Local patient treats prostate cancer at Winneshiek Medical Center.
Surviving Prostate Cancer
“You have cancer.” Three words Steve Schmitt of Fort Atkinson thought he would never hear.
“I had known that prostate cancer was in my family history, but all three men were on my mother’s side. I honestly didn’t worry about it – I thought prostate cancer had to come from the paternal side to be a threat,” says Steve. Because of his family history, Steve’s wife, Debby, strongly encouraged him to get a general physical at age 40. Never seeing the need for annual doctor visits, it had been years since Steve’s last check-up.
Steve scheduled a physical with Kevin Sand, M.D., Mayo Clinic Health System family medicine physician at Winneshiek Medical Center. Dr. Sand told him that it does not matter where in the family tree prostate cancer is present – equal risk exists if it is found on the mother’s or father’s side. Steve’s prostate-specific antigen (PSA) levels were taken and a baseline was established.
Then, ten years later, after continuing the annual physicals, his PSA was higher. “Dr. Sand told me that my prostate gland was not enlarged, but my PSA went from a level two to a level three. After ten years of getting a PSA test, it had never jumped like that before,” Steve says.
The change was enough to cause concern and a referral to Brad Orvis, M.D., Mayo Clinic Health System urologist at Winneshiek Medical Center. A PSA rise of more than three quarters of a point per year raises concern and, after an examination, Dr. Orvis recommended a biopsy. “During a biopsy, samples of tissue are taken from the prostate, and a pathologist compares the samples under a microscope to determine if there is cancer present and to rate its aggressiveness. The more the cancer cells differ from normal cells, the greater the chance it is aggressive and at higher risk of spread,” explains Dr. Orvis.
Prostate cancer is graded according to the Gleason score, a scale that determines if the cancer is slow- or fast-growing. The pathologist identifies the two most prominent types of cancer cells and assigns a grade to them.
The biopsy revealed that Steve’s prostate was cancerous with a mid-scale Gleason score. The results showed that the cancer was contained, they thought, but possibly aggressive.
Dr. Orvis explained his options to Steve. He says, “Prostate cancer is very curable if it is contained to the prostate. Yearly screenings make it much easier to find the cancer before it has spread to nearby lymph nodes or bones, which is why screenings should begin at age 40, or before if there is a family history.” He continues, “Options to treat prostate cancer vary depending on age, the aggressiveness of the cancer and the expectations of the patient. Steve was a young and otherwise healthy man – surgery to remove his prostate, thus eliminating the cancer cells from his body, was the best option.”
After leaving Winneshiek Medical Center, Steve called his wife from the parking lot; she had wanted to accompany him to the appointment, but he had discouraged it. He called his sons. Steve met with his family who happened to be visiting his father in a care center nearby; shock registered on their faces. He says, “My family all took the news very hard. Especially my brothers; they have the same family history as I do, and the same risks.” Steve’s mother calmly reassured him he would be fine.
At his next appointment, the results of his Computerized Axial Tomography (CAT) scan to determine if the cancer had left his prostate gland, his age, health and the particulars of his cancer were considered. Surgery to remove the gland was recommended, but six weeks were needed between biopsy and surgery. Steve had time to consider his options.
Steve says, “It was impossible to process the information I was presented at the time of the appointment. Dr. Orvis understood this, and he gave me a book to read about prostate cancer explaining all my options, which I could read when I was ready. I was leaning toward having surgery to remove my prostate as Dr. Orvis recommended, and I read up to that point in the book. I didn’t read beyond that because I sincerely hoped I would not need to know what the next steps were if the cancer did not go away.”
Then Steve’s father died, not unexpectedly, but a surprise nonetheless. His funeral was to be the day of the surgery. “Everything seemed to be happening at once. Cancer, my father’s death, surgery, and the time of year – we were approaching planting season. I didn’t know that I could handle it all, and things just weren’t getting better.”
Steve was able to reschedule his surgery for the following week. He says, “One of the benefits of receiving my care locally was that the doctors and nurses understood what was happening in my life, and worked with me to find a better time for the surgery. I would have had to wait weeks if I had been dealing with a larger medical facility, and in my gut, I didn’t think waiting any longer was a good idea.”
The surgery went smoothly, but the pathology on his removed prostate gland had a Gleason score of seven – one point higher than the biopsy had revealed; one point closer to “aggressive cancer.” The cancer was at the edge of his prostate – it could have spread throughout his entire body.
But it didn’t; they had stopped it.
Since Steve’s surgery, PSA tests have shown normal levels, a relief to anxious family and friends. Cancer is behind him, but never out of his mind, and by sharing his experience, he hopes his story remains in the minds of other men. “So many men that I talk to have prostate cancer in their family history, but have never had a digital prostate exam or a PSA test,” says Steve. He emphasizes, “The exams aren’t fun, but they need to be done. If I had not gotten the test, the cancer would have spread. I had absolutely no symptoms, and the cancer had almost reached the rest of my body. I don’t even what to think about how this story would have ended if I had not been screened.”