Challenge 21

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Alan MooreExecutive VP of ClinicalDevelopment andRegulatory Affairs,Cardiome Pharma Corp,Vancouver, Canada

E-mail:amoore@cardiome.com

Online 23 September 2004

� 2004 Published by Elsevi

Prostate prose

e

Alan Moore

r Ire

ike most guys I have an infinite capacity for

enial, and it took an aggressive general prac-

itioner friend to tell me, ‘‘I won’t be your

octor any more if you don’t go in for a digital

xam,’’ before I actually did anything about 2

ontinuous years of high prostate specific anti-

en (PSA) levels (around 6.7). Although the

rologist told me he felt nothing on a digital

xam, given the length of time the PSA had

een raised, he wanted to do a biopsy. The

iopsy, stunningly, showed that I had prostate

ancer, apparently early and within the pros-

ate itself. That was February 9th of this year.

As a professional scientist I knew I needed to

et all of the information I could, both from

he literature and via networking. I quickly

ound out that there are two broad choices for

herapy: surgery or radiation. Both have the

ownsides of incontinence and impotence, but

he cure rate with surgery, 100% at the early

etection stage, caught my attention. I also

etworked with Dr. Eduardo Marban, Chief

f Cardiology at Johns Hopkins University

JHU), and a member of Cardiome’s Scientific

land Ltd on behalf of WPMH GmbH.

Advisory Board. He put me in touch with

Dr. Patrick Walsh at JHU. Dr. Walsh developed

the nerve-sparing radical prostatectomy sur-

gery some 20 years ago. Clearly the key here

was to get cured, but not be impotent or

incontinent for the rest of my life. At the

same time, I learned that while the traumatic

effects of surgery are of course immediate, the

effects of radiation can be a lot more subtle

and longer term in onset. So I went for cure

and side effects that I could see going away,

rather than watching and waiting for them to

arrive.

I had my surgery May 4th at Johns Hopkins,

in Baltimore. The major issue was the first

bowel movement post surgery, which has been

likened to passing a ball of barbed wire

through one’s rectum. Much to my wife’s dis-

gust this turned into a macho competition

between myself and my two other ‘‘prostate

brethren’’. Dr. Walsh operated on the three of

us on the same day and we bonded as to who

would have the first bowel movement. I came

in second, but was accused of cheating because

of using a suppository.

It’s now 7 weeks post surgery, and I am still

wearing ‘‘man-pads’’ panty liners. On the

whole I have good urinary continence, and

no bowel incontinence, which is more a com-

plication of radiation than surgery, but I do

still have the occasional leak. None of my

prostate brethren, or myself, have yet returned

to full potency. I can masturbate and achieve

orgasm but because the prostate produces

most of the ‘‘juice’’ it is dry, which feels a little

strange. I have not been able to maintain a

sufficient erection yet for full penetration

intercourse. I am constantly being told these

are early days, but the psychological effects of

the temporary impotency are quite profound.

I have rapidly gone back to jogging 6 miles

every other day simply for running’s antide-

pressant effects. Depression and impotency

can be a self-sustaining vicious cycle.

Vol. 1, Nos. 2–3, pp. 273–274, September 2004 273

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Challenge 21

274 Vol. 1, Nos. 2–

My relationship with my wife has been good

uring this period as we were both well pre-

ared by the surgeon. On the other hand I feel

great sense of frustration, as I’m sure she does

oo, that things are not back to ‘‘normal’’ as

uickly as we would like. Constant spousal

eassurance, the willingness to talk openly

o each other, and engage in the mutual sexual

ctivity that I am currently capable of is very

mportant to maintain that sense of closeness.

So I am prostate cancer free, continent, and

ptimistic about my return to full sexual func-

ion. What have I learned? First, don’t ignore

igns of problems. If I had waited, this cancer

ould have been much harder to treat. Second,

3, pp. 273–274, September 2004

find an excellent surgeon. Obviously Dr. Walsh

is superb and JHU is one of the centers of

excellence.

Finally, don’t be afraid to experiment. I have

run clinical trials for many years, but except as

an undergraduate earning beer money, have

never been a participant. I am now enrolled in

a study run by Guildford Pharma, with Dr.

Arthur ‘‘Bud’’ Burnett as the principal investi-

gator, at JHU. The trial is to test a growth factor

that has been shown to regrow and speed the

recovery of traumatized penile nerves. Let’s

just hope I’m in the active treatment group!

Note added in proof: AFM is glad to report

potency has now returned.