do something about it.  Losing weight can help.”  If it’s severe, talk to your doctor.

 

In addition to the book, I have written about this story and much more about prostate cancer on the Prostate Cancer Foundation’s website, pcf.org. The stories I’ve written are under the categories, “Understanding Prostate Cancer,” and “For Patients.”  As Patrick Walsh and I have said for years in our books, Knowledge is power: Saving your life may start with you going to the doctor, and knowing the right questions to ask. I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened regularly for the disease. Many doctors don’t do this, so it’s up to you to ask for it.

©Janet Farrar Worthington

 

They lost each other, and found each other again.  They’re in this for the long haul.  No way is prostate cancer going to change that.

One of the best things about writing for the Prostate Cancer Foundation is the opportunity to meet amazing, unforgettable people.  There are two exceptional people in this story: one is Milton, who is fighting prostate cancer.  The other is Shawni, who is not only his wife:  she will tell you that she is his “battle mate.”  Previously, I said that every patient needs a treatment warrior – an advocate.  Milton has one of the strongest treatment warriors ever.  He is a mighty warrior, too.  I was privileged to interview them both.

Milton and Shawni Wilborn met in high school more than 30 years ago, but they weren’t high school sweethearts – although, they found out later, they both wanted to be.   “She was seeing someone else,” says Milton.  “I’d always try to talk to her; she would just giggle.  She wouldn’t talk to me – just giggle, giggle.  Sophomore year, junior year.  Senior year was the first time I got her in a conversation.  Before I left to go to the Army, I wrote her a letter and told her how much I liked her.”  In the letter, Milton invited her to a party, and said he hoped she would come.

Shawni never got the letter.  “Her dad intercepted the mail.”  Then, one day while she was doing laundry, she found it.  “She cried.  She was so mad because, unbeknownst to me, she really liked me – but was just scared to tell me.”  They each moved on.  But years later, single again, Shawni would tell her daughter, “I met a guy in high school, and who knows, maybe it could have worked out.”

Meanwhile, Milton got married and had two kids, a daughter and son.  “I went to my 10-year reunion.  I’m married,” and when he saw Shawni, “she had this look on her face.  I was like, ‘Oh, wow, you shoulda said something.’”  At the 20-year reunion, Milton was not married any more, but Shawni didn’t come.  However, she heard that he had been there, alone.  They found each other on Facebook.  She was still in their hometown of Pomona, California, and Milton was in Virginia.  They started a long-distance relationship.  “That’s how we rekindled, how we came to be now.”

Shawni moved to Virginia to be with Milton in the Spring of 2015.

Unfortunately, “that’s when my prostate issues started.  Maybe they were already going on, but I didn’t know.”

The first time he noticed something was not right, Milton was at the gym, working out.  “I always worked out, always exercised, always kept myself in shape.”  He did a “boxer’s workout,” with weights, calisthenics, jump rope, and the elliptical.  One day, he thought, “Man, I’m picking up weight!  So I stopped doing the elliptical and started jogging on the treadmill.  Shawni was getting ready to move from California, and I’m hitting the gym extra hard,” to look his best for her.  His left thigh started hurting, and the pain persisted.  He started taking Motrin, although at the time, he thought, “I’m not going to be taking no pills every day!”

The Motrin helped, but the pain from his thigh moved to his hip.  Milton powered through, at the gym and at his two jobs: at the barber shop and at the garage door company he owns.  He did activities with his son, who was in high school, and his daughter, who was in middle school.  The lower left side of his back started hurting, too.  In October 2015, Milton, who is a Mason, went to a Masonic convention in Hampton, Va.  He was feeling sick, so he took some cold medicine.  “The next morning, I couldn’t go to the bathroom.  I couldn’t urinate.  I was in so much pain.”  He went to the VA hospital in Hampton.  “They gave me a catheter.  The doctor comes back and says, ‘You must have taken a lot of cold medicine.  You know, if you have prostate issues, you have to be careful with this medicine.”  But Milton didn’t have prostate issues; he was way too young.

Milton went home and had the catheter removed in Fort Belvoir, Va.  The pain persisted, and he escalated to using a heating pad and taking Motrin.

