Background of Urologic Condition

In September 2020, my biopsy revealed prostate cancer after a mid 7 PSA and Prostate Imaging Reporting & Data System 5 scan. These terms were new. I was 50.

As a lifelong bachelor and recent transplant to East Texas, I faced this uncertainty “alone” in a physical sense. My Midwestern family 900 miles away was available to me, but I needed to plan for treatment alone. I also needed to plan for the results of treatment alone in a context different from the we-can-get-through-anything-together context that I assumed married and committed patients cherished post diagnosis.

The Approach Taken by My Health Care Team and Me

I would not disparage the efforts of 2 Texas urologists and 1 oncologist to begin whole-gland therapy. The choice was framed as radical prostatectomy or radiation therapy (possibly in tandem with androgen deprivation). These seemed to be the mainstream, though the 2 urologists spoke only of prostatectomy as a “gold standard.”

Lay Research on Options

I began a feverish internet search on options, considering prostatectomy or radiation. I read mainstream articles, including descriptions of successful prostatectomies on famous men ranging from Ben Carson to Joe Torre to Colin Powell to Harry Belafonte. I explored online-accessible journal articles and fought through jargon such as the “manageable QOL [quality of life]” and the opaque “odds ratio.”

I was vexed. I could not reach a decision on treatment. A prominent oncologist warned of androgen deprivation therapy toxicity in a 2020 Washington Post article.¹ Actor/comedian Ben Stiller, appearing with his surgeon on a 2016 Today Show episode,² suggested prostatectomy saved his life (Stiller has not described a recurrence since); however, this also carried widely documented quality of life risk.

I learned that prostatectomy cannot follow radiation as a rule. That did not occur to this layperson.

A Perspective on Risk of Traditional Treatments in the Context of Age and Daily Security

A newly diagnosed prostate cancer patient might read of Defense Secretary Lloyd Austin’s early 2024 trouble after prostatectomy and be advised of rare risks that compelled his hospitalization. While Secretary Austin is cancer-free and secure, informed readers know of his likely ongoing recovery with respect to incontinence and erectile dysfunction. Of course, other mainstream treatments carry toxicities.

Lloyd Austin is 70. How might a newly diagnosed patient of 50 describe his risks? Are risks calibrated by age? Toxicities incurred in mainstream treatments may prove lasting. The implications of lasting toxicities are weightier for the younger man with a presumed 20 more years to live. The 2 Texas urologists suggested my age was an asset with respect to toxicity due to presumed greater strength to recover. I was not convinced.

Further there is “daily security.” Secretary Austin enjoyed a 40th wedding anniversary recently. Many older patients have a spouse or adult children for support. That might be said most prostate cancer patients.

In some cases, that is not true, and that is where I found myself at 50. I was unmarried with no children, as I am today.

“Youthful” Risk-Taking at 50 to 51

My priority was the opposite of most doctors whom I encountered in 2020. Their priority, presumably that of the majority of medical doctors, was to undertake decisive force for cure, even in tandem with significant toxicity. They were risk averse with respect to cancer and risk tolerant with respect to toxicity.

I was risk tolerant with respect to cancer and risk averse with respect to acute treatment toxicity.

That risk aversion owed to my “youth” as a prostate cancer patient and single status. In enduring plausible acute toxicity, I would implicitly commit to live alone and longer with that toxicity.

An Excellent Medical Partner Who Shares My Sensibilities

In January 2021, I consulted with HALO Diagnostics of Indian Wells, California. Since about 2009, HALO has offered laser focal therapy, in which a tumor is ablated using a thin laser fiber in a single visit. The temperature is monitored in real time to determine intensity and duration of ablation.

Toxicity is very unlikely relative to prostatectomy considering both erectile dysfunction and incontinence, each near 1%.

HALO was prompt and direct in conversations both written and verbal with Dr John Feller, Dr Jeffrey Herz, and chief research officer and acclaimed research scientist Ms Bernadette Greenwood. Dr Feller and Ms Greenwood serve on many international and national committees for safety and standardization of focal therapy, and will submit deidentified outcomes data under institutional review board approval to a national registry through the Focal Therapy Society.

Close maintenance would be required post procedure. Recurrence was plausible, given my age approaching only 51 at this point.

Laser focal therapy is not covered by HMOs.

HALO administered laser focal therapy March 16, 2021. After a 10-day catheter period in Indian Wells, a post-procedure consultation showed a successful ablation. I had urinary urgency but was otherwise fully recovered 3 weeks post procedure. Even the catheterization period was breezy with some limited mobility.

Maintenance. At regular intervals with Dr Steven Gunberg of HALO, I have been scanned and biopsied on site after PSA draws in Indian Wells. HALO offered to accept tests from other practices, but the Indian Wells office is sublime. I am happy to travel. The biopsy results were always available right away.

There was a recurrence in 1 tumor that was treated recently.

Quality of life. To date, I have had urinary urgency flareups mildly impinging on quality of life in the bodily sense. I understand my luck may expire. I am just 54 with much time for which I must account.

One Patient’s Perspective

For this “young,” single, cancer patient, quality of life was not so quickly subordinated to life itself. All treatment options remain after 3 years.

Medical professionals and patients may find themselves sharing an ethos of sorts. HALO offered me in laser focal therapy an effective treatment in line with my risk-tolerance profile.