Prostate Cancer Curable with Early Detection

Some people dread their annual medical examinations, but not Doug Holbrook. He knows his annual executive physical saved his life. The doctor administering the first physical gave Doug, who was 45 at the time, the option of skipping the prostate screening because of his age. Doug, however, thought it made sense to take advantage of every test offered. This first test established a baseline measure of his prostate-specific antigen (PSA level).


Doug Holbrook

The prostate is a small gland located just below the bladder. The PSA test measures the level of PSA proteins in the blood that are produced by the prostate. For this test, a blood sample is sent to a laboratory for analysis. The blood level of PSA is often elevated in men with prostate cancer. In addition to prostate cancer, a number of benign (noncancerous) conditions can cause also a man’s PSA level to rise including inflammation and enlargement of the prostate.

Most doctors considered PSA levels of 4.0 ng/mL and lower as normal. In general, however, the higher the PSA level, the more likely it is that patient has prostate cancer. A continuous rise in the PSA level over time may also be a sign of prostate cancer, which is what Doug experienced.

Over the next year and a half his PSA levels increased. A biopsy of his prostate confirmed he did have cancer.

“We routinely cure prostate cancer when it is detected early,” says John M. Corman, MD, urologist and medical director of Virginia Mason’s Perioperative Unit. “That is why it is important for men over age 50 to discuss PSA-based prostate cancer screening with their primary providers and, when appropriate, to have yearly evaluations to rule out the disease.” Screenings include the PSA blood test and a physical examination.

After hearing his diagnosis, Doug was presented with several treatment options, including watch and wait, focused radiation or laparoscopic radical prostatectomy (LRP), a minimally invasive technique used to remove the prostate.

Doug chose the prostatectomy. “For me the choice was simple, as soon as I knew it was inside me, I wanted it out.” Six months after the surgery, he was symptom free and back to his busy life, traveling internationally for his company, hiking, fishing, snowmobiling and walking his two Labrador Retrievers. He continues to live a healthy life and is sure to make time for his annual physical.

A version of this story also appears in the Virginia Mason Health System 2018 Annual Report. 

Facing Prostate Cancer: Michael’s Story

To return his doctor’s phone call, Michael Webb found a remote office in his building and shut the door. A recent blood test showing an uptick in Michael’s prostate-specific antigen, or PSA – a protein produced by prostate cells – had prompted a biopsy. Now he braced himself to hear the results.

“Dr. Kozlowski said ‘I’ve got to tell you it’s cancer, but understand we’re going after it. Whatever we have to do, we’re going to get it,’” remembers Michael. “He was very straightforward with his delivery and I appreciated that more than anything.”

On the phone Michael was making a dizzying pivot, from the mental image of a perfect biopsy to a confirmed cancer diagnosis.

On the phone Michael was making a dizzying pivot, from the mental image of a perfect biopsy to a confirmed cancer diagnosis. He needed to talk treatment, even if just high level. Urologist Paul Kozlowski, MD,  presented some options, including total removal of the prostate. But he cautioned Michael not to make any immediate decisions. More information was on the way, in preparation for an appointment where Michael could learn more and ask anything.

“Then I called my wife and it was a complete meltdown,” says Michael. “She asked, how bad is it? I said I don’t know. I remember like it was yesterday, driving to that appointment with her.”

Michael and his wife met with Dr. Kozlowski and a radiation oncologist, who could address possible radiation therapies. But two big factors in Michael’s case made a good argument for cutting the cancer out: being just 51 years old, and having a high Gleason score, a number indicating the degree of cell abnormality. Michael decided on total prostatectomy. They had already discussed potential side effects, and erectile dysfunction was one giving Michael pause. But Dr. Kozlowski had a secret weapon in the form of minimally invasive surgery, aided by a robot known as the daVinci system.

Also called robotic prostatectomy, daVinci allows the surgeon to control robotic arms fitted with precision instruments to operate through small incisions in the abdomen. Advantages of this approach over open surgery include less pain, reduced blood loss and a faster recovery. Dr. Kozlowski explained that Michael’s procedure would be nerve-sparing, leaving tiny nerve bundles on either side of the prostate intact. An operation by an experienced robotic surgeon, combined with Michael’s age and good health would give him the best chance of recovery without long-term side effects.

Michael Webb shows off his PSA number

Time to celebrate: Michael shows off his new tattoo.

Michael underwent surgery on February 12, 2016. Dr. Kozlowski reported everything had gone according to plan, but that was small comfort to Michael who struggled to endure a catheter at home for 16 days. Much bigger comfort came when Dr. Kozlowski called to say they got it: the cancer looked to be contained in the prostate. Going forward, Michael would need blood tests every three months to monitor his PSA level. The number to look for, Dr. Kozlowski told Michael, is 0.01. That number says there’s no cancer.

“So that became a mantra for me and my wife, 0.01,” says Michael. “We became team 0.01. I told her if we get to the one year mark and we’re still there, I’m getting a tattoo!”

A successful surgery now behind him, Michael kept up with blood draws and visits with Dr. Kozlowski, who Michael remembers shifting into counselor mode. There was some physical stuff to work through in the healing process, and Michael found he could talk about it all with ease.

“I didn’t ever feel alone with Dr. Kozlowski, he was right there with me,” says Michael. “He was totally vested in my whole process. He really wanted things to work out well for me.”

If anyone wonders if things worked out well for Michael, they need only look at his left bicep. One year post surgery, his PSA remained locked at 0.01. It was time to schedule that tattoo. Michael discovered good tattoo artists are really busy – there’d be a three-month wait. But then in May it happened. The guy who had been deathly afraid of needles before his diagnosis sat for a long session under one forbidding needle, and got the deed done.

Not long after Michael’s inking, it was time for his six-month blood draw, having graduated from the three-month schedule. Michael asked to know as soon as the results were in. Dr. Kozlowski’s message came back: “0.01, just like your tattoo.”


Original Sketch of Michael’s Tattoo