Surgery got rid of his prostate cancer

Surgery successfully treats his prostate cancer

BY JIM HOWE

A series of medical tests provided Donald Gregory of Camillus with good news and bad news.

At an annual physical in 2021, Gregory, 69, found out he had an elevated level of PSA, or prostatespecific antigen, indicating he might have prostate cancer. He underwent a biopsy, where tissue samples are taken from the prostate gland, a walnut-sized gland that surrounds the neck of a man's bladder and urethra, the tube that carries urine from the bladder.

Donald Gregory says of his battle with prostate cancer: “I survived it. It wasn’t easy. It was uncomfortable, but it gets better with time.” He is shown in the kitchen of his Camillus home.

PHOTO BY SUSAN KAHN

Gennady Bratslavsky, MD

That biopsy confirmed he had cancer. That was the bad news.

The good news: it was caught early enough that it could be treated.

Among American men, prostate cancer is the second most common cancer, after skin cancer, and is the second leading cause of cancer death, after lung cancer. Most prostate cancers are found in men over the age of 65.

Choosing an operation

Facing the choice of radiation or surgery for treatment, Gregory chose surgery, which led him to Gennady Bratslavsky MD, the chief of urology at Upstate.

“I liked him right off. He explained the differences between surgery and radiation,” Gregory recalls of his meeting with Bratslavsky.

Gregory underwent a roboticassisted laparoscopic radical prostatectomy. This means the surgeon uses robotic arms as he operates to remove the entire prostate gland and some surrounding tissue. Laparoscopic refers to using a series of tiny cuts instead of a large cut.

He was warned of the possible consequences of this surgery, such as erectile dysfunction and incontinence, but told Bratslavsky, “ ‘Doc, I’m not a kid anymore; I’m more concerned with getting rid of the cancer.’

“He couldn’t be nicer,” Gregory says of the urologist, also praising everyone assisting in the operation and his care.

A smooth recovery

After the surgery, he had to urinate through a catheter for about a week, and it took about six to eight weeks before he was back to his normal daily routine.

A later blood test showed his PSA had dropped from above 5 (4 is often considered the upper limit of safety) to zero, confirmed by another test six months after that.

Bratslavsky, in a telemedicine visit because of the pandemic, gave Gregory a thumbs-up sign, then formed a zero with his fingers and said, “ ‘We got it all. We got all the cancer,’ ” Gregory recalls. “I said, ‘Thank God I went through this and got good results.’ ” He will be checked again down the road.

What would Gregory advise other men facing prostate cancer?

“I survived it. It wasn’t easy. It was uncomfortable, but it gets better with time.”

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A new option for hormonal therapy

The Food and Drug Administration approved a new type of hormonal therapy for men with advanced prostate cancer in December 2020. Instead of traveling to a medical office to obtain an injection of a medication to suppress testosterone, men could swallow a tablet. The medication, relugolix, “has been a significant improvement, especially during the COVID-19 pandemic era,” says urologic oncologist Hanan Goldberg, MD. “We tried to limit patients coming to the hospital or the clinic because cancer patients are more at risk of COVID-19.” Androgen deprivation therapy – to suppress male hormones – may be prescribed to slow the growth of prostate cancer cells, and it has been shown to extend the lives of men with advanced prostate cancer. The oral and injectable medications are likely to produce the same side effects: hot flashes, fatigue, mood swings and others. Goldberg tells his patients it’s similar to menopause. He notes one important difference with the oral medication. A study published in the New England Journal of Medicine found a 54 percent lower risk of major cardiovascular side effects in men who took relugolix, compared with those who had injections. “For patients who have prostate cancer but also have cardiovascular issues going on, this drug is probably preferable.” A main advantage of relugolix, Goldberg says, “is the higher percentage of patients who recover their testosterone to normal range 90 days after stopping treatment, compared to those treated with injections (54% vs. 3%).”