Soon afterward, he started having trouble with frequent urination – needing to go every five or 10 minutes.  He went back to the hospital, where they checked him for diabetes.  Some of the symptoms sounded like diabetes – frequent urination, weight gain, lower back pain.  “They gave me some medication for the pain, and pills for the urination.”

A few weeks later, the pain in his back was no better.  “It was just killing me.”  At the hospital, they recommended that he try ice instead of heat for the inflammation in his back.  “They gave me a couple ice packs, and sure enough, after a while, the ice took the pain away.  I left there, kept working, then I’d go home and put an ice pack on.”  Shawni was working nights at the time.  “That’s what we did.”  October, November, December.  Milton was getting fed up; the pain wasn’t getting better.

“I told you something was wrong.”

In January, he decided to get a physical.  Monday, January 11, 2016, his 45th birthday, he went to the urology clinic at Fort Belvoir.  The nurse said, “Have you ever had your PSA checked?  You’re an African American male.  You need to know what your PSA is.”  He had his blood drawn.   They told him his labs were normal.

Three days later, on Thursday, they called him back.  “They said my PSA was extremely high, in the 200s, and the pain in my back was due to my prostate.”  He went back to the hospital.   A urologist at the clinic said, “’I’m sorry to tell you, you have prostate cancer.  There’s nothing more we can do for you here.  Do you have any questions?’”

Oh yes, Milton had questions.  “Last week, they said everything was fine.  This week they’re telling me I’ve got cancer.  No way!  Bull crap!”  Shawni was crying.  “I said, ‘I told you a long time ago, something was wrong!’”  The urologist said, “‘I’m so sorry, there’s nothing more we can do.’  I was cursing, being upset.”  The urologist told Milton that he could have his testicles surgically removed to stop him from producing testosterone.  “There’s nothing more we can do for you here.  Go to oncology.  Maybe they can do something for you.  I’m so sorry.”

“That was it,” Milton says.  “Not sympathy, and no compassion.  Just ‘we can’t do anything else for you.’”  He went to oncology.  “Sign in, wait, get triaged, take vital signs. The pain’s a 10, kidney pain, back pain.  The doctor comes in and says, ‘Your prostate cancer has already spread outside the prostate.  We can’t cure it.  However, we can get control over it by giving you hormonal therapy.  We can give you a shot in the stomach, every three months.  That will help stop you from producing testosterone.”  They gave him some steroids for 14 days, and told him to come back after that to start chemotherapy, with taxotere.  “So that’s what we did.”  They gave him morphine for the pain.

In the two weeks since his first PSA test, his PSA had more than doubled, to 548.

“We prayed, and cried.  I called my mom.  My dad wasn’t doing well, and my mom was taking care of him.” Shawni called her parents.  They told their four kids, who took the news hard.  “Our two oldest girls are living in Texas, our son had just graduated high school and was set to go off in the military.  Our youngest daughter was getting ready to be a freshman in high school.  It was a really tough time.”  Milton started chemo, and he kept on working.  He had a Picc line placed in his bicep, so he wouldn’t damage his veins from the chemo.

The chemo made him sick.  It lowered his white blood cell count, made him throw up.  He lost his hair – on his head, his body, his eyebrows.  But he stayed focused on getting better.

“Cancer is by no means going to tear us down.” 

Milton talked to his pastor, and they prayed for him to stay strong.  He also focused on gratitude.  “You come across people who are just taking their life for granted, complaining about some of the craziest things.  You just don’t know.  You don’t know how blessed you are.”

He and Shawni got married in 2017.  “She took care of me.  She’s been by my side the entire way.  She’s been my angel, my nurse, my caregiver, by my side for it all.  She’s everything to me.

“I always try to let her know nothing can stop us.  We can’t let lack of communication or something else bother us, because we’re bigger than that.  We’ve been through tougher days and back.  We just push on.  We fight.  We fight and fight and fight.  Cancer is by no means going to tear us down.” 

