As a 1983 Graduate of the US Naval Academy has chosen an aviation career path, I’ve always been proactive with annual flight physicals and health screenings which is why, at age 50, I began requesting prostate cancer screening including annual PSA blood test and Digital Rectal Examination. My Prostate Specific Antigen (blood test) score average of 2.5 and in 2014 jumped to an elevated 5.4 reading. The result of this test was sent by letter (snailmail) after my annual physical, but it was never received as I was working overseas. It was not until my annual physical in 2015 that I learned of another drastic change. My PSA had risen to 14.7 within 12 months. Even with a PSA level nearly 4x the score normally prompting a biopsy, I was told by the urologist at the VA it would be 29 days until I could even schedule an appointment. Pushing my way through the Phoenix VA to an appointment with the urologist the following day, I was told I “most likely had prostate cancer” and was told to return in 6 months and have another PSA blood test. At that time they would schedule a biopsy along with a subsequent radical open prostatectomy surgery as that was all Phoenix VA offered. (At the time the Phoenix VA did not have access to robotic surgery technology only performing open prostatectomy surgeries.)
After receiving the VA urologist’s recommendation, I took matters into my own hands and consulted with a radiation oncologist specializing in prostate cancer. He had immediate concerns and scheduled a biopsy the following day at a private health care facility. Only through my general knowledge of prostate cancer, the identification of possible symptoms along with consultation with a urologist, radiation oncologist, and my family, the decision was made to immediately undergo a biopsy. The subsequent result of the biopsy was those three dreaded words, “You have cancer.” During this journey, I realized there was a need to educate the Veteran Population. Veterans Health Administration providers were not having conversations with patients about prostate cancer screening. Studies and statistics show Veterans fall into a higher risk category much like the African American population or men with a family history of prostate cancer. The cause of this higher rate of incidence is not fully understood, but exposure to hazardous environments such as “Agent Orange”, radiation sources, and combat-related stress are most likely contributing factors. As was the case with my experience, if the patient did not request an annual prostate cancer screening and PSA test, it was not offered or discussed let alone recommended. This was in line with the US Preventive Services Task Force Guidelines on Prostate Cancer at the time.
In addition to the lack of early screening, the VA urologist offered only one option for treatment of prostate cancer, radical prostatectomy surgery. The potential side effects associated with open radical prostatectomy were enough to motivate me to again take matters into my own hands and learn about other prostate cancer treatment options. After days of research and numerous phone calls, I decided that Stereotactic Body Radiation Therapy “SBRT” with the CyberKnife system was the right treatment option. My decision brought attention to yet another problem within the VA Healthcare system being the inadequate modern treatment options offered to Veterans. At the time, the entire VA healthcare system had only one CyberKnife radiation machine and it was not being used to treat prostate cancer. Determined that CyberKnife was the right treatment, I elected to step outside of the VA and was successfully treated at Swedish Radiosurgery Center in Seattle Washington under my private insurance provider. Following treatment, and with the encouragement of family, doctors, fellow cancer survivors, and fellow Veterans, I formed the organization, Veterans Prostate Cancer Awareness Inc. “VPCa”. The objective of VPCa is to educate Veterans and caregivers about prostate cancer and the need to screen men, particularly high-risk populations early and annually. A secondary objective was to ensure all Veterans had access to the same advanced treatment modalities and therapies as men receiving healthcare in the private sector.
In 2015, only Veteran patients who met the 30 day wait or 40 mile or greater travel criteria were qualified to access healthcare services outside the VA through the newly established Veterans Choice Program. Veterans Choice has now been “retired” and replaced with the 2018 Mission Act and the permanent program within the VHA renamed the “Community Care Network”. The recent VA Budget passed in 2018, along with the legislation titled the “Mission Act” has gone a long way to support Veteran’s need to seek state-of-the-art care outside the VA in their local communities. Providing access to the most modern technology and medicines is a right of every American, especially our Veterans. As the VHA system mobilizes and adapts to the new technologies available, there is now a program to support the mission of providing equal care to Veterans.
In 2018, I had a recurrence of prostate cancer and was introduced to a number of advanced imaging techniques such as Axumin, and new PSMA imaging clinical trials. In 2020 in the midst of the COVID pandemic, I underwent a very intense course of treatment since my cancer recurred in the previously treated tissue spreading to two lymph nodes in the presacral area. Also, I underwent a Focal Laser Ablation of the identified tissue in the prostate, 25 rounds of radiation to the pelvic area, and 10 rounds of SBRT radiation to specific lymph nodes, all with a six-month course of Androgen Deprivation Therapy (ADT-Lupron) plus an Androgen Receptor Inhibitor (Xtandi). After a follow-up PSMA imaging scan there appears to be no reported active cancer, PSA is undetectable, and no reported serious side effects. (KNOCK ON WOOD)