Neil Baksh was doing everything right. He was eating the right things. He wasn’t smoking. He was exercising six days a week. So he was shocked when he was diagnosed with prostate cancer.
Equally surprising was that he had symptoms at all, and they weren’t even symptoms of prostate cancer, which is usually symptomless. They pointed to a problem with his bladder and an enlarged prostate; the latter is common in older men and usually benign. But not this time.
Neil was only fifty-six and doing fine until, on a Christmas trip to Toronto in 2012, he was unable to discharge urine. As a nurse, Neil is very open about his story, and he wants to help raise awareness. “I had the urge to pee on the whole eight-hour trip but couldn’t. It was extremely uncomfortable.”
Having grown up in Toronto (he was born in Trinidad), Neil called a urologist he knew there. He was told to come straight in and waited “barely five minutes” before they did a scan and, to his great relief, inserted a catheter. They checked his bladder and his prostate, which was enlarged. The doctor asked Neil what he wanted to do; no mention was made yet of possible cancer.
“I said let’s reduce the size of it,” said Neil, and scheduled surgery for January 9, 2013. When they returned to Pennsylvania, Neil’s wife, a nurse practitioner, didn’t want to wait. She suggested he see Dr. Scott Owens, a urologist with Urology of Central PA (www.urologycp.com) in Camp Hill. Neil agreed.
Dr. Owens investigated further with biopsies from Neil’s bladder and prostate. He found prostate cancer. Neil was motivated to act quickly, especially after his wife told him his son had asked a heartbreaking question: “Is Dad gonna die?”
“Neil’s was not a typical approach,” says Dr. Owens. “He had irritative symptoms and frequency, and we picked up the cancer by doing the PSA blood test as part of an overall assessment. Neil was young, but his PSA [prostate-specific antigen] was high.”
Dr. Owens explains, “We separate men with high PSA levels into three groups: low-grade, interim disease and high, which would be grade three. Neil’s was stage one, localized. It would have spread within seven to ten years, and once it spreads we can’t cure it. We can only treat it and slow down the growth.”
Dr. Beth Horenkamp of Lancaster General Health says she’s now seeing men with prostate cancer that has metastasized. This is largely due to controversy surrounding PSA screening, which identifies more prostate cancers than need to be treated. She explains, “As medical oncologists, we’re seeing more prostate cancer. Ten years ago you wouldn’t have called me, since I’m not trying to prevent prostate cancer; I’m only treating it once it’s metastatic” [meaning it has spread].”
Since many family physicians stopped ordering the PSA test and some insurance companies stopped covering it, some cases aren’t being identified as early.
“These are $50 tests,” complains Dr. Owens. The pushback comes, he says, from having a global treatment for everyone. He says that’s changed. “Now we understand the behavior, the biology of the cancer. Some are slow, some are intermediate, some are high. We take those with slow or low-grade and we treat those more conservatively now.” Referring to the recent drop in testing, he says that, in cases like Neil’s, “It’s horrible from a physician’s standpoint. We wouldn’t be having this conversation [about Neil’s survival] if we hadn’t tested his PSA.”
But, thankfully, we are. And, as an exercise physiologist, Neil made sure his recovery was as quick as possible. He upped his weights before surgery. He stayed only one night at the hospital, refusing to lie down in the bed but sitting up in a chair to foster the healing process. He insisted on walking down the hall two hours after surgery, again before bed and again in the morning.
“I wasn’t waiting for anybody because you have to be proactive, and if you’re not, it’s going to hurt in the long run. It’s not a walk in the park, but you have to suck it up.” Sucking it up for Neil meant continuing to earn his master’s degree as a family nurse practitioner. He missed one class, the day of his surgery, and was back the next week.
“I went back to class with my catheter,” he confesses, laughing.
The catheter stays in for ten days post-surgery, and there are temporary issues around libido and urinary control. “Some people say the surgery and treatment are worse than the cancer,” says Dr. Owens, “but Neil is a classic example. His quality of life has been relatively regained, and a cancer he might have died from in ten years is eradicated.”
Dr. Owens adds, “Neil had that self-motivation and desire that ‘this is not going to slow me down.’ It was reflected in his personality and approach; his impatience helped him with his recovery, a desire to want to heal fast. That motivation is extremely important.”
Neil is definitely not waiting for anyone. He’s working back up to his usual forty-five minutes per day of aerobic exercise and another forty-five of lifting weights. And this spring, just to prove he can, he’s running a half-marathon with his wife.