Shawni could have bailed out, Milton says.  But she didn’t, and she wouldn’t.  “I wouldn’t fault her for it,” says Milton.  “I’ve caught her crying.  I say, ‘What’s wrong?’ ‘Oh, nothing.’  ‘Yeah, right.’”

Sometimes, he says, life just gives you a journey and a path to walk on.  “This is my journey.  This is my path.  We’re going to keep on walking it, keep on fighting.

It’ll be all right.”

They both like Steven Krasnow, M.D., Milton’s oncologist at the Washington, D.C., VA Medical Center, very much.  “He’s just been awesome.  I’ve got the best doctor in the hospital looking after me.  The nurses who take care of me, they’re awesome.  They care.”

Milton and Shawni try to give back, to help other cancer patients they see at the VA.  “I’m 48,” says Milton.  “I don’t look 48; I look probably 40.  Shawni’s 47, and she looks 30-something.  We look pretty good for our age.  People are always surprised to see us in oncology.”  Shawni says, “People will ask, ‘Oh, are you here with your grandfather?’ I say I’m here with my husband.”

“Treat him as if he’s going to live forever.”

Shawni and Milton didn’t know about the levels of prostate cancer until the physician’s assistant (PA) happened to close the door in the office, and they saw a poster of prostate cancer and all its stages.  “We were both looking at it, reading what each stage is,” says Shawni.  When the PA came back in, they asked about Milton.  “’He’s stage 4.’  It was like the air got knocked out of us.  People hear stage 4, and automatically think that person is terminal.

“From that point, we told Dr. Krasnow, we don’t want to know the time frame.  We just want you to treat him as if he’s going to live forever.  How long does he have?  He has forever.  Once people start hearing the diagnosis, it’s like they start living by a calendar.  Life slowly starts to deteriorate.  We never discuss that with anyone.  They all know not to talk about time frames with us.  We’ve seen people come and go in the office.  He’ll talk to the cancer patients when they’re in chemo.  I give the caregivers my story.  We try to be positive, to be uplifting as much as we can.”

Says Milton:  “God put me in a position to be able to tell my story.”  He is determined to remain thankful.  “I have a song that I play, when my alarm for medication goes off.  It’s the Clark Sisters, ‘I’m Looking for a Miracle.’”  The lyrics include these words:  “I expect the impossible.  I feel the intangible and I see the invisible.  The sky is the limit.”

“She wiped my tears away.”

Says Milton:  “That song is just so beautiful to me.  It gives me a reason to keep pushing.”  It’s on his playlist, on repeat, when he’s getting the chemo.  “A year ago, I did a 5K walk and run down in Virginia Beach for Prostate Cancer awareness.  I was hurting.  I put that song on.”  His son and Shawni were on the sidelines, cheering him on.  “I just kept on pushing to the finish line.  One hour, 14 minutes.”

In September 2019, Milton was in the hospital for back pain.  It was Sunday.  He was on his iPad, getting ready for the live-stream service of his church in Dumfries, Virginia – his “bedside Baptist,” he jokes.  “I just heard this crunch, just from the base of my neck up into my head.  I’m just holding my neck, like you’re doing sit-ups.”  He wrapped a rolled-up towel around his neck, “made my own neck brace.”  A CT scan later revealed a fractured C2 vertebrae.  “The cancer is in my neck, back, shoulders, hips, thighs, and my ribs.”

Milton says he got mad.  This happened while he was just sitting there!  “I didn’t question God, anything like that.  I was just mad.”  Shawni was crying, but she told him, “It’s going to be okay.  She saved her tears for later, and she wiped my tears away.  For four years, we’ve been fighting this.”

Milton hopes to take part in a clinical trial.  He went through a painful bone marrow biopsy to be eligible for a radionuclide trial, but “they only needed 800 people,” and 1,000 applied.  Milton didn’t get in.   He is being treated with radium-223, which treats the cancer in his bones.  “Everywhere the cancer is or has been, it causes so much pain.  But I can’t complain too much.  I keep pushing through.”

