Shot in Dramatic Health Films format, this segment tells the complete story of Mark's battle with prostate cancer and the help he gets along the way from his wife Julie and his doctor, Ash Tewari.

Mark:



My name is Mark, and I'm 54 years old. I'm married, and I've been married 32 years.



Julie:



I'm Julie, and I'm Mark's wife. There's cancer on both sides of our family. His father had colon cancer and my grandmother had both breast and colon cancer, and lived to be ninety-nine by the way. It's hard not to have cancer touch your life in some way.



Text:



One in six men will be diagnosed with prostate cancer.



Mark:



This probably started, as I'm sure it does with many men, with getting up in the middle of the night to go to the bathroom.



Julie:



I was certainly aware that he was having to get up. it didn't register with me that that might be something very serious.



Mark:



As I got older and older, I started monitoring the PSAs and asking my internist to do that. In the last year, it has been trending up.



Julie:



When the PSA went up, that registered with me. So I insisted that we really stay on top of that.



Text:



Usually, the higher the PSA, the more aggressive the disease.



Mark:



When one of the PSAs came back and was just slightly higher, she was insistent that I go back and have another one in just three or four months. Which I did--I've learned to do that over the last 32 years. My father had prostate problems but back at that time they were not doing PSAs, but I've often wondered whether he didn't have something and it was just not ever diagnosed.



Text:



If your father had prostate cancer, you have twice the risk.



Julie:



It was probably about a year ago that the PSAs first started to go up.



Mark:



And once it trended up for a second time, I was referred to a urologist to get a biopsy. It was something I had never experienced before and I hope I don't have to again. There were some suspicious cells but they could not confirm cancer.



Julie:



Most of the slides were clear, but there was one slide that nobody could decide exactly what was on it. So what that led to was another biopsy.



Mark:



So I took a month break, and then went in and had a second biopsy done.



Julie:



We got the results, and in a couple of cores they were positive for cancer. So I said, "Well that's what we've got. What's our next step?"



Text:



Partners report more emotional distress than patients.



Mark:



There was anxiety--a lot of anxiety and a lot of concern. "What if I'm not the lucky one? What if it's worse than I thought?"



Julie:



Fear was definitely our first reaction, or at least my first reaction. Have you seen the movie Jaws? And there's the shark music in the background and you feel fear and dread? That's the way it was for about three months. You just got anxious to know, so that you could deal with it.



Text:



Dr. Tewari is Mark's doctor.



Dr. Tewari:



I don't think that there is one set way in which to deal with every patient in terms of their anxiety. Every individual is unique. They have their own feelings and own issues and they combine them all together and some of them they express them and some of them they keep inside.



Julie:



One of the things that really helped me was going out online and seeing the stories and the lists of people that are in the public eye that have had prostate cancer and that you see in the newspaper every day and that lead very active, full lives. Joe Torre, Norman Schwartzkopf, Colin Powell, Rudy Guiliani...I mean the list goes on and on and on.



Text:



A man has a 35% greater chance to develop prostate cancer than a woman has to develop breast cancer.



Mark:



The one thing I found about men with prostate cancer is that they seem to be anxious to talk about it. They're initially hesitant, because it's embarrassing but the networking and the talking really helped because it allowed me to start comparing experiences. That led me, us, to a meeting.



Text:



USToo was formed in 1990 by prostate cancer survivors.



Mark:



The night that I went, they were focused on robotic surgery, that evening. And so there were a couple urologists that were giving presentations about robotic surgery, giving the statistics of this versus radiation vs open, and so on. I really started going in deep and looking at robotics and the pros, the cons...



Mark:



There's a longer term concern that is much more serious, and that is the recurrence of cancer. It gets to be very striking when I'm told, at 54 years old, you could watchful wait, and you probably won't be symptomatic for ten years.



Text:



Immediate treatment might not make sense for men who have very slow growing cancer or early treatment cancers.



Mark:



That didn't sound very good to me.



Julie:



There was no way we were gonna do watchful waiting. Neither one of us had the temperament for that.



