Men with low-risk prostate cancer have similar recurrence-free survival rates when treated with surgical robotic prostatectomy or brachytherapy, but those who received surgery had fewer urinary or sexual problems two years after treatment, a randomized trial in Italy has concluded. The study was recently published in the April 2017 issue of the Canadian Journal of Urology [Claudio et al, 24 (2), 8728-8733].
Treatment of early-stage or low-risk prostate cancer relies on active surveillance, surgery or radiation therapy. In particular, both robot-assisted radical prostatectomy (RARP) and brachytherapy (BP) — a type of internal radiation therapy in which radioactive seeds are placed inside or near a tumor — have been shown to effectively treat prostate cancer. However, until now little was known about their long-term effects. “Treatment decisions that men with low-risk prostate cancer have to make can be difficult, as a lot of it depends on what the patient is looking for and what type of experience their physician has to offer,” said Dr. David Samadi, chairman of urology and chief of robotic surgery at New York’s Lenox Hill Hospital
Italian researchers at Milan’s San Paolo Hospital conducted the single-center, prospective study from January 2012 to January 2016 to compare the outcomes of 165 patients randomly assigned to receive either RARP or BT. They followed all patients for up to two years after treatment, including clinical evaluation and determination of prostate-specific antigen (PSA) levels.
Researchers also evaluated urinary and erectile functions, and found that overall biochemical recurrence-free survival rates were similar among the two groups. Patients undergoing RARP had a 97.4 percent recurrence-free survival rate, compared to 96.1 percent reported in the BT-treated group. Biochemical recurrence is the term used when a patient’s PSA levels start rising again. “This was actually expected,” said Dr. Samadi. “A two-year follow-up is a short period of time to ascertain much difference between the two procedures.”
While the recurrence-free survival was similar in both groups, researchers saw different outcomes when analyzing sexual or urinary symptoms. Men undergoing BT regained continence faster than those who received RARP during the first six months of follow-up. But this difference was no longer significant after 12 months and 24 months. Interestingly, men in the BT group had more urinary symptoms during the two-year follow-up.
Regarding sexual function, both groups showed a decreased ability to maintain an erection right after treatment. However, RARP-treated men recovered potency much more quickly than their BP-treated counterparts. By the final follow-up, 90 percent of RARP-treated men were back to normal, compared to only 60 percent of men in the BT group. “These are factors any doctor and the men they see with low-risk prostate cancer need to take into consideration when making any treatment decision,” Dr. Samadi said. “When they make the comparison between RARP and BT, RARP clearly shows the upper hand in treating prostate cancer effectively and managing symptoms better at this stage.”
It must be noted that these results may vary somewhat with the experience of the medical personnel involved and should be discussed with one’s physician if applicable.
A few months ago, my long-time Johns Hopkins urology surgeon, Dr. Jacek Mostwin, suggested that we prepare a joint presentation for the meeting cited above. I readily agreed. The annual conference on Religion and Medicine encourages physicians, care-givers and hospital pastoral staff to see their patients as more than data, results and medical information but instead as unique, multi-faceted, spiritual individuals. The effects of spirituality on medical conditions and outcomes is a general theme. The conference is a way to support the religious experience that is often left behind by more secular bioethics in modern medicine. This meeting has also created a growing community of many different types of people who are interested in the human side of medicine. This interfaith forum and growing community includes practitioners who feel the religious dimension of their work is important, and theologians and chaplains who may feel otherwise quite marginalized in secular medical centers – here they find a sympathetic medical collegiality.
The text of our 15-minute talk is as follows.
God and Prostate.net; Illness, Mortality, Faith, Evangelism and the Doctor-Patient Relationship in the Digital Age
Introduction as presented by Dr. Jacek Mostwin, Johns Hopkins. “I am here today with my friend and colleague, Dr. Bjarne Gabrielsen, to talk about his website, Godandprostate.net, and its intertwining, related themes: Illness, Mortality, Faith, Evangelism and the Doctor-Patient Relationship in the Digital Age. In 1995, Dr. Gabrielsen became my surgical patient for treatment of prostate cancer. It quickly became clear that we shared a belief in the role of faith in medical experience. We have remained in close contact over these 22 years. For Dr. Gabrielsen, faith is the heart of life. The website Godandprostate.net is a public extension of his spiritual diary; a personal blog integrating medical and spiritual entries. It is a bold testament of belief in God’s faithfulness and an affirmation that life’s many stages have meaning.”