Their faith – in God, and in each other – keeps them going.  “It’s crazy to say this,” says Milton, “but for things to be so bad, it also turned out to be so good, because there are so many things that I guess people take for granted.  So many things I’ve learned about myself, so many things I’ve learned about my faith in God.”  He refers to the parable of the mustard seed in the Bible.   “A mustard seed is pretty small, not much bigger than a grain of salt.  Just believe this much, God is saying.

“We stop and remind ourselves where we’re at, and what we’ve been through,” how glad they are that they found each other again.  “Sometimes we forget how lucky we are, and we remind each other how blessed we are, how grateful we are that God has given us this challenge.  He says all you’ve got to do is just believe.  Live right.  Treat people right.  I just need you to take care of these things right here, and I’ll take care of the rest.  Everything’s going to be okay.  We just keep pushing.”

Note: Less than a year after I wrote this story, Milton entered hospice care.  Shawni said at the time, “I feel like my heart is slowly being torn to pieces.”  A few weeks later, he died of prostate cancer, and those of us at PCF who had been fortunate enough to get to know them, and who had been praying for them and trying so hard to find a clinical trial or something that might help Milton felt torn to pieces, too.

In addition to the book, I have written about this story and much more about prostate cancer on the Prostate Cancer Foundation’s website, pcf.org. The stories I’ve written are under the categories, “Understanding Prostate Cancer,” and “For Patients.”  As Patrick Walsh and I have said for years in our books, Knowledge is power: Saving your life may start with you going to the doctor, and knowing the right questions to ask. I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened regularly for the disease. Many doctors don’t do this, so it’s up to you to ask for it.

©Janet Farrar Worthington

 

 

If you’re a young man diagnosed with prostate cancer, maybe your first thought is, “Am I going to die?”  And then, “What’s the best way to treat this?”  And then:  “Will I ever get my life back?”

And here’s the thing:  By the time they get to that third question, a lot of men get complacent or worn out, or discouraged.  They accept the new normal.  They figure:  “The cancer’s gone.  Yay!  I should just be happy for that.”

And if the cancer is gone, thank goodness!  What a blessing!  There are many men who would give anything to be in your shoes.  But what if you’re in your late forties, or early fifties, with decades ahead of you?  Is it wrong to want more?

Hell, no!  Listen to these words:  It is not wrong to want to have your old life back after treatment for prostate cancer.

So, if you have had surgery, and you’re having persistent incontinence, talk to your urologist.  There are lots of things you can do, including biofeedback, Kegel exercises, or surgical options that we will discuss in another post.

If you are having persistent trouble with sexual recovery, there’s help for you, too.  A lot of men, once their cancer is cured, are basically turned loose by their urologist: be free, and enjoy your life.  But they need extra help, which starts with penile rehabilitation.   We have discussed that here and here.  Options include pills (there are several, including Viagra and Cialis); penile injections; a vacuum erection device; and a penile prosthesis.  In this post, Johns Hopkins urologist Trinity Bivalacqua says:  The prosthesis is “just phenomenal.  Pills like Viagra are popular, because they’re easy to take, and when they work, they’re great.  But the next most popular option is the penile prosthesis, and it works as advertised 100 percent of the time.”  I also commented in that post that “It also looks 100 percent natural.  It’s not some cyborg penis.  For all practical purposes, it is your actual penis – just more reliable.”

But I’m not a guy, and I’m not a urologist.  What do I know?  Well, I’m proud to say, I now know Serge Thomas.  Although I have heard about penile prostheses for years from urologists, I have never talked to anyone who actually has one.  Serge is not only willing to talk about it; he’s written a book.  It is funny, very candid, and optimistic.

“Out of the Blue”

Briefly, Serge, who lives in Michigan, was diagnosed in 2012 at age 52.  He had no family history of prostate cancer; the diagnosis, he says, “came out of the blue,” and the cancer wouldn’t have been found at all if he hadn’t been seeing a urologist for low testosterone treatment.  The urologist insisted that Serge get his prostate checked every year.  In 2011, his PSA had been 1.9; at his next visit to the urologist, it was 3.8.  Two weeks later, another test came back at 4.1.  “This fit all the criteria for a serious situation that shouldn’t be taken lightly,” Serge recalls.  “Well, I decided to take it lightly,” and he spent a month “resistant and in denial.  This could not be happening to the ‘macho-me’!  This would pass, and the reading would eventually return to a normal range.”

