Routine check up leads to lifesaving treatment

Going to Primary Care Provider Dr. Christopher Lege for a wellness checkup every six months was nothing out of the ordinary for Joel Loeffelholz because he has diabetes. At his checkup in October of 2016, Dr. Lege reminded him that it was time to schedule his annual PSA test. Joel had this test every year, and every year his PSA results came back normal, except this time—the levels were high.

The PSA test measures the level of prostate-specific antigen proteins produced by normal, as well as malignant, cells of the prostate gland. In general, the higher the PSA level, the more likely there is prostate cancer. One in nine men will be diagnosed with prostate cancer at some point in his life. Experts recommend that men at average risk begin having prostate cancer discussions with their provider starting at age 50 or 55.

Rising levels signal rising risk
“I had my annual PSA test, and my level usually runs around 2.0 ng/mL. That’s what it was for years, then all of a sudden it went up past 4.0 ng/mL,” Joel explains. Most men without prostate cancer have PSA levels under 4 ng/mL of blood. Normally, a significant increase in PSA levels like Joel’s would indicate that the levels should be monitored and additional testing might be necessary. Men with a PSA level less than 2.5 ng/mL typically only need to be retested every two years, while men whose PSA levels are 2.5 ng/mL or higher should be tested yearly. Joel says, “Being the type of doctor he is—very thorough—Dr. Lege said just to be safe you need to consider having an examination by a urologist.” After discussing this with Dr. Lege and doing his own research, Joel made an appointment with Dr. Richard Vanlangendonck based on a recommendation.

Robotic surgery helps smooth recovery
Once at the appointment, Joel says, “We hit it off immediately.” Dr. Vanlangendonck conducted his examination and, sure enough, found a tumor the size of a pinky fingernail. After the tumor was discovered, Joel went for an MRI. It was determined that he had what they call “three by three” slow-growing cancer.

Normally with these types of slow-growing cancers, physicians would watch the cancer cells until the next checkup and not immediately operate or treat the cancer. In Joel’s case, there was an overabundance of cancer cells, so it was determined that he needed treatment sooner rather than later. In January of 2017, Joel had a prostatectomy to remove the cancer cells and had a very smooth surgery and recovery. When speaking of his prostatectomy, Joel explains, “The advantage of robotic surgery is that the recovery period is hardly anything compared to when they cut you wide open.” During the surgery, Dr. Vanlangendonck took the lymph nodes surrounding the prostate cancer and sent them off for additional testing.

Close call, averted
Once the reports came back it was determined that all the lymph nodes were clear. However, one report indicated that some of the cancer cells had reached within one millimeter of escaping the capsule of the prostate gland. When the cancer escapes the capsule, it is called microscopic capsule penetration and can cause the prostate cancer to spread beyond the area of the prostate. Joel credits Dr. Vanlangendonck for being so precise during the surgery and lymph node removal because, he says, “Someone else might have nicked the capsule and that cancer could have escaped. “That’s how close I came,” Joel says that following his surgery he was having his PSA level tested every six months. Now he has been cleared so he no longer requires frequent testing. His PSA level now measures at the very lowest number at which the PSA machine is set. Essentially, he is cancer-free and cured.

Early detection saves lives
Finding prostate cancer when it is still at an early stage offers the best hope for living cancer-free for a long time. The five-year survival rate for all men with prostate cancer is nearly 100 percent when detected early. “The sad thing about prostate cancer is that most men don’t want to go to the doctor, especially if they don’t feel sick,” says Joel, “but by the time you start experiencing the symptoms of it, it’s 90 percent deadly.”

Advanced surgical options at Touro
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