After beating cancer, taking time to smell the flowers has a whole new meaning for Chris Carmichael, an avid gardener who is the associate director of Collections and Horticulture at the University of California Botanical Garden in Berkeley.
In 1997, after a routine digital rectal exam (DRE) detected an abnormal growth on Carmichael's prostate, he was diagnosed with locally advanced prostate cancer. As a healthy 42-year-old without any noticeable symptoms, he says the diagnosis was a "rock your world shock."
"It was very strange because I wasn't experiencing any symptoms, so it felt almost like a virtual disease, but one that can kill you at some point," says Carmichael.
Carmichael was a patient at Kaiser Permanente in Oakland, Calif. where his doctors recommended a radical prostatectomy — the surgical removal of the entire prostate gland and some surrounding tissue. However, this procedure may cause life-long side effects, such as sexual dysfunction and incontinence. So Carmichael's urologist suggested he visit UCSF Medical Center for a second opinion about his treatment options.
After discussing both surgical and non-surgical radiation therapy treatment approaches with UCSF urologic oncology experts, Carmichael decided to undergo 3-D conformal radiation therapy, a state-of-the-art form of external beam radiation therapy that uses a sophisticated computer program to map the prostate gland to precisely pinpoint radiation beams from different directions. This allows for an accurate, high dose of radiation to target the cancer site, while sparing nearby healthy tissue.
Compared to surgical removal of the prostate, 3-D conformal radiation therapy is less invasive. Although long-term side effects may occur with either treatment, sexual dysfunction and incontinence are typically more common with surgery and evidence does not suggest that one treatment is more effective than the other.
"Given that there isn't one agreed upon treatment for prostate cancer, it's very important to be as informed as possible when making your treatment decisions," says Carmichael. "I decided on 3-D conformal therapy because preserving my quality of life and avoiding long-term side effects was crucial to me."
Carmichael was treated by Dr. Mack Roach III, an internationally renowned radiation oncologist at UCSF who specializes in the treatment and management of prostate cancer. Roach's research includes 3-D conformal and intensity modulated radiotherapy (IMRT), as well as brachytherapy for prostate cancer.
"When Mr. Carmichael was treated at UCSF, relatively few other medical centers had as much experience with 3-D conformal therapy," says Roach. "We helped pioneer the technique and given the high-risk nature of Mr. Carmichael's disease, we could not be more pleased with his successful outcome to date."
Carmichael experienced virtually no side effects from the radiation therapy and was able to continue his regular routine during treatment. For two years, he also received testosterone suppression hormone therapy, which shrinks the prostate tumors and increases the efficacy of radiation therapy. Prostate cancer cells usually require testosterone, the main male hormone, to grow. Therefore, lowering hormone levels can help to stop or slow cancer growth.
However, most men, like Carmichael, experience temporary side effects of hormone therapy, which are related to lowering the body's testosterone levels. These side effects may include a decrease in libido, some level of erectile dysfunction and other symptoms, such as hot flashes and breast enlargement. Carmichael admits that these side effects were difficult to endure, but they were temporary and eventually disappeared after hormone therapy.
And Carmichael's prostate-specific antigen (PSA) level eventually decreased to 0.6 ng/ml from 29 -- his level at diagnosis -- which means that he is now officially cancer-free. PSA is a substance that is naturally produced in the prostate gland to help liquefy semen and a small amount circulates through the bloodstream. If a higher than normal level of PSA is detected in the blood or rises over time, it may indicate prostate cancer.
"Cancer has had a profound impact on me and it made me really aware of life and death issues at an age and time when I least expected it," says Carmichael, now 51-years-old. "It made me much more grateful for my life and life in general. I take many fewer things for granted than I may have before."
Story written in July 2006
Abby Sinnott is a freelance writer in San Francisco.