Dr. David Spearman shares how his medical background, family history, and advocacy for early PSA screening led to the timely diagnosis and successful treatment of his prostate cancer. He emphasizes the importance of understanding personal risk factors, seeking second opinions when needed, and detecting prostate cancer early when it is most treatable.
I'm Dr. David Ronald Spearman. I'm wearing two hats in this situation. I'm a retired internist and after about 40 years or so of primary care internal medicine. And so in that capacity, I've had the opportunity to be very cognizant of the need for prostate cancer screening and in those high-risk patients. Particularly the African American males, because of the much higher incidence of prostate cancer in that population of patients, which obviously includes myself, and the higher rates of higher morbidity and mortality in that setting. And several years prior to my diagnosis, I was of the age where I had begun to experience some of the symptoms of prostate enlargement and as a consequence of that was ultimately referred by my primary physician to a community practice for the management of that.
But in addition to the ethnicity, I also have a significant family history, which includes a brother, three years of my junior, who was diagnosed at about age 50, a maternal grandfather and a paternal uncle, both of whom had advanced prostate cancer at some point. And so because of that, I've always had a somewhat higher concern for myself. But for several years prior to the time of my diagnosis, my PSAs were generally in a range commensurate with my age just above or just below two. And about maybe four or five years prior to my diagnosis, my PSA increased to just under four. Not above four, but not at that point, which led to my first biopsy, which was normal. My PSA fluctuated a little higher and a little lower for the next couple of years or so.
And I had a second biopsy about two years prior to my diagnosis, which showed changes that were precancerous changes, but were not malignant. And then near the time of my diagnosis, my PSA increased again significantly to a level of over five. And at this point, because of my risk profile, as I alluded to earlier, I was concerned about that. However, there were certain criteria that were not fulfilled at least in the minds of the community practitioners and the recommendation was for a six-month followup. But again, because of the increased risk, i.e., being of African American descent and having a significant family history, I was not comfortable with postponing that and sought a second opinion at the Georgia Cancer Center and was seen by Dr. Klaassen and who was very much in agreement that further evaluation was necessary. And I had an MRI scan that in lay terms, I had areas of significant concern that were biopsied, and of course that result was substantially positive.
I think I had a total of 16 biopsies, 12 of which were positive. And so at that point the decision then was what to do about it and since the diagnosis was very apparent, and Dr. Klaassen counseled me very thoroughly in extending options of different types of treatments, surgery and radiation, and made referrals. And after talking with the radiation service and the surgeons, I made a personal decision to proceed with surgery and that we had very outstanding robotic capabilities here through the Georgia Cancer Center. And I had the robotic radical prostatectomy and with a very favorable outcome. I had essentially no incontinence and no complications and had a very quick recovery from that, and in fact was able to return to my practice within three weeks or so. Fortunately, I've had a very successful, very benign course since, and I'm three and a half years out now with a PSA that's undetectable, and for which I'm very grateful for all of the persons involved, Drs. Klaassen, Dr. Madi and the support service of the Georgia Cancer Center.
Well, that's an interesting story, and wearing my practitioner's hat now. About maybe 20 years ago, a little longer now, before we had the advances in surgery, I favored radiation for persons of a certain age category, and surgery particularly when open radical [inaudible 00:04:53] is what was the surgical mode prevailing at that time, but ... And I actually had given some consideration to radiation myself because at that time I was approaching age 70, but after researching it and looking at the available options and the expertise that was available through the Georgia Cancer Center, I decided surgery on a personal basis because although there are obviously a number of successful cures with radiation, my feeling was that if there was an opportunity to remove the tumor in its entirety, that I would favor that option and with radiation being a secondary choice. But I would hasten to say that I don't deride radiation as an unacceptable choice.
I think the radiation has been significantly improved over the last year, over the last decade or so now with more sophisticated targeting techniques that greatly minimize some of the collateral damages associated with radiation. And so I think that it's a personal decision, but for myself, I felt that the surgery offered a better chance, statistically a better chance of removing the tumor in its entirety, and this is why I made that decision. There is an organization through my church that focuses on aspects of health and in particular men's health. And because of my experiences with prostate disease in general, I have developed a series of talks and PowerPoint presentations that I've delivered locally and on a statewide basis discussing the prostate disease in general, particularly the consequences of the diagnosis of prostate hypertrophy and the importance of getting that evaluated and properly managed with more emphasis on prostate cancer in which we've talked about the epidemiology of prostate cancer and the importance of assessing one's risk for prostate cancer and acting on that and also emphasizing the availability of resources for potential cures, particularly if the cancer is diagnosed early.
I usually try to emphasize the fact that while prostate cancer is certainly one of the more common cancers seen in men and it's still in an untreated manner can result in significant morbidity and mortality. Then on the other hand, with early intervention, early diagnosis and early treatment, that it's certainly something that can be very effectively cured. Well, the reception is generally positive, and I think that some of the things that I'm impressed with is that there has been just a lack of awareness of how it can be prevented.
And also there's been some reticence to discuss this, and I think that by discussing it and relaying it from a personal point of view that it becomes more relevant. And I would like to think that some people have been more proactive in having themselves evaluated and getting PSAs done and following through with that. As a practitioner, I'm concerned that I have seen so many instances of patients who have had advanced prostate cancer when they did not have significant other comorbidities and would have had the potential for living perhaps into their late 80s and 90s and beyond, only to have had a pretty miserable existence dealing with the consequences of advanced prostate cancer in their 70s and 80s.
And so I think that it's very important to be able to eliminate that potential risk with early intervention. For people who are susceptible, I think for any person, any group of people that PSA should be done, and I think that ... Well, a personal feeling that I have is that I don't necessarily ascribe to the age limits on PSAs. I mean, I know that some public health announcements have emphasized that PSAs may be not necessary after a certain age, but my feeling is that if a person's in good health and has the potential for living a long life that I would certainly not arbitrarily just discontinue the PSA. If the person has the ability to withstand the treatments for that, then I would certainly encourage having the appropriate evaluations and appropriate treatment as indicated.