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Evan Saugstad: My Prostate; my journey – Part 2: Making a decision

A lthough September is known as Prostate Cancer Awareness Month, I have chosen to tell my prostate journey for Movember, Men’s Health Month.


Although September is known as Prostate Cancer Awareness Month, I have chosen to tell my prostate journey for Movember, Men’s Health Month. I have also chosen to discuss subjects that are not normally found in our local newspaper; one’s personal health, one’s sexual health, and one’s cancer.

Movember is the month where the largest percentage of donations are made in support of curing men’s cancers and improving our health. Please support Movember. 

If the discussion of a man’s body parts, or medical procedures or men’s sexual health offends you, then skip the rest of this. Just be assured I am still alive, still kicking, and still adjusting to life with cancer and cancer treatment. 

 • • •

With my PSA (prostate-specific antigen) at 18.32 in March 2019, and my doctors suggesting no more watchful waiting, off I went to learn more about my cancer.

I was back at Vancouver General Hospital (VGH) in April for a full body bone scan. Good news: no cancer detected in any of my bone mass.

It was then over to the BC Cancer Agency to discuss treatment options. The doctor suggested two.

One was surgical removal, or radical prostatectomy, which takes three to four hours of surgery; or a combination of hormone (androgen deprivation) treatment for six months, followed by five to six weeks of external beam radiation therapy (EBRT), which is akin to having multiple X-rays, followed by the insertion of radioactive beads around my prostate. 

The doctor carefully explained the pros and cons, the possibility and likelihood of side effects, and longer-term implications.

Hormone therapy reduces the size of the prostate and lowers one’s androgen levels. A smaller prostate is easier to treat with radiation beams and lower androgen levels slows the growth of cancerous cells. Of note, androgens are manufactured in the testicles and control the development of male physical traits, such as a deep voice and facial hair.

EBRT is the process were radiation is beamed into the body targeting the prostate, once per day for up to six weeks. This virtually “cooks” the prostate, rendering it non-functional. Once completed, radioactive beads are inserted, surrounding the prostate and remaining in place as the body dissolves them.

Both processes could be completed in either Vancouver area hospitals or in Prince George.

Armed with a whole bunch of literature and online references to read, I went back to my urologist for a more fulsome discussion about surgery.

He and his team still use the “old fashioned” approach, a retropubic prostatectomy. They would try to employ “nerve sparing” surgery, which entails leaving one or both sets of nerve bundles in place. These nerves are immediately adjacent to the prostate and control erectile functions.

Surgery would entail making a three-inch vertical incision above the pubic bone, detaching the bladder to allow access to the prostate, removing the prostate and associated lymph nodes in the immediate vicinity, reattaching the bladder, inserting a catheter, and then stitching me back up.

It would take three to four hours in the operating room under a general anesthetic, follwed by one to two days in the hospital, then two weeks with a catheter and six weeks with no strenuous exercise or lifting, and I should be good to go.

My time had come to face reality, make a decision and move on, as doing nothing had been ruled out.

There were lots of thoughts. What are the risks? What does one want to live with? What will I be satisfied with? What are the side effects? A lot to think about and discuss with Karen.

I tried to digest all this information and the statistics. Both radiation and surgery options have risks, and no doctor can say for certain just how close to normal your body will be after removing or obliterating your prostate.

Developing incontinence issues (leaky valves) is greater with surgery as compared to radiation. It could take up to a year for these valves to either regain their composure, or for one to understand just what the full extent of the impairment is. Normal bladder control usually returns within a few weeks, but in some cases, it doesn’t. One can speed up the process by immediately beginning Kegel exercises to strengthen one’s urinary valves.

The severity of any erectile dysfunction can be about the same for both. Surgery results in immediate impairment, while radiation may take a few years. Post operation, there will be changes and there will be effects that can range from never achieving another erection to partial erections that can still allow for intercourse. 

As with the incontinence issues, it can take up to a year for nerves to recover or repair themselves and find out just what the level of impairment is. With practice, and concentration, one can still achieve an orgasm after either method, but both will result in no ejaculation and both will result in complete infertility.

Surgery has greater risks for infections and anesthetic complications. Radiation has greater risks for rectum irritations and bowel infections.

Doctors can’t say for sure just how we will be affected after the operation. In general, the older one is, the more likely it is to have issues with incontinence and erectile dysfunction. And, as always, the more experienced the surgeon, the less likelihood there will be complications.

Making a long story a bit shorter, I chose to stick with my urologist and a retropubic prostatectomy, as that is how they operate. 

I could have found another urologist elsewhere and had a laparoscopic surgery (multiple small incisions using a small remote camera to guide the surgeon), or gone to a VGH surgeon and had robotic-assisted laparoscopic surgery (a surgeon guides a robot), but chose not to.

All three of these methods have similar success, complications, and side effect ratios, and all depend upon the skill and expertise of the surgeon and their team.

Next week; Part 3; Surgery. Until next week, please support Movember as Men’s Health Month, give generously and help fund cancer research.

Evan Saugstad is a former mayor of Chetwynd, and lives in Fort St. John.