My presentation. “My name is Bjarne Gabrielsen. I have a Ph.D. in organic chemistry with research interests in medicinal organic chemistry and natural products. My career was spent equally in academia (University of Florida) and government, the last 20 years at the National Cancer Institute (NIH) where I retired as a Senior Advisor in Drug Discovery and Development. I am first generation Norwegian-American, raised in a conservative Lutheran background, and married for the first time in 2000 at the age of 58 (very happily). I am also a prostate cancer survivor since 1995 now classified as having advanced prostate cancer though asymptomatic (thank God). Through the years, I have been blessed with first-class medical support.
My personal story starts in 1995 when I received the dreaded phone call from Johns Hopkins that my biopsy had revealed prostate cancer. It didn’t take long for God to intervene and make His presence known. Sharing the news with a close friend later that morning, I noticed a sparrow walking unafraid at my feet. Immediately, the word came to me from Luke 12:6-7, “Are not five sparrows sold for two pennies? Yet not one of them is forgotten by God. Don’t be afraid; you are worth more than many sparrows.” Shortly thereafter, God gave me Dr. Mostwin who performed successful surgery at Hopkins in late 1995. The night of my surgery, I was reading my Bible when Dr. Mostwin visited me. We had a brief but meaningful conversation about how one can believe and trust the words written in the Bible. Looking back on this incident, the theme of the truth and relevance of God’s Word would dominate my future years. My cancer, though treated at a very early stage, recurred biochemically in 2002, which devastated me at the time. Additional radiation therapy did not eradicate it completely. Looking back now, I see that God allowed this in my life so I could create my website among other reasons. God always has a long-range purpose for us even in what we perceive at the moment to be devastating developments.
I had started a personal spiritual diary in 1995 expanding it from 2002-2010. During these years, Dr. Mostwin asked me to examine a book written by a prostate cancer survivor to comment on its value for others. I read it and concluded the author provided limited encouragement even though he had been anointed with oil by his church leaders as described in James 5:14-15, and performed in many Christian denominations. Such anointing with oil would play a huge role in my own life in 2004. Dr. Mostwin then seriously suggested I write my own book. I decided on a website instead since books have endings and websites go on. Godandprostate.net now comprises over 250 separate posts and has over 820,000 hits. There are medical posts from journals and periodicals and spiritual ones from various devotional books in a 2:1 ratio. A Medical Resources section includes information from the National Cancer Institute, Prostate Cancer Foundation, Prostate Cancer Research Institute, Johns Hopkins etc. Medical topics are updated regularly such as; finding the right physicians, resources for newly diagnosed men, prostate cancer for beginners, scans and imaging, pathology, approved treatments and side effects, immunotherapies, clinical trials, life style, diet, nutraceuticals and vitamins like D3. Spiritual sections include: a) “Scriptural Medicines” (Biblical verses and promises of encouragement); b) “God Still Heals Cancer” (two personally known examples of healing from brain and breast tumors); c) “How to Enter a Personal Relationship with God” (a general and personal testimony) and lastly, d) “Lessons Learned” (or being learned on a personal level).
Can there be a major purpose of disease? Isaiah 40:1 says “comfort, comfort my people says your God.” Isaiah’s mission was to comfort the hurting people of Israel. Likewise today there are countless hurting people who need God’s comfort. Illness of any kind can be a training ground to prepare us to share comfort with another. I may be asked to endure the same afflictions that are plaguing others before I can truly be of comfort and help.
Now I will present nine lessons learned or being learned:
1) God has a specific goal for all aspects of our lives. Jeremiah 29:11-12 states “for I know the plans that I have for you declares the Lord, plans for welfare and not for calamity, to give you a future and a hope.” But can those God-ordained plans include prostate cancer? Our abstract states that “diseases of one kind or another and eventual death are things we will all experience. We all want every aspect of our lives to have significance, be of value to others, be meaningful and fulfilling including our education, career, family, friends, specific interests and talents. But what about sickness, disease and eventual death? Can these fit the “meaningful” category? My answer is “yes”, hence my website written to empower and encourage men. Many people desire that a higher power be involved in many aspects of their lives. Why shouldn’t God be involved in diseases and eventual death? We don’t cease to exist if a disease such as prostate cancer takes our lives. God has a purpose for everything even prostate cancer. Jesus and His disciples once encountered a man who had been blind from birth. His disciples asked Jesus why the man had been born blind to which Jesus answered that “it was in order that the works of God might be displayed in him” (John 9:3). And so it can be with prostate cancer. God’s ideal plan consists of two main goals; a) to glorify Himself and His Son Jesus through all aspects of our lives including sickness and disease; and, b) to experience that “God causes all things to work together for good to those who love God.” (Romans 8:28). God uses sicknesses to glorify Himself, to increase our faith, to allow others to see God and Jesus in us, and, to make us more sensitive to people around us and their specific conditions.
