Cystoscopic Examination

Early in February 2001, I underwent a second cystoscopic examination. My urologist felt that my incontinence had gone on too long - since the transplant about nine months ago -- and was too intense not to merit investigation. He was looking for a radioactive seed that might have moved out of my prostate and into the wall of the urethra, where it would could cause irritation that could lead to the incontinence I was experiencing. A second possibility was that scar tissue from an earlier procedure (catheterization or my first cystoscopy) might be irritating the duct.

Once again I found myself prone on the examination table, naked except for a surgical gown, and thoroughly mortified as two nurses swabbed me with antiseptic solution and injected an anesthetic jelly into my penis.

The cystoscope twitched and squirmed its way into my bladder and I felt the tightening drumhead of my bladder pressing against my abdominal muscles as water was injected into the bladder to test the functioning of my lower urinary tract. After about five minutes of examination the scope was withdrawn and I vaulted from the table and toward the waiting commode.

Surprisingly, the test was inconclusive. There was a small area of irritation at the base of my prostate, but everything else appeared normal. There was no scar tissue and no migratory seed was evident. My urologist told me that I was retaining a small amount of urine within my bladder, but that the amount was not significant. He suggested that I discontinue Dytropan and begin taking Flomax, a drug he had prescribed for a brief period following my seed implant.

The logic of this advice bewildered me. I had been taking Dytropan in the hope that it would quiet my overactive bladder and lessen my incontinence. Now I was being told to resume taking a drug that promoted urination. My urologist assured me that the Flomax would help empty my bladder and, thus, might decrease the frequency of urination. As for the overall phenomenon of the incontinence, my urologist had little to say. This was not supposed to happen with a seed implant and, indeed, he had never seen a case like this before.

I installed a fresh diaper and left the clinic bemused by it all. My reading had suggested that radioactive seeds might continue to deliver radiation to the prostate for a full year. Thus, it seemed logical that any side effects from the implant could persist for a year. It had been nine months since my seed implant and so, I reasoned, I could expect to wait another three months before things began to improve. I decided I would just grin and bear it and see how things developed during the next three months.

At the time of the exam I also received the results of my most recent PSA test, the blood test that measures the amount of a protein - the prostate specific antigen - in the blood. While it is often present in small amounts in men who do not have prostate cancer, the amount of PSA usually rises when prostate cancer is present. The number was 1.2, up a bit from the .9 registered a few months earlier, but still well within the safe zone.

Both my urologist and my radiation oncologist agree that PSA results can be unreliable during the first year following a seed implant. Radiation stirs things up as it does its work, and PSA readings can swing wildly for a while. The hoped for result at about two years following an implant is a stable PSA reading in the safe zone below 4.0. We'll see.

In the week following my exam I attended another meeting of my prostate cancer support group. The topic of this meeting was impotence, and judging from the sudden surge in attendance it is an issue that is in the forefront for most prostate cancer patients. Our usual group of about thirty- five members swelled to nearly one hundred, and the men and women in attendance were hyper-alert during the presentations.

We heard from an urologist who specialized in the treatment of impotence following prostate cancer therapy. He explained the available options and discussed current research and promising new therapies that are in the pipeline.

The current options range from drug therapy (Viagra) for the mildest cases, through surgical implants, external pumps, suppositories, and direct drug injection for more severe cases of impotence. The aim of all these therapies is to produce an erection that is firm enough and sustainable long enough for satisfactory sexual performance.

We then heard from several men, each of whom had undergone radical prostatectomy and sustained varying degrees of impotence as a result of the surgery. While all of the men were clearly struggling to redefine the role of sex in their lives following surgery there was also an almost heroic component to their presentations. Each of these men had been wounded by a disease that entered his life with the randomness of a shooting star, but they all had determined to move forward with their lives in a positive way.

As the urologist who led the discussion explained, there is no way to tell before surgery whether nerve sparing techniques can be used successfully; and there is no guarantee that nerve sparing surgery will be fully successful in every case. "It's a mess in there," the urologist said, "and we don't know what we'll find until we make the incision and see what we are actually dealing with."

For all of us, prostate cancer is a tricky proposition. My choice of a seed implant improved the odds for preservation of the sexual function versus surgery, but my incontinence is far worse than was experienced by any of those who spoke at the meeting. There is a real possibility that a year or two from now the effects of the radiation will produce some form of impotence that I will have to deal with. It has been known to happen in a small number of cases. Prostate cancer can recur - after surgery, as well as after radiation therapy; and if there is a recurrence, the options for therapy are few, and unpleasant.

We make our decision and we roll the dice, hoping for the best result. We make our decision and we roll the dice, hoping for the best result. Each man makes his decision based on uniquely personal reasons and must then live with that decision and its consequences. I have made my decision and the other members of our support group have made theirs. The thing now is to get on with life and live it the best way we know how. We are all trying to do that.