Mark:



I was aware of the different approaches with radiation: the seeds, the breaking therapy, the external beam type approaches. And they are certainly good options for the right kind of patients. But what was driving me more towards the surgery, rather than the radiation, is with the physical exams you only get one side of the prostate. And you never know for sure exactly how much cancer is there unless you take it out and you section it and you look at it.



Text:



Another major emotional problem patients cite is the unpredictability of their future.



Dr. Tewari:



He has a reasonably significant score of cancer, which, given his long life expectancy, could bother him down the road. That's the reason he wanted to be having a definitive approach.



Mark:



I feel like I'm a good surgical candidate. I'm generally healthy. I would have more peace of mind just having it removed.



Julie:



I was very supportive of the surgery. Immediately we would deal with it and we would go on.



Mark:



Once you've made a decision and you go forward with it, be optimistic about what you've done.



Mark:



I was aware of at least a couple of the different approaches to the surgery. I knew people who had had the open procedures. The abdominal approach is the one that is probably the more traditional one right now. You can get fascinated with the robotics, and I am. I think the technology is great but the robot's not doing the surgery. The surgeon is doing the surgery. It's only going to be as good as the surgeon.



Julie:



What was really difficult about the robotic surgery was that it was so new that finding people who had experienced the robotic surgery was very difficult.



Mark:



A friend of Julie's heard someone talking about his experience with prostate cancer and having surgery done robotically. I called him a couple days later and that's how I found out some insights on not only his experience but also Dr. Tewari, who had done his surgery. And he said, "Before you do anything else, you must talk to him."



Text:



Dr. Ash Tewari is Director, Robotic Prostatectomy at New York-Presbyterian Hospital Weill Cornell Medical Center.



Mark:



Dr. Tewari was very busy, and it was going to be some time before I could get in. So I started seeing other people that I had on the list.



Dr. Tewari:



I think second opinions are a good tool for patients who are supposed to become an expert in a short span of one or two weeks. And a second opinion can give him some very different views about the same problem. None of them right or wrong, it't just that medicine is less of a science and more of an art, so they get different perspectives.



Text:



A recent study finds that 30,000 cancer patients are misdiagnosed annually.



Mark:



We had a very informative, very positive interaction with Dr. Tewari.



Julie:



At the end he turned to me and he said, "Tell me what is in your mind." And I was very impressed with that--that he would turn to me in addition to asking my husband that question.



Mark:



I look for someone to be a partner with me in my health. I'm not looking for someone to dictate to me. There are things I don't know, there are things I do know, but I'm looking for a partner in this.



Dr. Tewari:



And patients kind of relate, they look into my eyes and I look into their eyes, and sometimes we shake hands and one squeeze tells it all. So we come onto the same pages and we extend our emotions to each other and we go through this journey together.



Mark:



When you have prostate cancer, people focus on different things, but I think for men, the first thing is to get the cancer under control. But once you've taken care of that, the two major issues are the bladder, the continence, getting dry again, as it's called, and secondly, the erectile dysfunction or sexual dysfunction aspect of it.



Text:



Improvements in treatment have significantly reduced the severity of side effects.



Julie:



Prostate cancer affects men--it hits them where they live. It affects them both physically and emotionally. It assaults their masculinity.



Dr. Tewari:



Prostate cancer is one surgery in which we don't get any credit by what we take out. We get credit by what we leave behind. The prostate happens to be situated in a very strategic location. It is surrounded all around by certain nerves which are actually supporting the erection. These nerves are actually really fine structures. They are like hair, and intermingled with the prostate and difficult to identify, difficult to differentiate. And the challenge is that we have to get all the bad guys out and still leave this fine hair-like structures intact.



Julie:



And from my standpoint, the only thing that I could think of that I could really do was to reassure him that our relationship was going to be the same no matter what happened, and that that was one piece that he did not have to be concerned about.



Mark:



Well I'm leading up to surgery tomorrow, to be prepped, and go see Dr. Tewari. My role is actually very easy. I just have to show up and go through the process. I think it's much harder probably for the people that have to wait.



Julie:



I waited in the waiting area for about another couple of hours and a got a call from the recovery room and they said that he was waking up and that I could come in and see him.