Serge’s thoughts will probably seem pretty familiar to any man who has gone through the diagnosis of prostate cancer:  “You know us guys and our manhood.  Nothing can get in the way of it and nothing will compromise it.  And the prostate removal thing:  just NO!”  Better not to know, he decided, because if there was cancer, “my choice is a life with a good and functioning prostate; not life without a prostate, because … if I lost it, it’d mean that I’d lost my manhood, too.  My wife would notice and nothing in our life of intimacy would be the same.”  Serge decided “to stay the course, without any significant intervention or surgery.”

Then his wife, Lisa, found out and nixed this plan.  Serge got an ultrasound biopsy immediately.  Then, before he even found out the results, he nearly died – from sepsis, a rare complication of transrectal biopsy.  He was hospitalized with a 104-degree fever and terrible chills.  A few days later, his urologist came to his hospital room to deliver the biopsy results:  Serge did, indeed, have prostate cancer, Gleason 3 + 4.

Serge did his due diligence on what to do next.  He decided on surgery, then did further research to find an excellent surgeon – one with expertise and a proven track record in performing radical prostatectomy.   He chose Mani Menon, M.D., of the Henry Ford Health System in Detroit.  Before surgery, a therapist on Menon’s team met with Serge to talk about penile rehabilitation after surgery, “the goal being to restore organically stimulated erections” – never a problem before, Serge notes.  “I was known to get erections at three years old, while I was watching Elizabeth Montgomery as Samantha on ‘Bewitched.’  So at this time, my known organic erections were working for the past 49 years!”  The therapist told him that the rehabilitation would begin with a low dose of Cialis.  “She explained that it is extremely important to keep a steady supply of blood flowing to the penis and that this would be the initial start of penile rehabilitation.”  Then, at two weeks after surgery, “we would start with penile injections, the goal of which is to keep up with the regular engorgement of the penis, as this would lead to eventual organic erections,” which would occur “within two years of the start of the injection protocol.”

Serge had confidence in Menon and his team, and this “gave me a peace and confidence to move forward, no matter the outcome and its consequences.”  He spent a lot of time in reflection during this period, and came to come conclusions, particularly: “Finding the most special person in my life, and entering marriage with her held some implicit guarantees that I was not going to give up on.  In our marriage, I effectively warranted my love, friendship, care, and support in all forms and whatever I would be capable of physically, intimate and otherwise.  I was fully intending on delivering on each one of those commitments.”

What if his erections never came back?  Lisa told him it didn’t matter, that “sexual intercourse is only one form of intimacy, and that we have many ways to be intimate.  In fact, she said that it wouldn’t matter to her if we had intercourse ever again.”

Serge didn’t know what to think of this:  “First, I’m thinking that this is some form of compliment – or no, in fact, it is the opposite of a compliment, even an insult! That it’s of no consequence whether we have sex/intercourse again?  Whoa!  A lot goes through a guy’s mind in such a situation!”

Fast-forward a few months.  The surgery went well, and Serge recovered continence.  However, he was not so quick to recover erections.  The pills did not work for him.  “No benefit,” he says.  The injections, which he discusses in detail in his book, allowed Serge and Lisa to resume intercourse, and all was well for about six months.  Then the effects of the injection “became only marginal,” Serge recalls.  “In many cases, the erection would be like on half-power and inadequate for penetration.  I became exceedingly frustrated, while Lisa became exceedingly understanding.”  The therapist suggested that Serge switch to a different formulation, a “tri-mix” instead of the “bi-mix” he had been using.  The tri-mix not only caused terrible pain; it produced a four-hour erection.  The therapist told Serge that some men can’t tolerate the tri-mix, and advised him to go back to the bi-mix.

