When the fourth biopsy in four years revealed some of the cancerous cells were now more aggressive than during the previous four years of active surveillance, I found it very hard to accept that the other shoe had actually dropped. I'd been sailing along
with a Gleason 3 + 3, the least aggressive prostate cancer category. I hoped/believed the numbers would stay that way as I lived through the rest of my 70s and into my 80s and who knows how long from there. After all, my father had lived with prostate cancer
and died from unrelated issues at 86.
As with so many other men, I had the first biopsy after a PSA test suggested a possible problem. In my case the PSA had risen slowly over a decade from 1.4 to 3.7, but being 67 at the time and research changing some of the previous thinking about PSA levels
in older men, the initial urological surgeon and I decided a biopsy was a reasonable option.
My fears after getting the news from the fourth biopsy were:
Navigating My Treatment Options
The urologist who had been following me urged surgery (he performs robotic prostatectomy) and I provisionally scheduled the operation for six weeks hence. I needed time for the biopsy site to heal, digest the diagnosis, and collect and process more
As a dentist turned health reporter, my almost 40 years as a health journalist turned out to be a mixed blessing as I tried to intelligently navigate the daunting amount of often contradictory and confusing information, even for a health professional. I
discovered one of my greatest strengths as a reporter—the ability to thoroughly and unemotionally research virtually any health topic—failed me dismally because this time I was too emotionally involved. I would read the same sentence or paragraph over and
over or talk at great length to trusted sources and come away even more confused. Yes, get the cancer out. No, you can safely keeping watching. Surgery? Robotic or open? Radiation? But what type? Or perhaps one of the less tested treatment options? You can
imagine the toll this emotional roller coaster took on my family: Arline my wife of 41 years and my two sons.
Finding My Advocate: A Six Week Journey
As the six weeks dwindled to two, I still felt uncertain—and frightened—about my decisions and options. While agonizing on the phone one night with my older son he said, “Stop it, Dad! More than most, you are in a position to find one voice you can trust who
can guide you to a decision that you and mom can live with. Find that voice."
I did: Dr.
Charles Brendler, Co-Director of Northshore's John and Carol Walter Center for Urological Health. I was referred to Dr. Brendler by a close personal friend of mine, who is also a physician and serves as a department head at a major Chicago medical center.
He told me Dr. Brendler was the person he would see if he were in my position. Now I understand why.
During the nearly two hours Dr. Brendler spent with Arline and me, he painstakingly reviewed my medical records, gently and carefully examined me, and, for most of the two hours, engaged with us in heartfelt conversation. He reassured both of us, spoke caringly
about our feelings on the personal and intimate issues unleashed by prostate cancer and its treatment, and offered compassionate understanding and objective advice.
Three decisions emerged from our meeting. Two involved additional confirmation of the status of my prostate cancer, one via MRI (Dr. Brendler supported my desire to have the scan) and the other through a second opinion of the interpretation of my four biopsies.
The third and most important was the deciding to accept Dr. Brendler’s recommendation to see a urologic surgeon, who, because of his unparalleled skill in performing open prostatectomies, would be the best fit for me.
When Arline and I exited Dr Brendler's office and walked through the parking lot, we looked at each other and breathed the first sigh of relief in more than a month because we knew we had found peace with my prostate cancer journey. We followed through on
each of the decisions and three weeks after our fateful meeting my prostate was removed by the surgeon Dr. Brendler recommended. The cancer was locally contained and completely removed.
Thanks to active surveillance, I had four years without treatment. And thanks in large part to Dr. Brendler, I remain totally continent and am on the road back to sexual function seven months post-surgery. I’m grateful beyond words that when my son urged
me to find the one voice I could trust, the voice I heard was Charles Brendler's.
Kidney stones can cause pain that ranges from mild to excruciating; however, stones typically do not cause symptoms until they move from the kidney into the ureter (the tube that connects the kidney to the bladder). So how do they form? Kidney stones develop
when urine consists of more crystal-forming substances than the urine can dilute. Often there is no single definitive cause of kidney stones but there are factors that increase one’s risk for developing them. Determining the type of kidney stone can be helpful
in determining its cause and preventing recurrence.
Main kidney stone types:
Amanda Macejko, MD, Urologist at NorthShore’s Jon and Carol Water Center for Urological Health, answered several questions about kidney
stones, including hereditary risk factors, and how best to treat and prevent recurrence:
If there is a family history of kidney stones, are you at an increased risk for developing them at some point?
Stones can certainly have a hereditary component. So, yes, if there is a family history one could be prone to developing stones. One of the best things you can do to decrease your risk is to make sure you drink plenty of water (2.5-3 liters of water daily).
Is there a particular group of people who are at higher risk of developing kidney stones?