Mark:



When I woke up I was in the recovery room and heard Julie's voice and it's a welcome sound. Later on in the morning Dr. Tewari came in.



VO Dr. Tewari:



Hello there. Good morning.



VO Mark:



Good morning.



VO Dr. Tewari:



How've you been?



VO Mark:



Feeling ok. You feel like you got it all?



VO Dr. Tewari:



I did a couple of further sections and there were a couple areas that were bumpy on one side and 95% of the patients don't need any radiation or anything. So there's a 95% chance that you will not.



Mark:



And of course he wanted to see me walk and get up. He walked down with me down the hall and around the corner and so on. So he got a good feel for how I was doing--the color, the pain.



VO Dr. Tewari:



Are you feeling ok?



VO Mark:



Yeah. I am.



Mark:



After Dr. Tewari left, another one of his residents came in and said, "You can go home at any time."



Text:



With robotics prostatectomy, blood loss is minimized and the recovery period is shortened.



Mark:



When I returned roughly six days--well it was six days after the surgery, the pathology report had come back.



Julie:



You're just silently sending little prayers heavenward, and just hoping and hoping and then she read the report to us and its just like, "Oh, thank you!" You're just--it's the most wonderful feeling in the world, I think: that anxiety lifted from you.



Mark:



The margins were clean. The lymphnodes--there were twelve lymphnodes--those were all clean. So there was no evidence of cancer in any of the surrounding tissues or any migration so that was a very nice holiday present. Dr. Tewari came over and gave Julie a hug, gave me a hug, and we said, "Wonderful pathology report." And he said, "Couldn't have been better, couldn't have been better."



Mark:



When you come back to have the catheter removed, the urinary catheter removed, that starts your issues around continence. You've had the surgery, the muscles are still weak and you really have to relearn how to deal with urinary flow.



Text:



Exercise before and after surgery is critical.



Mark:



One of the major frustrations for men about continence is how long will you have to put up with wearing pads, or in the most severe cases, the full pants. I must say that I have been very, very blessed personally from that standpoint because I used them for two weeks.



Dr. Tewari:



I think we'll learn today as to how he's doing in terms of continence and sexual function. He's about six weeks, and I'll be getting an over as to how his recovery's been, and then we will be checking the PSA.



VO Dr. Tewari:



Let me just look at your belly.



Dr. Tewari:



In prostate cancer surgery, emotions play a major role. Sense of security, sense of confidence in their own decision, and the support system they have at home all combine together and make a major difference as to how that patient is going to heal and be emotional after the surgery.



VO Julie:



Well he's had such a good outcome, and we've been talking to other patients and he's doing so well everyones saying, "What was the secret? What was it that you did with him?"



VO Dr. Tewari:



He has been a good patient, that's all. And with both of you having such a positive attitude--I think it's 20% surgery and 80% attitude. The rest is what kind of cancer we are dealing with. Your cancer was aggressive, but not too aggressive. From this point on basically think of all the things but your prostate, because that's behind you. Churchill or somone said, "It's a good feeling being shot at and being missed."



Mark:



A colleague that I worked with called, and he was just diagnosed with prostate cancer. It is a tough road, and a lot of it is because of the unknown. And if you can talk to people who have been through it, you can get a flavor of what might be ahead. Once you've had an outcome that's as nice as what we've ended up with, you give some encouragement to the other people. We try to balance out the bad stories and the bad things that people read with some hope and that good things can happen and they can happen to you.



Julie:



Our daughter is getting married in the spring, and that call kind of had be backburnered a bit because we had to focus on Mark. Time--once we got back the pathology report, then we could turn our attention back to the future and what it held after that.



Mark:



And I can certainly say today, the fifth week post-surgery, I'm fully back to looking at more of the longer-term activities. I'm back to normal, have moved on--everything to be encouraged about.



Julie:



He's had very minimal problems with either one of the side effects, I'm happy to report. I think part of it was preparation and the psychological role that he took.



Mark:



Julie's role has been major. She has been a person to complain to. At times, a person to get upset with. A person to calm me down, to give me another opinion, another view. She's been a friend, a wife, a mother--absolutely critical.