The Danger Zone

“We had sub-standard performance until I decided that if one injection doesn’t work, how about one and a half times the normal volume of the drug for the injection?  And if that doesn’t work, how about twice the normal prescribed volume of the drug?  I now had begun to operate in the danger zone.”  This strategy did work, “and Lisa and I were the beneficiaries of its working.”  But this resulted in priapism, prolonged four- and five-hour erections, including a nearly seven-hour one that resulted in a trip to the emergency room.  “I was like a crack addict,” Serge recalls.  “I wanted the sex and intimacy with my wife at all costs.  So what if I use a little more juice, I told myself. Wrong!”  In early 2014, Serge noticed that after the injections, his penis was “curved up and vertical.”  He had developed Peyronie’s syndrome.  “My God, wherever I moved, that thing was looking at me!”

After the year and a half of injections, the penile wall had built up scar tissue, “so when the erection occurred, it was constricted by the scarring and caused a pull and a curvature.”  His therapist advised him to stop the injections immediately, and referred him and Lisa to a sexual and marriage psychologist – who, in turn, referred him to Dana Ohl, M.D., director of male reproductive urology at the University of Michigan Medical Center.  Ohl told Serge that he was a candidate for a penile implant – a prosthesis.

Ohl said that by stopping the injections and moving forward with the penile implant, this would correct the curvature, allow him to regain the ability to generate regular and firm erections, and restore the level of intimacy with Lisa that he previously had enjoyed.

Serge asked, “How does it work?”  Ohl told him that two polymer tubes would be inserted into the cavernous areas on both sides of the penis.  A small reservoir of saline would be tucked in the muscle wall of Serge’s abdomen, and a ball-shaped pumping device would be placed in his scrotum, and whenever he wanted an erection, “you pump up the ball-shaped device in your scrotum.”  Afterward, “you depress a little button on one side of the ball-shaped pump device, and the saline flows back into the reservoir and the penis returns to normal.”  The model Serge would receive is called the Coloplast Titan.

“Does the thing ever wear out?” Serge asked.  “No, you’re good for the remainder of your life with this, assuming I do the surgery,” Ohl explained.  Serge felt an overwhelming sense of relief:  “Oh, my God, no more f—ing needles,” he thought, and then, with more enthusiasm than he had felt in two years:  “Yes!  Sign me up!”

Serge had the surgery.  The implant was covered by insurance – in large part, he says, because Ohl “sat in front of Congress and explained that reconstructive breast surgery after breast cancer is akin to a male having an implant after prostate cancer.  Out of pocket, it was 60 bucks for me.”

Off to the Races!

There was a six-week recovery period.  And then, as Serge puts it:  “It was off to the races!  What to say other than life is absolutely great?  Lisa and I were again making music.  To this day, over five years later, we are enjoying ourselves with regular, recurring intimacy of all forms.  I’m back in the game!  Actually,” he jokes, “the implant works so well, it would have been better to have it earlier in my life, like at 18 years old, and without the prostate cancer!”

This is why Serge is telling his story.  He wants to help other men.  But he’s doing even more:  through Dana Ohl, Serge learned about COP-MICH, a collaborative project between the University of Michigan Medical Center and the University of Copenhagen Medical School, to help obtain semen from paraplegic or otherwise injured men and “use it to help those men and their wives have children, which otherwise would be impossible.

“Dr. Ohl had done such a great thing for me in restoring the physical intimacy in my relationship with my wife,” that Serge wanted to pay it forward.  “These teams on both sides of the Atlantic are giving husbands and wives the possibility of having children and growing families.”  Serge supports this project, and is also donating a portion of the proceeds from his book to COP-MICH.  “This is not only about a couple’s happiness in the bedroom; it’s life-changing.”  Because of the help he received, “I feel absolutely compelled to help them in any way that I can.”

In addition to the book, I have written about this story and much more about prostate cancer on the Prostate Cancer Foundation’s website, pcf.org. The stories I’ve written are under the categories, “Understanding Prostate Cancer,” and “For Patients.”  As Patrick Walsh and I have said for years in our books, Knowledge is power: Saving your life may start with you going to the doctor, and knowing the right questions to ask. I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened regularly for the disease. You should start at age 40.  Many doctors don’t do this, so it’s up to you to ask for it.

©Janet Farrar Worthington