2) God speaks to us about our conditions predominantly from His Word, the Bible. God may speak through prayer, circumstances, our experiences or interactions with others but these are always coupled with a specific scriptural promise or reference. We can even question God about our conditions. But we should reject the tendency to focus on our circumstances, negative emotions and fears, but instead trust on God’s promises in His Word. His Word is filled with scriptural anchors (see scriptural medicines section) to keep us steady in the faith.
3) We have the assurance that through our relationship with God through faith in Jesus, we will live forever, in a new heaven and a new earth with a new, perfect body. Life is a series of “anticipations.” When we were 12, we looked forward to being a teen, then graduating, then a successful career, then marriage and family, then retirement, but then what??? We should always have a goal to which we aspire and live each day intentionally. We all will eventually die of one cause or another. Having the assurance of eternal life in spite of potentially life-threatening conditions, totally changes our outlook. This assurance based on God’s Word (e.g. John 3:16) removes the fear of death (though we often fear the process of dying). It also gives true inner peace knowing that the best is yet to come in “the twinkling of an eye” when we are transported from this life to the next, immortal phase.
4) God’s purposes can often be to change us rather than our circumstances. While our own circumstances may not change, God may use other people, events and especially His Word to change us inwardly, “perfecting” us for any task we need to accomplish according to His will.
5) Focus on issues and relationships in our lives which would have the most lasting or eternal effects. I must accept that in my life, I can care for others as unique individuals and possibly affect them. Writing a personalized “legacy letter”, I can share the most important issues and experiences in my own life as they would relate to any one friend, colleague or family member, voicing specific thanks for past experiences and a hope for an eternal future together.
6) Remember the times God has previously protected and delivered us. In the Old Testament, God often instructed Israel to erect a monument at a specific site in remembrance of God’s previous miraculous deliverances. They were constantly reminded to “remember when God…..”. We likewise are instructed to celebrate God’s faithfulness and remember what God has done previously in our lives and how He has delivered us in the past. His faithfulness remains to this day and forever.
7) Learn to cope with life’s “thorns”. Acknowledge our own weakness. Like the apostle Paul, many of us are given “thorns in the flesh”, namely conditions which we’d rather not have but which God has not chosen to remove. Mine has been prostate cancer. The apostle Paul had his “thorn” most likely a condition involving his eyesight. But through it all, God’s message is that “His grace is sufficient” and God’s “power is perfected in our (my) weakness.” Recognition of my helplessness unleashes God’s power. I need to affirm as the apostle Paul did, that when I am weak (in myself), then I am strong (in Christ). What God can accomplish through me and my life experiences is directly proportional to my level of dependence on Him.
8) Learn to experience the peace of God. Even though it is hard not to think about the fact that there are cancer cells in me, instead I should receive the gift of peace offered in John 14:27, “Peace I leave with you; my peace I give to you; not as the world gives do I give to you. Let not your heart be troubled nor let it be fearful.”
9) Lastly, be thankful for everything, taking nothing for granted. I have so much for which to be thankful including a wife whom I cherish, many supportive friends, a career that I could not have planned nor imagined for myself, and most of all, an eternal life in God’s presence in a new heaven and a new earth with a new body to which I can aspire. Finally I am very thankful for the opportunity you all have given me to share with you today.”
Concluding remarks from Dr. Mostwin. “When I was a surgical resident at the University of Michigan in Ann Arbor in the late 1970’s, surgical attendings would invite their patients to come before the entire department to speak about their experiences. A subliminal message conveyed to us was the unique bond between surgeon and patient that extended beyond the operating room and the hospital bedside, something that seemed special for me then, though I did not understand how and why. We don’t do that sort of thing very much in medical education now. But in this presentation, we have done just that and in doing so have shared with you the closeness of medicine, faith and the unique circumstance of life that brought us together and kept us that way. We are grateful for your attention.”
P.S. Only an hour or so before the presentation, Dr. Mostwin shared with me two very pertinent verses he had just read in his daily devotional as follows. “I have told the glad news of deliverance in the great congregation. I have not restrained my lips, as Thou knowest O Lord. I have not hid thy saving help within my heart. I have spoken of Thy faithfulness and Thy salvation; I have not concealed Thy steadfast love and Thy faithfulness from the great congregation.” (Psalm 40:9-10).