Peak incidences of stones occur in people between the ages of 30-60. Caucasians and people who live in warm, dry climates are at higher risk of developing stones. Additionally, people with higher body mass index (BMI) are also at increased risk.
Aside from drinking a lot of water, what other preventative measures can be taken to avoid recurrence of kidney stones?
The stone prevention diet includes: limiting salt intake, avoiding foods high in oxalates and limiting consumption of animal protein. Salt intake increases calcium in the urine so we recommend avoiding canned, processed and fast foods which contain a lot of
For people with calcium oxalate stones, foods high in oxalate should be avoided, which includes tea, spinach, nuts, and, I’m sorry to say, chocolate. Animal protein, including red meat, chicken, fish, should also be limited. It is important to note that
calcium restriction is not recommended.
I've had multiple stones over the years, do I need further tests?
For someone with multiple stones or a strong family history of stones , I highly recommend a metabolic work up. This involves blood work and a 24-hour urine collection (48 hours the first time). This helps your physician figure out what your specific risk factors
are for stone formation, as well as look for possible underlying medical conditions. We perform this service in the Stone Clinic which is staffed by myself, Dr. Park (urology) and Dr. Sprague (nephrology).
Can kidney stones cause renal failure?
Nonobstructing stones in general should not cause renal (kidney) failure; however, untreated obstructing stones may eventually cause renal impairment.
Should you always go to the hospital for kidney stones?
This is really important. If your pain is tolerable with pain medication, whether over the counter or prescription, then you can probably follow up with your primary care doctor or urologist in the office to work out a plan. However, if your pain is not well
controlled or you have significant nausea/vomiting, you will need to go to the emergency room. Typically they will be able to control your pain and/or nausea and you can return home. Most importantly, if you have fever (higher than 100.5˚ F.) or shaking chills,
you need to go to the emergency room immediately. An obstructing stone associated with an infection is very serious and can be life-threatening.
If someone has a kidney stone but would rather attempt to pass it at home, what can he or she do to ease the pain from home?
Most patients take some form of pain medication whether it be over the counter or a prescribed narcotic while they are passing a stone. Additionally, we often prescribe an alpha-blocker. These are the same medications used to increase the flow of urine through
an enlarged prostate. These medications have been shown to help relax the ureters and increase the rate of stone passage.
What can be done for larger stones that cannot be passed on their own?
Kidney and ureteral stones that are too large to pass often require treatment. Common outpatient treatments include shock wave lithotripsy or ureteroscopy. Shock wave lithotripsy is a procedure performed under anesthesia in which we break the stone using sound
waves. After the procedure you then pass the fragments. In ureteroscopy, a small scope is passed through the urethra and bladder and into the ureter. The stone is broken up with a laser fiber and the fragments are subsequently removed with a tiny basket.
Have you ever had a kidney stone? What do you do to prevent them?
Prostate cancer is one of the common cancers found in men (especially in those over 65). Although diagnosis of any type
of cancer can be scary and lead to feelings of uncertainty, in most cases, prostate cancer is slow growing and can be easily managed and treated when identified at its early stages.
Michael McGuire, MD, Urologist at NorthShore, offers the following tips to men about determining their risk and identifying prostate cancer:
While there are mixed reviews about when you should receive the Prostate-Specific Antigen (PSA) test, it is important to talk to your physician about any of your health concerns during your annual visit.
Do you know if your family medical history includes prostate cancer?
Urologists treat all conditions involving the urinary system in both men and women, including the kidneys and bladder.
They also treat all conditions involving the male genital system (prostate, penis and testicles).
While urinary incontinence and bladder infections are some of the first conditions that may come to mind, urologists treat other major diseases, including cancer, kidney stones, infertility and sexual health concerns.
Even though urological conditions differ in severity, they are relatively common. The American Cancer Society estimates that urological cancers –of the bladder, kidney, prostate and testicles—account for nearly one quarter of all cancers in the United States.
In infants and children, abnormalities of urological organs occur more commonly than in any other organ system.
Charles Brendler, MD, Co-Director of the John and Carol Walter Center for Urological Health, identifies some of the key preventative measures for maintaining urological
What are you doing to reduce your risk of urological conditions? What other questions do you have about urological health?
Talking to your physician about sexual health issues may not always be an easy, comfortable conversation – even if conditions
are common in men and women of all ages.
Sexual disorders can be a result of cancer treatments and other health concerns, menopause, medication and environmental/lifestyle factors. With the right treatment, these disorders can often be minimized and resolved.
Jeffrey Albaugh, PhD, Urology Clinical Nurse Specialist at the John and Carol Walter Center for Urological Health, identifies sexual disorders found in
both men and women:
What other sexual health topics would you like to learn more about?